Treatment for head lice

Head lice is a common problem is school aged children.
GPs need to have an approach in dealing with this problem. Give clear instruction to parents of how to deal with it. Usually diagnosis is via clinical examination. Visualisation of nits and live lice in the hair is diagnostic.

Key points:

1. It is caused by the louse pediculus humanus capitis.
2. Patients can present with significant itching on the scalp and neck.
3. Wet combing: apply generous amount of hair conditioner and comb with fine toothed comb. The conditioner stunt the lice and stops them from crawling for 20 minutes. The method only has around 40 % successful rate.
4. permethrin 1% topically, leave for a minimum of 10 minutes; repeat treatment in 7 days (there are other treatment options, please see therapeutic guideline). Use the wet combing method the day after treatment to check for live lice. If live lice are found despite treatment, that means the lice are resistant to the product used.
5. In between treatments, use the wet combing method twice to remove all eggs less 1.5 cm from the scalp.
6. Wet combing should be repeated weekly for few weeks to ensure complete clearance.
7. Bed sheets and linens should be washed with hot water 60 degrees.
8. Treat all household members
9. Notify school but can still go to school after treatment
10. Treatment resistant: use a different product or ivermectin 200 mcg/kg as a single dose with fatty food, repeat in 7 days.

References:
- eTG
- John murtagh 5th edition