Bound by tradition: severe pediculosis capitis in a breastfeeding mother with religious headwear

A 25-year-old breastfeeding woman from rural India presented with a 2-month history of intense scalp pruritus, formication and fever. Examination revealed a severe <i>Pediculus humanus capitis</i> infestation involving her scalp, face and religious headscarf, with extensive live lice, nits, pustules, excoriations, crusted papules and dermatopathic lymphadenopathy. Treatment with permethrin 1% lotion and weekly oral ivermectin for 4 weeks, in conjunction with broad-spectrum antibiotics and supportive care, resulted in near-complete eradication. This case represents one of the most severe presentations of pediculosis capitis documented, demonstrating how cultural practices can impede early detection and complicate management.