Children susceptible to bedbug, lice infestations

Pittsburgh - Pediatric patients are threatened by infestations such as bedbugs, head lice and scabies, so parents need to be vigilant of these risks, according to the chief of the division of pediatric dermatology at the Children’s Hospital of Pittsburgh.

“It seems that over the past couple of years bedbugs, which have always been around, appear to be resistant to eradication, and are spreading beyond the bed, for lack of a better term,” says Douglas Kress, M.D., a pediatric dermatologist and clinical associate professor of dermatology, University of Pittsburgh School of Medicine.

Dr. Kress says bedbugs have been found in locations such as retail stores and airplanes. Recently, a large Nike retail outlet in New York was found to be infested with bedbugs.

“The name is a bit of a misnomer,” Dr. Kress says. “It is not that the bugs are exclusively found in beds, but the bed is the site where people are most commonly bitten. They (bedbugs) are attracted to carbon dioxide, which we all exhale, so they can be located near the bed, such as behind the baseboards in a bedroom, but not necessarily in the bed."

Because of the economic downturn, Dr. Kress says people are more likely to inherit items - such as second-hand cribs, used mattresses and other second-hand furniture, increasing the potential for bedbugs - rather than buying new items.

Treatment options
“The standard treatment for bedbugs is oral antihistamines to turn off the itching and allergic reaction,” Dr. Kress says. “The inflammation associated with being bitten by a bedbug is rather deep, so we usually use prescription-strength topical steroid creams for the individual bites.”

People who have been exposed to bedbugs in their homes should also solicit the services of an exterminator, Dr. Kress says.

Children are more likely to develop insect hypersensitivity, which is a more severe reaction to being bitten and results in more visible evidence of bites, he says.

“Only the child may be allergic enough to show the bites,” Dr. Kress says. “That is the reason people (adults) may think they do not have bedbugs, because no one else in the home is showing bites.”

Many people are familiar with the concept of drug-resistant bacteria, especially with the spread of methicillin-resistant Staphylococcus aureus, previously only seen in hospitalized patients, to patients in local communities.

Although lice are much larger and more complex organisms than bacteria, they can still develop resistance against drugs designed to eradicate them, Dr. Kress says, and, in fact, many lice have developed resistance to standard therapies, both over-the-counter and by prescription.

Outbreaks of head lice predominantly occur in schools with majority Caucasian populations, as opposed to schools with majority African-American populations, Dr. Kress says.

“They can happen anywhere, but it’s not likely to occur in a school where students are mainly African-American,” Dr. Kress says.

The louse has difficulty in attaching itself to African-American hair, he says, which has a slightly different shape than Caucasian hair, making it almost impossible for the head lice to attach their eggs and thus establish an infestation.

Other remedies
People sometimes turn to traditional remedies, such as shampoos, to treat lice, but there is resistance to these treatments from the organisms.

Malathion, a pesticide that was used years ago and was dubbed toxic, has made a comeback as a treatment that will overcome resistance, Dr. Kress says.

“It turns out that very low concentrations of malathion (0.5 percent preparation), a product which has recently returned to the market in the U.S., handles lice fabulously,” Dr. Kress says. “It is available by prescription.”

Unfortunately, Dr. Kress says, he believes general practitioners are likely sending patients to get over-the-counter remedies for head lice, which are ineffective.

Addressing scabies
Scabies is another infestation that affects pediatric patients, Dr. Kress says.

“Because they are not visible, it is hard for general practitioners to diagnose scabies infestations on their own,” he says.

Confirmation of scabies can only be made by a microscopic examination of an affected patient’s skin. The test is typically performed by dermatologists, Dr. Kress says.

A scabies infestation is typically treated with permethrin, a scabicide. Other members in a household should be treated if a child has a scabies infestation, he says.

The incubation period for scabies can be up to six weeks, so that it may seem that only one child in the family has it, but if the child is young, it is likely that many other family members have been exposed, but are not yet symptomatic.

Disclosures: Dr. Kress reports no relevant financial interests.