Not lice but what?!

Specialties School

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Specializes in NCSN.

I had a little one sent to me with a pass that said "something in hair". After a really long assessment, this newbie is stumped.

Small 2mm black ovals (not moving, looked under maginfying glass lamp combo forever at it and it doesn't look like an insect) and small, but slightly larger golden colored ovals. Attached to top of scalp, no where else in hair.

Student denies EVERYTHING, wasn't outside, didn't put anything in her hair, no changes in shampoo, no itching, didn't walk under a tree on the way into school (I was/am grasping at straws). There is a hx of eczema, but that usually is only behind her ears.

Any ideas my SN mentors?!

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without seeing a picture - could it be small scabs and dried serous drainage of eczema? Like from scratching your head if it itched and not outwardly breakin the skin?

Or blackheads in the hair pores?

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Specializes in ICU/community health/school nursing.

The golden color makes me thing of impetigo (honey colored crusting) but that's waaay too far north for impetigo...

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Specializes in School Nurse.

Is it possible it's brand-new, unhatched nits? I've seen new nits that were tiny and blackish attached on the hair shaft very close to the scalp. They especially stand out on light-colored (blonde) hair. Older nits I've seen are usually clear (hatched) or whitish. Just a thought... of course, if it's not on the hair but the scalp, then I don't know what it might be at that size...

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Sounds to me as if it's likely nothing health concerning. Sometimes educational staff influence us to think something is wrong when it's not. Remember your the nurse and don't let other non medical staff influence you. But teachers are so afraid of lice. Probably was fuzz :wacky:

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Specializes in NCSN.

Or blackheads in the hair pores?

They kind of did look like blackheads in the pores! I was able to comb out the golden pieces but the black ones were just stuck on her scalp.

I should've got a picture

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Did it look like this? Does she pull her hair out?

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Did it look like this? Does she pull her hair out?

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A friend's daughter has trichotillomania (among other mental/emotional health issues). So sad.

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Specializes in ICU/community health/school nursing.
Did it look like this? Does she pull her hair out?

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Holy gravy, MHDNurse!! I learn something new every day!

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Specializes in School nursing.

What color is student's hair? My first thought was ingrown hair blackhead.

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Specializes in NCSN.

Update: Mom took her to the doctor today because she also was stumped. The MD is saying it is a flare up of her eczema that is affecting the hair follicles. They are going to use a rx shampoo.

I'm still a little skeptical because there was no redness and it wasn't really flakey like eczema is, but we will see what the little looks like on monday!

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