Diagnosis: Pediculosis Capitis (Head Lice Infestation)

• Image 1 (close-up macro view): Multiple elongated, dark hair shafts with numerous small white/translucent oval structures firmly attached along the shafts. These are nits - the egg casings of Pediculus humanus capitis. They are cemented to the hair by a proteinaceous matrix and cannot be easily slid off (unlike dandruff flakes or hair casts).
• Image 2 (wide scalp view near the ear): White particulate deposits scattered throughout the hair shafts at and near the scalp, concentrated around the hairline and above the ear - the classic anatomic distribution of head lice. There also appears to be a small raised scalp nodule near the ear, possibly a secondary change from scratching (folliculitis or excoriation).

Treatment

Step 1 - First-Line Topical Pediculicides

• Wash hair with a non-conditioning shampoo, towel dry
• Apply permethrin to scalp and entire length of wet hair
• Leave on for 10 minutes, then rinse off
• Repeat in 9-10 days to kill any newly hatched nymphs
• Safe from age 2 months onwards

• Apply to dry hair in amounts sufficient to saturate the scalp
• Leave on 10 minutes, rinse off
• Repeat in 9-10 days (no residual activity, so repeat is mandatory)
• Contraindicated in chrysanthemum/ragweed allergy

Step 2 - Prescription Options (if OTC fails or resistance suspected)

Step 3 - Mechanical Removal (Nit-combing)

• Use a fine-toothed nit comb after applying a conditioner to wet hair
• Comb through small sections from root to tip
• This is essential even after chemical treatment, as most pediculicides are not 100% ovicidal
• Repeat daily until no live lice are found

Step 4 - Environmental Measures

• Wash all bedding, clothing, and hats used in the past 48 hours in hot water (≥ 60°C / 140°F) and dry on high heat
• Non-washable items can be sealed in a plastic bag for 2 weeks
• Soak combs and brushes in hot water for 10 minutes
• Vacuum carpets and upholstered furniture
• Note: Head lice do not survive more than 24 hours away from the scalp, so extensive environmental decontamination is not critical

Step 5 - Household and Contact Screening

Key Points

• "No-nit" school exclusion policies are not recommended - children with head lice do not need to leave school, as the risk of spread in a classroom setting is low
• Hair length, hair texture, and frequency of shampooing have no influence on susceptibility
• Duration of infestation can be estimated by nit distance from scalp: hair grows ~1 cm/month, so nits >1 cm from scalp suggest older (possibly resolved) infestation

Disclaimer: This is an image-based clinical assessment for educational purposes. A confirmed diagnosis requires in-person examination with a fine-tooth comb or dermatoscope. Please consult a physician or pharmacist before starting treatment.