Abstract
Dear Editor,
In the period from January 2016 to July 2017, we observed a total of 26 women with Phthirus pubis infestation. All patients were Caucasians, with age ranging from 34 to 52 years (mean age: 41.4 years). The diagnosis was clinical and based on the observation of adults and/or nits and/or faeces of the insects. Twenty-four out of 26 patients (92.3%) had pubic hair; two women (8.7%) were hairless. In the same period, we observed 54 males with P. pubis infestation. All of them were Caucasians, with age ranging from 18 to 61 years (mean age: 29.8 years), with pubic hair.
In recent years, the prevalence of P. pubis infestation in the metropolitan area of Milan significantly decreased. In a period of 18 months, in three different dermatological centers (the Dermatology Unit of the University of Milan, the European Institute of Dermatology and the Centro Dermatologico Milanese), only 26 female patients with pubic lice were observed. This means that in these three centers, a total of 1.4 patients/month was observed (the population of the metropolitan area of Milan is approximately 3,300,000 inhabitants). Our observations confirm what happened in the United Kingdom, where the prevalence of pubic lice significantly fell from 2000, despite the increased number of patients and the prevalence rates of other sexually transmitted infections (STIs).1,2 Some authors suggested an association between the introduction of pubic hair removal practices, in particular the “Brazilian” wax, and the rates of P. pubis infestation.1–3 It is interesting that 24 out of 26 of our patients had pubic hair. On the other hand, P. pubis showed remarkable adaptation skills: an outbreak of P. pubis infestation of the scalp in nine elderly women has been recently reported. 4
Our observations, based on a small number of patients (although as previously mentioned, this is the current epidemiology of this infestation in the metropolitan area of Milan), confirm that pubic hair removal is an effective preventive procedure against P. pubis infestation. The removal of pubic hair can lead to eradication of pubic lice, as the natural habitat of this parasite is destroyed. 2 On the other hand, it has been demonstrated that pubic hair removal is associated with an increased risk of skin infections and STIs, in particular Herpes simplex virus, human papillomavirus, molluscum contagiosum5–12 and Streptococcus pyogenes. 13