HEAD LICEINFORMATION

&TREATMENTS

TRACY DICKENS SCHOOL NURSE MARCH 2012

HEAD LICE(PEDICULUS HUMANUS CAPITUS

Six legged, no winged insectsThey live close to the scalpThey feed from blood from the headThey spread through head to head contact

They vary in size from a full stop – about 3-4mm longFemale louse lays eggs when she is about10 days old she will lay about 50-150 eggs during her lifespan

Lice are the insects, young lice called nymphs are transparent until after their first bloodMealLice lay eggs close to the scalp which makes them difficult to detectNits are the empty shells that stick to the hair shaft

Detection of head lice

1. CHECK

• Parents once a week check your childs head

• Wet hair, condition, leave conditioner in, use head lice comb

• If lice are detected treatment is advised

• Diagnosis can only be made when live louse are found

Treatments:Four principle treatments 1.Pesticides two types in the BNF Malathion – (derbac)• Lice can develop high resistance to chemicals• Favourable safety record• Not recommended if child has eczema/asthma• Can cause skin irritation• Not to be used on broken skin• Eradication rate 33% (Thornton and Ross 2010)

Permethrin – lyclear not recommended in BNF current preparation too diluted to be effective (BNFC 2011-2012)

2. Non pesticides: Dimeticone (Hedrin)• Coat the outside of the louse causing interference with

water balance it to die, research suggests that because this is a physical process the lice cannot build resistance. (BNF 2011; NPF 2011)

• Less effective against eggs and needs to be repeated after 7 days (BNF 2011)

• Eradication rate 97%

• Avoids resistance (Thornton and Ross 2010)

3. Wet combing/bug busting

• 38% – 57% effective at eradicating lice

• Labour intensive, relies on commitment of both parent and child – therefore cannot be relied upon to tackle at community level (Schweiger 2012)

• No chemicals involved therefore preferred by Some parents

4. Alternative remedies Electronic devices not suitable for general use

Herbal/essential oilsEucalyptus oil/tea tree oils/lavender oil limited evidence to assess their effectiveness some oils can be toxic

Some products claim to act as repellents not recommended

(Schweiger 2012)

What is the best product?Systematic review of RCTs, Case studies and Cohort studies comparing the above treatment methods found that in all cases

Dimeticone was significantly more effective at the eradication of head lice compared to malathion (Burgess et al 2007; Schweizer 2012)

Burgess et al (2007) was a small sample for a RCT, total random sample of 73 children with head lice 25 cures and 5 reinfections (Dimeticone) 9 cures and 1 reinfection (malathion)

Which To Choose?

• Age – not licensed for under 6 months• Contra-indications – asthma, skin problems• Resistance – what has been tried

previously why is it not working• Avoiding resistance• Parent preference

Apply sufficient lotion evenly overDRY hair ensuring that the scalp isfully covered

Allow the hair to dry naturally.

• Leave on the hair for at least 8 hoursor overnight.

• Wash the hair with normal shampoo,rinse thoroughly with water and dry.Duration of treatment

• It is important that Hedrin® Lotion isapplied again after seven days to dealwith any lice which may hatch in thattime. Failure to repeat the treatment mayresult in the return of a louse infestation

Thornton and Ross (2010)

Hedrin 4% lotion – 50mls (£2.98) 150mls (£6.92)

Hedrin once – liquid gel (100ml (£8.00) 250ml (£17.35)

• SHAKE THE BOTTLE WELL BEFORE EACHUSE.• Apply sufficient gel evenly over DRY hair,to ensure that the scalp and hair are fullycovered and the hair is SATURATED.

• Work into the hair with the fingers or anordinary comb spreading the gelthoroughly and evenly from the roots totips.

• Leave on the hair for at least 15 minutes(or longer if more convenient).

• Apply shampoo directly to the entiresurface of the hair without first wetting it,shampoo thoroughly then rinse withwater. Repeat the process, then applyconditioner, rinse and dry. (Thornton and Ross 2010)

Hedrin Once spray gel 100ml (£9.00) 60ml (£5.00)

The spray comes ready assembled. Before useremove the coloured safety clip from under thespray nozzle. This may be retained or disposedof safely.

• Holding the spray approximately 10cm from the hair carefully spray sufficient solution evenly over DRY HAIR to ensurethat the scalp and hair are fully covered and the hair is saturated.

• Leave on the hair for at least 15 minutes or longer

• Wash the hair with normal shampoo, do not wet hair first, rinse thoroughly with water and dry. (Thornton & Ross 2010)

• Apply straight onto dry hair, following the instructions on the pack.

• Shake the bottle well before use then rub or comb the lotion into the hair until it’s covered from root to tip.

• Leave on for at least 8 hours or overnight

• Rinse or shampoo it out, you’ll find it comes out really easily.

• Repeat after 7 days

(Thornton and Ross 2011)

Hedrin treat & Go mousse 100mls (£10.00)

Hedrin Once spray gel 100ml (£9.00) 60ml (£5.00)

The spray comes ready assembled. Before useremove the coloured safety clip from under thespray nozzle. This may be retained or disposedof safely.

• Holding the spray approximately 10cm from the hair carefully spray sufficient solution evenly over DRY HAIR to ensurethat the scalp and hair are fully covered and the hair is saturated.

• Leave on the hair for at least 15 minutes or longer

• Wash the hair with normal shampoo, do not wet hair first, rinse thoroughly with water and dry. (Thornton & Ross 2010)

References:

BNF (2011) BNF for children the essential resource for clinical use of medicines in children. London. BMJ

Burges, I. Lee P. Matlock, G. (2007) Randomised controlled, assessor blind trial comparing 4% Dimeticone lotion with 0.5% malathion liquid for head lice infestation. Plosone (11) pp 1121-1127

NPF (2011) Nurse prescribers formulary for community practitioners.London. BMJ.

Schweiger, M. (2012) Head lice – Evidence based guidelines based on the Stafford Report 2012 update. Public health medicine controlled group.

Thornton and Ross (2010) New best practice guidelines for tackling head lice. [online] available from:http://www.checktreatcomplete.co.uk/about-this-module/about-hedrin.php [Accessed 9/3/2012]

PRACTICE STANDARDS• Licence as a prescriber (only prescribe from relevant

formulary)• Accountability• Assessment• Need (must be genuine clinical need)• Consent (information sharing)• Communication• Record keeping• Prescribing and administration (kept separate)• Prescribing and dispensing (kept separate)• Evidence based prescribing• Delegation• Gifts and benefits

NMC STANDARDS OF PROFICIENCY FOR NURSE PRESCRIBERS

• Assess client’s clinical condition• Undertake thorough history (including medications)• Decide on appropriate management of condition (?prescribe)• Identify appropriate products if medication required• Advise client on effects and risks• Write prescription (with client consent)• Monitor response to medication and lifestyle advice