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LICE – LICE – IDENTIFICATON & IDENTIFICATON & TREATMENT TREATMENT

LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

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Page 1: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

LICE – LICE – IDENTIFICATON & IDENTIFICATON &

TREATMENTTREATMENT

Page 2: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

Pediculosis CapitisPediculosis Capitis - head lice infection or infestation - head lice infection or infestation

Pediculosis Corporis Pediculosis Corporis - body lice - body lice - usually associated with poor - usually associated with poor socio-economic conditions i.e. – homeless – socio-economic conditions i.e. – homeless – infrequent change of clothing/poor hygiene infrequent change of clothing/poor hygiene

Page 3: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

TransmissionTransmission Usually head-to-Usually head-to-

head contacthead contact Can be contracted Can be contracted

through the sharing through the sharing of brushes, hats, of brushes, hats, scarves, coats, scarves, coats, bedding/linens, etc. bedding/linens, etc.

Obligate human parasite (a parasite Obligate human parasite (a parasite organism that cannot complete its organism that cannot complete its life cycle without dependence on its life cycle without dependence on its host) host) cannot cannot be transferred be transferred through pets/animalsthrough pets/animals

Page 4: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

Life Life CycleCycle

Mature female can Mature female can lay 3 – 6 eggs/day lay 3 – 6 eggs/day and live for about 1 and live for about 1 monthmonth

Eggs hatch within 6 – 10 days, Eggs hatch within 6 – 10 days, maturity reached after another 10 daysmaturity reached after another 10 days

nits may survive up to 3 weeks after nits may survive up to 3 weeks after removal from the hostremoval from the host

Page 5: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

MALEMALEFEMALEFEMALE

Page 6: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

Most commonly affects children Most commonly affects children 3 – 11 years of age but 3 – 11 years of age but anyone can be anyone can be affectedaffected

Common to have outbreaks Common to have outbreaks at schools, dormitories, etc at schools, dormitories, etc

Prevalence - Female > MalePrevalence - Female > Male Likely many unreported due to Likely many unreported due to

stigma attached to infectionstigma attached to infection Lice prefer a Lice prefer a cleanclean environment environment

FactsFacts

Page 7: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

Approx. 1 – 3 mm longApprox. 1 – 3 mm long FlatFlat Wingless Wingless 3 sets of legs - 3 sets of legs - insectinsect

Page 8: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

Signs & SymptomsSigns & Symptoms Most often found on the Most often found on the

warmer areas of the head – warmer areas of the head – behind the ears & back of behind the ears & back of head & neckhead & neck

Itching common, especially Itching common, especially at nightat night

Excessive scratching can Excessive scratching can cause inflammation and cause inflammation and secondary bacterial secondary bacterial infectioninfection

Lice lay eggs or “nits”, Lice lay eggs or “nits”, cemented, close to the base cemented, close to the base of the hair shaftof the hair shaft

Eyelashes (rarely) may be Eyelashes (rarely) may be involved as wellinvolved as well

Page 9: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

IDENTIFICATIONIDENTIFICATION Live lice may be detected, but they move very Live lice may be detected, but they move very

quickly, and shy away from light so detection of live quickly, and shy away from light so detection of live lice may be difficult –advantageous to use 2 people lice may be difficult –advantageous to use 2 people to check the infected personto check the infected person

- many of those infected will have < 10 organisms - many of those infected will have < 10 organisms present present

Lice appear Lice appear sluggish away sluggish away from the warm from the warm scalp scalp

Usually 24 hour Usually 24 hour survival off the host survival off the host

Some recent data suggest Some recent data suggest for up to 55 hours for up to 55 hours

Page 10: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

IDENTIFICATION OF NITSIDENTIFICATION OF NITS Important to distinguish nits Important to distinguish nits

from other possibilitiesfrom other possibilities Dandruff, residues from Dandruff, residues from

gels/lacquers can look like nitsgels/lacquers can look like nits Recent, viable “un-hatched” Recent, viable “un-hatched”

eggs are creamy-yellow and eggs are creamy-yellow and very close to the scalp while very close to the scalp while older “nit shells” are further older “nit shells” are further away from the scalp and white away from the scalp and white in colourin colour

Oval in shape, slightly smaller Oval in shape, slightly smaller than a sesame seed, than a sesame seed, nevernever irregular in shape, fuzzy, or irregular in shape, fuzzy, or encircle the hair encircle the hair

Page 11: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis
Page 12: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis
Page 13: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

TREATMENTTREATMENT A NIT REMOVAL COMB A NIT REMOVAL COMB

IS AN EFFECTIVE IS AN EFFECTIVE SCREENING TOOLSCREENING TOOL

Manual Manual removal removal may be the may be the most most important important step, and it step, and it is possible is possible to treat to treat head lice head lice with this with this method method alonealone

Page 14: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

TREATMENTTREATMENT Mainstay of treatment – insecticidesMainstay of treatment – insecticides

Page 15: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

Lice and other arthropods are killed Lice and other arthropods are killed by these medications blocking by these medications blocking nerve impulses – causing paralysis nerve impulses – causing paralysis and death of the parasiteand death of the parasite Products should be Products should be applied to applied to clean, dry clean, dry hairhair in sufficient in sufficient quantity to saturate quantity to saturate the hair/scalp the hair/scalp (especially behind the (especially behind the ears and the nape of ears and the nape of the neck) and left on the neck) and left on for 10 minutes, then for 10 minutes, then rinsed.rinsed.

Other treatments, Other treatments, petroleum jelly, petroleum jelly, kerosene, Tea-tree oil kerosene, Tea-tree oil and others are either and others are either ineffective or unsafeineffective or unsafe

Page 16: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

Nit or egg removal should follow with a Nit or egg removal should follow with a fine-toothed nit comb. fine-toothed nit comb.

Soaking the hair and wrapping the scalp Soaking the hair and wrapping the scalp with a 50/50 solution of vinegar and with a 50/50 solution of vinegar and water for at least water for at least 15 minutes15 minutes

Machine wash Machine wash (hot) (hot) and dry all hats, and dry all hats, scarves, coats, bedding, if possible, and scarves, coats, bedding, if possible, and dry in dryer on the dry in dryer on the hothot setting setting

For articles that cannot be For articles that cannot be cleaned this way, dry clean cleaned this way, dry clean or seal up in a plastic bag or seal up in a plastic bag for one week for one week

Page 17: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

The nit comb, as well as other combs, The nit comb, as well as other combs, brushes, barrettes, etc can be soaked in brushes, barrettes, etc can be soaked in rubbing alcohol for rubbing alcohol for 1 hour1 hour

Clean house room by Clean house room by room by thorough room by thorough vacuuming (rugs, vacuuming (rugs, furniture, floors)furniture, floors)

All close contacts All close contacts should be thoroughly should be thoroughly screened and treated screened and treated only if necessaryonly if necessary

After treatment, person should be After treatment, person should be checked regularly for any evidence of checked regularly for any evidence of lice or nits lice or nits

Re-treatment may be necessary and Re-treatment may be necessary and alternate agents may have to be used alternate agents may have to be used - resistance - resistance

Page 18: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

Itching, redness, Itching, redness, and inflammation and inflammation may persist for may persist for several days after several days after successful successful treatment and may treatment and may not necessarily not necessarily mean re-application mean re-application is requiredis required

Even the presence of live Even the presence of live organisms several hours after organisms several hours after treatment does not indicate that treatment does not indicate that the treatment was unsuccessful; the treatment was unsuccessful; often these parasites take often these parasites take several hours to die after several hours to die after exposure to treatmentexposure to treatment

Page 19: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

ALTERNATE ALTERNATE TREATMENTTREATMENT

Electric – battery-powered comb Electric – battery-powered comb “zaps” lice “zaps” lice

Some success Some success Price - $50Price - $50

Page 20: LICE – IDENTIFICATON & TREATMENT. Pediculosis Capitis - head lice infection or infestation Pediculosis Capitis - head lice infection or infestation Pediculosis

1)1) Centers for Disease Control and Prevention. Parasitic Centers for Disease Control and Prevention. Parasitic disease information: head lice infestation. Division of disease information: head lice infestation. Division of Parasitic Diseases. http://www.cdc.gov. Parasitic Diseases. http://www.cdc.gov.

2)2) Hansen RC, et al. Guidelines for the treatment of Hansen RC, et al. Guidelines for the treatment of resistant pediculosis. resistant pediculosis. Contemporary PediatricsContemporary Pediatrics 2000 2000 Aug:S1-10. Aug:S1-10.

3)3) Hipolito RB, Mallorca FG, Zunia-Macaraig ZO, et al. Hipolito RB, Mallorca FG, Zunia-Macaraig ZO, et al. Head lice infestation: single drug versus combination Head lice infestation: single drug versus combination therapy with one percent permethrin and therapy with one percent permethrin and trimethoprim/sulfamethoxazole. trimethoprim/sulfamethoxazole. Pediatrics Pediatrics

2001;107(3):p.e30.2001;107(3):p.e30. 4)4) Burson, SC, Permethrin-Resistant Head Lice Burson, SC, Permethrin-Resistant Head Lice

Pharmacist's LetterPharmacist's Letter 1999;15(11):151116 1999;15(11):151116

5)5) Clinical PharmacologyClinical Pharmacology http://cpip.gsm.com http://cpip.gsm.com

REFERENCESREFERENCES