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 it is historically uncommon in adults, recent reports indicate a rising incidence, particularly among adult women. This case series highlights the diagnostic challenges of pediculosis capitis infestation in adult women from Southeastern Nigeria, where persistent scalp itch is often misdiagnosed and treated as seborrhoeic dermatitis, leading to delayed or inappropriate management. Four women aged 20-41 years with persistent scalp pruritus were initially misdiagnosed as having seborrhoeic dermatitis, which was later confirmed through trichoscopy as pediculosis capitis. 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 Pediculus humanus capitis (head louse) infestation. Healthcare providers often overlook head lice infestation as a potential cause of scalp itch because of its resemblance to other common scalp conditions, potentially delaying treatment and promoting spread through shared hair grooming tools. Increased awareness among healthcare professionals 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.