Macula Ceruleae with Head Louse

Abstract

A 21-year-old female patient presented with generalized acute urticaria and itching over the scalp for the past 1 week. On cutaneous examination, wheals of varying sizes were noted. On closer examination of scalp, multiple live nits and lice were present predominantly on bilateral temporo-occipital region which were demonstrated on microscopy [Figure 1]. In addition, few reddish brownish macules of size 1–2 cm were also observed over the same site [Figure 2]. On dermoscopy of these lesions, dusky-brownish hue on erythematous macules with superficial white scales were observed [Figure 3]. Figure 1 Microscopic image of live nits onscalp hair (hair mounted on a slide and coated with normal saline and coverslip, 100x) Figure 2 Dusky erythematous macules of size 1–2 cm onleft temporal scalp Figure 3 Dermoscopy of maculae ceruleae showing patchy brownish hue (red arrow) over erythematous background with absence of vessels and superficial scaling (green arrow) (Handheld contact dermoscope: Derm-Lite DL3 gen. Polarized view with magnification ×20) Maculae ceruleae are bluish-brown macules of some millimeters to centimeters in size; they have been typically described with pediculosis pubis infestation.[1] It has been hypothesized that these lesions acquire typical color because of hemosiderin deposition secondary to louse bite marks.[2] We concluded that these lesions are maculae ceruleae, secondary to pediculosis capitis bite, and have not been described with head lice.[3] The patient was treated with topical permethrin 1% lotion and tablet ivermectin 12 mg stat. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.