Infestations

Question 1

Which formulations should be used for lead lice and which should avoided?

Answer 1

Lotions, Cream rinse or Liquid

Shampoo avoid - diluted too much to be effective

Question 2

Treatment options for headlice?

Brand and generic name and age

Answer 2

Dimeticone (Hedrin) 6 months +

Permethrin (Lyclear) insecticide 6 months +

Malathion (Derbac-M) chemical insecticide 6 months +

Isoproyl myristate + cyclomethicone (Full marks) 2+

Question 3

How does Dimeticone (Hedrin) work?

Why is it preferred over the insecticides (permetherin and malathion)

Answer 3

Traps, coats and suffocates the head lice they can’t release water.

Resistance doesn’t occur like with the insectides. E.g. Lyclear/permethrin resistance is high in the UK.

Question 4

(1st line) Wet coming and Dimeticone 4% lotion (hedrin) safer for which patient groups?

Answer 4

Pregnant/Breastfeeding
6 months - 2 years
Asthma/Eczema

Question 5

How to use Dimeticone (Hedrin) or Iopropyl myristate with cyclomethicone (Full marks)

Answer 5

Cover hair and leave overnight / 8 hours

Treatment should be reapplied after 7 days

Detection combing after a few days

Question 6

How often should wet combing be done?

Answer 6

4 sessions spaced over 2 weeks.

On day 1, 5, 9 and 13

Question 7

Signs and symptoms of scabies

Answer 7

Scabies are mites that burrow under the skin leaving grey-silver lines. - causing allergic reactions - itching

Hands, wrists, web of fingers etc

Question 8

OTC treatment for scabies? 1st line, 2nd line

Other advice that patients need to do?

Answer 8

1st Line - Permethrin 5%(Lyclear cream) - especially for those uncrusted scabies, children over 2 months, preg etc

2nd line - Malathion 0.5% (Derbac-M)

if contra-indicated/not tolerated to permethrin OR ALLERGIC TO CHRYSANTHEUM in permethrin

Wash all bedding, clothes, towels at high temp 60+ and then dry on high temp, leave in a sealed bag for 72 hours.

All members of household should be treated. Infected people may not show signs until up to 8 weeks later.

Question 9

Application points for Lyclear cream and Derbac-M ?

Answer 9

Apply to whole body from chin and ear downwards

Include face and scalp if immunocompromised, young children, elderly

Leave for 8-12 hours (lyclear)
Leave for 24 hours - (derbac-M)

Repeat after 7 days

Question 10

Referral points for scabies?

Answer 10

Secondary infection
Babies - younger than 2 months
Treatment failure
Unclear diagnosis

Question 11

What is recommended for the itching due to scabies?

Answer 11

1. Antihistamines

2. Crotamiton (Eurax) cream

Question 12

Symptoms of threadworm (pinworm)

Answer 12

Itching around the anus especially at night

Threadworms in stool

Question 13

Referral signs of threadworm? (5)

Answer 13

1. Recent travel abroad
2. Pregnancy
3. Broken or weeping skin
4. Treatment failure
5. Under 2 years old

Question 14

Treatment for threadworm?

Counselling points?

Answer 14

Mebendazole (Ovex) 2+
as well as hygiene for 2 weeks.

Treat everyone in house
Repeat after 14 days
Avoid in pregnancy

Question 15

Additional advice for threadworm?

Answer 15

Eggs can survive outside the body for several weeks and highly contagious

Keep good hygiene - bath in morning, wash and scrub hands etc

Wash all toys

Vacuum thoroughly and wet dust

Change and wash bedding daily

Question 16

Threadworm treatment options for under 6 months and pregnancy?

What about 6 months to 2 years?

Answer 16

Good hygiene measures for 6 weeks (approx life span of adult threadworm)

Wash hands with soapy water 
Cut nails, avoid biting
Shower each morning 
Wash change bedding daily 
Dust/vacuum/wet dusting 

Between 6 months - 2 years - refer specialist