Head Lice Treatment - Wilson School Head Lice Infestation: A Common Pediatric Condition • Pediculosis

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  • Head Lice Treatment

    New Options for an Ancient Adversary

    US.IVE.12.03.005

  • Presentation Outline

    I. Head Lice Are With Us

    II. Approaches to Head Lice Treatment III. The Role of Health-Care Providers (HCP)

    in Head Lice Management IV. Sklice (Ivermectin) Lotion, 0.5%

    V. Educational Resources

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    Full Prescribing Information for Sklice Lotion will be provided.

  • Head Lice Are With Us

    “Lice occur wherever there are humans.”1

    Reference: 1. Lice (pediculosis). In: Paller AS, Mancini AJ, eds. Hurwitz Clinical Pediatric Dermatology. A Textbook of Skin Disorders of Childhood and Adolescence, 4th ed. New York, Elsevier Saunders, 2011:424-427.

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  • Head Lice Infestation: A Common Pediatric Condition

    • Pediculosis is the most prevalent parasitic infestation among humans1

    • Head lice infestations are pervasive among school-age children in the United States2,3

    • ~6-12 million infestations occur each year in children 3 to 11 years of age3

    – More common in females4

    • All socioeconomic groups are affected2-4 – Contrary to myth, “head lice prefer clean, healthy

    hosts”4

    References: 1. Hodgdon HE, et al. Pest Manag Sci. 2010;66(9):1031-1040. 2. Frankowski BL, et al. Pediatrics. 2010;126(2):392-403. 3. Centers for Disease Control and Prevention (CDC). Head lice. Epidemiology & risk factors. http://www.cdc.gov/parasites/lice/head/epi.html. Accessed July 16, 2012. 4. Meinking T, et al. Infestations. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1525-1583.

    Photo Researchers

    Getty Images/Peter Dazeley

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  • Pediculus Humanus Capitis: A Closer Look at the Critter1

    • The adult louse is 2-3 mm long (size of a sesame seed) – Usually pale gray; color

    may vary (red when engorged with blood)

    • The louse feeds by injecting small amounts of saliva and taking tiny amounts of blood from the scalp every few hours

    • Lice usually survive less than 1 day away from the scalp at room temperature

    References: 1. Frankowski BL, et al. Pediatrics. 2010;126(2):392-403. 2. Meinking TL, et al. Infestations. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1525-1583.

    Head louse family portrait, left to right: nymph stages 1, 2, and 3; adult male, adult female.2

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  • The Life Cycle of the Head Louse1,2

    Female lives 3-4 weeks

    Lays ≤10 eggs/day

    Eggs tightly attached to hair,

    close to scalp

    Eggs hatch in 7 – 12 days

    Female lays 1st egg 1 or 2 days

    after mating

    Without treatment, the cycle may repeat every

    3 weeks

    Become adults 9 -12 days after

    hatching

    3 nymph stages

    1

    2

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    References: 1. Frankowski BL, et al. Pediatrics. 2010;126(2):392-403. 2. Meinking TL, et al. Infestations. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1525-1583. 6

    Illustration by Penumbra Design Inc.

  • Transmission: Think Head-to-Head1,2

    • Transmission of lice typically occurs by direct head-to-head contact with an infested individual1,2

    • Indirect spread via contact with personal items (combs, brushes, hats) is less likely but can occur1,2

    • Itching is the most common symptom – It may take 4-6 weeks for itching to develop

    in someone infested for the first time1

    • In someone with previous episodes, itching may develop within 48 hours3

    – Excoriation, crusting, secondary bacterial infection may result from scratching1-3

    References: 1. Frankowski BL, et al. Pediatrics. 2010;126(2):392-403. 2. CDC. Head lice. Epidemiology & risk factors. http://www.cdc.gov/parasites/lice/head/epi.html. Accessed July 16, 2012. 3. Meinking TL, et al. Infestations. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1525-1583.

    Getty Images/Photodisc

    Getty Images/Westend61

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  • Careful Inspection Needed for Proper Diagnosis

    A 10-year-old girl complained of scalp pruritus for several weeks. Nits (within white circle) were visible on hairs above the ear. Note the brown scaly fecal material below the hair line (black circle).

    Photo © Bernard Cohen, MD. DermAtlas; http://www.dermatlas.org. 8

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    Unhatched nit of a head louse, firmly cemented to hair shaft.

  • Although uncommon in the US, secondary bacterial infection may result from pruritus and excoriations associated with head lice infestation. The photo here shows a case of streptococcal-staphylococcal pyoderma.

    It is important to note that decreases in the prevalence and severity of scalp pyoderma have been noted following treatment for head lice, even without the use of antibiotics.

    Reference: 1. Meinking TL, et al. Infestations. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1525-1583.

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    Reproduced with permission from Meinking TL, et al.1 © Elsevier 2011.

    Infection: An Uncommon Consequence

  • Nymphs, Nits, and Knowing What to Do

    • Definitive diagnosis is made by finding a live louse or nymph on the scalp or head1,2

    • Nits attached >1 cm from the scalp are usually non-viable1

    – In some warmer climates, viable nits may be found several inches from the scalp3

    – Close inspection is needed • Nits may be confused with dandruff, fibers, scabs,

    hair casts, droplets of hair spray, plugs of desquamated cells, or particles of dirt1,3,4

    References: 1. Frankowski BL, et al. Pediatrics. 2010;126(2):392-403. 2. CDC. Head lice. Diagnosis. http://www.cdc.gov/.parasites/lice/head/diagnosis.html. Accessed July 16, 2012. 3. Lice (pediculosis). In: Paller AS, Mancini AJ, eds. Hurwitz Clinical Pediatric Dermatology. A Textbook of Skin Disorders of Childhood and Adolescence, 4th ed. New York, Elsevier Saunders, 2011:424-427. 4. American Academy of Pediatrics. Pediculosis capitis (head lice). In: Red Book. 2012 Report of the Committee on Infectious Diseases. Pickering LK, ed. 29th ed. Elk Grove Village, IL, American Academy of Pediatrics, 2012, 543-546. 10

  • Approaches to Head Lice Treatment

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    Current Treatment Paradigm for Head Lice1

    • Availability and awareness of OTCa products; limited parent knowledge, poor perception of Rx choices

    • Immediate access to OTC products (avoid delay in treating)

    • Access to “trusted advisors”: school nurse, pharmacist

    Treat On Their Own Contact Health Care Provider

    46% are instructed to try OTC first

    54% receive a prescription for an OTC product or traditional Rx

    72% of Households

    (n = 133)

    28% of Households

    (n = 68)

    Reference: 1. Sanofi Pasteur Inc., Data on file. Excel Omnibus Studies. 12

    Diagnosis: often by school nurse,

    parent, or caregiver

    a OTC = Over-the-counter.

  • OTC Prescription

    Nix®,a (permethrin, 1%) Lindanec 1% shampoo

    RID®,b et al (pyrethrins with piperonyl butoxide)

    Ovide®,d (malathion, 0.5% lotion)

    Ulesfia®,e (benzyl alcohol, 5% lotion)

    Natroba®,f (spinosad, 0.9% suspension)

    Sklice®,g (ivermectin, 0.5% lotion)

    Treating Head Lice: Many Choices

    a Nix® is a registered trademark of Insight Pharmaceuticals, LLC. b RID® is a registered trademark of Bayer HealthCare, LLC. c Lindane is manufactured by Morton Grove Pharmaceuticals. d Ovide® is a registered trademark of Taro Pharmaceuticals, U.S.A., Inc. e Ulesfia® is a registered trademark of Shionogi Pharma, Inc. f Natroba® is a registered trademark of ParaPRO LLC. g Sklice is a registered trademark of Sanofi Pasteur Inc. 13

    Full Prescribing Information for Sklice Lotion will be provided.

    Important Safety Information for Sklice Lotion The most common adverse reactions for Sklice (

  • Other Approaches

    • Home remedies and ”natural” products1 – Essential oils, plant extracts – Occlusive agents: Mayonnaise, petroleum jelly, tub

    margarine, Cetaphil cleanser – Vinegar and vinegar-based products

    • Removal of nits and lice – Products such as dimethicone gel (LiceMD®,a) and gel

    containing citric acid, isopropanol, other ingredients (Lycelle®,b)

    • Nitpicking salons

    Reference: 1. Frankowski BL, et al. Pediatrics. 2010;126(2):392-403. 14

    a LiceMD® is a registered trademark of Quantum Pharmaceuticals. b Lycelle ® is a registered trademark of Mission Pharmacal Company.

  • Nitpicking Salons: An Emerging Phenomenon

    • Nitpicking salons have gained favor in certain parts of the US (California, Florida, Texas, Northeastern states) with some franchises1,2

    – Advertise a “natural” or “chemical-free” approach to lice and nit removal

    – $100 per hour for a “comb-o

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