Pediculosis capitis: an overlooked cause of scalp itch in Nigerian women and the role of trichoscopy in diagnosis

Pediculosis capitis, caused by human head lice, is a common yet frequently overlooked cause of scalp pruritus. While historically uncommon in adults, recent reports indicate a rising incidence, particularly among adult females. This case series highlights the diagnostic challenges of pediculosis capitis infestation in adult females from Southeastern Nigeria, where persistent scalp itch is often misdiagnosed and treated as seborrheic dermatitis, leading to delayed or inappropriate management. We present four cases of females aged 20-41 years with persistent scalp pruritus initially misdiagnosed as seborrheic dermatitis but later confirmed as pediculosis capitis through trichoscopy. These cases underscore the importance of considering pediculosis capitis in the differential diagnosis of any case of scalp pruritus, especially in geographical regions with a high prevalence of pediculosis capitis infestations. Health care providers (HCPs) often overlook head lice infestation as a potential cause of scalp itch due to its resemblance to other common scalp conditions, potentially delaying treatment and promoting spread through shared hair grooming tools. Increased awareness among HCPs and the use of trichoscopy can facilitate accurate diagnosis, prevent unnecessary treatments, and improve patient outcomes. Pediculosis capitis remains a neglected yet significant cause of scalp itch, warranting greater attention in clinical practice.