the exceptions of the common cold, head lice affect more school-aged children
than all other communicable diseases combined.
Studies show that the public wants to receive more advice from their
pharmacist, and the trend in pharmacy practice is to provide more consultative
services. All summed up, this means
that pharmacists will, and should, assume a leadership role in the community
effort to develop a sound and standardized approach to controlling head lice.
There is a lot of misinformation on this disease and its
control. This is especially true on the
Internet. There are many products being
marketed as safe and natural alternatives yet labeled with pesticidal
claims. The majority of these products
have not been reviewed or approved by the Food and Drug Administration for
human safety, manufacturing practices, or efficacy.
Encourage everyone to get the facts and CHECK A HEAD.TM
Determine if the patient has head lice: If there is not a
diagnosis from a qualified health professional or knowledgeable parent, you may
need to advise on how to identify an infestation.
inspecting the scalp and hair, look for nits tiny yellowish-white oval eggs
firmly attached at an angle to the side of the hair shaft. Unlike what most pharmacists were taught in
school, the nits a quarter inch from the scalp or further are not necessarily
dead. Viable eggs can be found anywhere
on the hair.
infestation is often detected by seeing nits rather than by finding head
lice. Head lice, which shy away from
the light and move quickly, may also be seen.
They are the size of a sesame seed; are transparent as nymphs but with
blood meals take on a reddish brown to black color.
an effective screening device, such as the NPAs LiceMeister® comb, go through
each section of hair from the scalp to the end of the hair. (Head lice can also be found in the eyebrows
and eyelashes. Children should be examined
by their physician in this situation.)
Pesticides should not be used on or near the eyes.
sure that patients do not confuse nits with hair debris such as desquamated
epithelial cells (DEC plugs), which are bright white and irregularly shaped clumps
of dandruff stuck to the hair shaft, or haircasts (elongated segments of
dandruff that encircle the hair shaft).
Both can occur in patients who have been over-treated with pesticides. Such debris can cause diagnostic confusion.
may be found throughout the hair, but are often found at the nape of the neck,
behind the ears, and at the crown.
parents that routine screening and early detection is the best and only
prevention. Pesticides should not be
used to prevent head lice.
mindful that some parents will assume that they or their children are infested
whenever they hear that there is an outbreak.
This is okay if it prompts them to screen
but not if it causes them to
use pesticides unnecessarily.
2. Alert those who
are at greatest risk from the use of pesticides. These issues also apply to the person administering the
treatment. Some of the factors
impinging on the treatment choice include:
health/age/size of the child.
the person applying or using the product is pregnant or nursing.
there are several infested family members to be treated by one parent.
who have had repeated earlier pesticidal treatments.
on medication or with pre-existing medical conditions such as allergies,
asthma, epilepsy, cancer, or with open wounds on the hands, scalp or neck.
on increasing reports of head lice resistance on a national level, the NPA
advises parents to discontinue the use of head lice pesticides at the earliest
sign of treatment failure. MANUAL
REMOVAL IS THE BEST OPTION WHENEVER POSSIBLE AND ESPECIALLY WHEN TREATMENT
PRODUCTS HAVE FAILED.
lice treatments should be used over a sink, as opposed to a bath or shower as
it will minimize the exposure of pesticides to the body. Caution against allowing these products to
get near the eyes.
against the use of head lice sprays.
Using head lice sprays on bedding, furniture, and carpets is
unwarranted, has no scientific basis, and may pose personal and environmental
not recommend products containing lindane.
The Food and Drug Administration (FDA) regards it as potentially more
toxic than all other pediculicidal choices and no more effective. None of the commercially available products
will kill 100% of the nits.
educational materials about head lice control near the head lice products in
the pharmacy, and encourage affected persons to discuss their experience with
current endemic nature of head lice among children challenges the traditional
management concept that the lack of efficacy in pediculicides can be countered
by retreating children in 7-10 days later to kill the newly hatched lice. The 7-10 day time span is nebulous. More importantly, such a measure does not
take into account the opportunities to become reinfested from another child in
Additional Control Measures for Patients
parents screen as part of personal hygiene routinely just as they brush their
teeth. Early detection is key and is
consistent with traditional communicable disease control methods.
parents machine wash all potentially exposed clothes, sheets, etc. in hot
water, and dry them in a hot dryer.
item that cant be washed or dry-cleaned can be vacuumed. Recommend vacuuming as the safest and most
effective alternative to spraying.
professionals have suggested bagging items in plastic bags. Discourage bagging and encourage
vacuuming. Having head lice can be
traumatic, especially for children.
Often its their favorite stuffed animal, or blanket that gets bagged,
just when they need it most. Parents
should know to save their energy for that which benefits them the most:
attention to the scalp and hair for early detection along with complete lice
and nit removal.
recommend retreatment based on the patients scalp being itchy. Remember that prior treatment itself can
cause the scalp to itch and this symptom does not validate an infestation.
about daily screening and thorough nit removal. Remind the patient that an ongoing infestation is predictable
without these measures.
Prevent new outbreaks.
parents to notify their childs school, camp, childcare provider, and
neighborhood parents regarding possible outbreaks. Parents should check for head lice on a regular basis. Remember that head lice affect all social
groups. Reporting should be encouraged.
AGAINST treating anybody who is not infested.
Do not recommend prophylactic treatment.
Public Health Aspects: Minimize community outbreaks by taking a
leadership role in lice prevention in your community.
Inform your community that you
want to be part of a community approach that you are available for
educational information as well as advice about treatment and head lice
You may choose to provide
in-service training for local teachers, YMCA staff, camp directors, childcare
Support the important step of
reporting outbreaks, treatment failures, and adverse reactions to the NPAs
National Reporting Registry, local health departments, and
school officials. Remember that early
reporting can mobilize communities to do preventive screening.
Encourage routine screening, early
detection, and complete removal of both lice and nits.
a leadership role in lice prevention in your community.
Teach others how to minimize
outbreaks. Because most head lice
information comes from product advertising, you should look to the National
Pediculosis Association® for impartial resources and materials.
Encourage everyone to join the
NPAs Back-To-School National Pediculosis Prevention Month activities that
continue throughout the year.
others to exercise caution in selecting and using products for treatment.
Overuse of anti-lice pesticides
has caused insect resistance similar to the current situation with some
bacteria and antibiotics.
physicians about possible new treatments and issues related to Pediculosis.
Head lice are often perceived as
unglamorous and unworthy of serious attention. As a result, there is conflicting information and no nationally
standardized approach. Encourage
everyone to get the facts and CHECK A HEAD.TM