Pigmented basal cell carcinoma: uncommon presentation in blue-eyed patients.

treatments include benzyl alcohol, spinosad, and ivermectin.5,6 All of these topical treatments require thorough washing of the hair after application and can have adverse effects such as irritant and contact dermatitis if left in place; rare toxic effects also has been reported with application. Oral ivermectin and trimethoprim-sulfamethoxazole are parenteral agents that have been reported to be efficacious in widespread or resistant infestations. Nonpesticidal therapies also include fine-tooth combing; topical application of petrolatum jelly, mayonnaise, or olive oil; meticulous manual removal; or shaving of the head.3 We present a challenging clinical case in an immunosuppressed host complicated by our patient’s extensive infestation involving his dreadlocks. Traditional topical therapies were not possible without washing because of concerns for topical allergic or irritant dermatitis, and physical methods such as combing out the nits and cutting the hair were refused by the patient. Oral medications were considered but also refused. The Lice Lifters center provided a program and combined intensive topical, nontoxic treatments at a local center and at home and manual removal of nits. These techniques should be considered when traditional therapies are not possible.