Head_Lice_Flashcards
What is head lice?
Head lice (pediculosis capitis or ‘nits’) is a common condition in children caused by the parasitic insect Pediculus capitis, which lives on and among the hair of the scalp of humans.
What do head lice feed on?
Head lice feed on human blood.
What do head lice eggs look like and where are they found?
Eggs are grey or brown and about the size of a pinhead. They are glued to the hair, close to the scalp and hatch in 7 to 10 days.
What are nits?
Nits are the empty egg shells which are white and shiny. They are found further along the hair shaft as they grow out.
How are head lice spread?
Head lice are spread by direct head-to-head contact and are more common in children because they play closely together. They cannot jump, fly, or swim.
What are the symptoms of a newly infected case of head lice?
Newly infected cases have no symptoms, but itching and scratching on the scalp occurs 2 to 3 weeks after infection. There is no incubation period.
How is head lice diagnosed?
Fine-toothed combing of wet or dry hair.
When is treatment for head lice indicated?
Treatment is only indicated if living lice are found.
What are the treatment options for head lice?
A choice of treatments should be offered: malathion, wet combing, dimeticone, isopropyl myristate, and cyclomethicone.
Do household contacts of patients with head lice need to be treated?
No, household contacts do not need to be treated unless they are also affected.
Is school exclusion advised for children with head lice?
No, school exclusion is not advised.
summarise
Head lice
Head lice (also known as pediculosis capitis or ‘nits’) is a common condition in children caused by the parasitic insect Pediculus capitis, which lives on and among the hair of the scalp of humans.
Head lice are small insects that live only on humans, they feed on our blood. Eggs are grey or brown and about the size of a pinhead. The eggs are glued to the hair, close to the scalp and hatch in 7 to 10 days. Nits are the empty egg shells and are white and shiny. They are found further along the hair shaft as they grow out.
Head lice are spread by direct head-to-head contact and therefore tend to be more common in children because they play closely together. They cannot jump, fly or swim! When newly infected, cases have no symptoms but itching and scratching on the scalp occurs 2 to 3 weeks after infection. There is no incubation period.
Diagnosis
fine-toothed combing of wet or dry hair
Management
treatment is only indicated if living lice are found
a choice of treatments should be offered - malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone
household contacts of patients with head lice do not need to be treated unless they are also affected
School exclusion is not advised for children with head lice
The mum of an 8-year-old girl emails the surgery asking for advice about head lice treatment. Her daughter has caught head lice for the third time this school year, and her mum is concerned about the repeated use of insecticides. She is asking are there any alternative ‘less toxic’ options.
Which of the following is a safe, effective treatment option recommended by NICE which may be more acceptable to the girl’s mother?
Coconut oil shampoo
Electric nit comb
Head lice repellent spray
Tea tree oil
Wet combing
Wet combing
Wet combing (without insecticides) is an effective treatment option for head lice
Important for meLess important
NICE CKS endorses three main treatment options for head lice: physical insecticides (such as dimeticone), chemical insecticide (Malathion), and wet combing. Wet combing works by physically removing the lice and avoids the need for insecticides. Wet hair is combed carefully with a nit comb according to packet instructions, repeatedly over the course of a couple of weeks. The aim is to remove new lice before they have a chance to lay eggs.
There are various head lice products on the market that are not recommended by NICE due to lack of evidence of safety or efficacy. Coconut oil products, tea tree oil (and other essential oils), electric combs, and head lice repellent sprays are all specifically listed as treatments that are not recommended.
The dad of a 7-year-old girl phones for some advice because they are struggling to treat her for head lice. Despite three treatments with an insecticide (Malathion) over the past few weeks they keep finding live lice. The parents have checked themselves and the girl’s 11-month-old baby brother for lice using a detection comb and not found anything, but wonder if they should use the treatment too anyway, in case they are the source of reinfection.
What should you advise about the treatment of her household contacts?
They do not need treating unless they too have lice
Parents should be treated with insecticide, but not the baby
Treat all household contacts with insecticide
Treat all household contacts with wet combing
Treat if they have an itchy head, with insecticide
They do not need treating unless they too have lice
Household contacts of patients with head lice do not need to be treated unless they are also affected
They do not need treating unless they too have lice. This is the correct answer. According to NICE CKS, household contacts of people with head lice do not need to be treated routinely. Household contacts should carefully check to see if they are affected (using a lice detection comb), and be treated only if an infestation is confirmed.
Treat if they have an itchy head, with insecticide. Itchy head with no lice detected is not considered an indication for treatment - because when told about head lice, people often start feeling itchy!
Parents should be treated with insecticide, but not the baby, treat all household contacts with insecticide, treat all household contacts with wet combing. As above, household contacts of people with head lice do not need to be treated routinely. If they do need treatment, certain products are not licensed for under 2s. Wet combing can be an effective treatment and is suitable for all ages.
Treatment failure, in this case, might be due to resistance to Malathion (advise they try a different product or wet combing), re-infestation eg. from school friends, or incorrect method of treatment application.
