A man in his 90s presented to the dermatology department with pruritus of 6-months’ duration near his groin. The pruritus was severe and caused frequent scratching, sometimes to the point of bleeding. The patient denied exposure to new contactants or irritants, but he recalled having sexual intercourse with a new partner 1 year prior.
Examination was notable for innumerable adherent brown concretions along the terminal hairs of his groin as well as scattered erythematous macules and papules on the underlying pubic skin (Figure). Adult lice were visualized on closer inspection. Dermoscopic examination demonstrated brown, oval nits as well as translucent empty egg casings adherent to hair shafts. Pinpoint blood spotting was present diffusely on his underwear. With the diagnosis of pediculosis pubis confirmed, the patient was treated with permethrin, 1%, cream and experienced complete resolution of symptoms by 1 month.
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Creighton-Smith M, Sloan SB. Pediculosis Pubis. JAMA Dermatol. 2019;155(12):1416. doi:10.1001/jamadermatol.2019.2718
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