RISK FACTORS: Pediculosis corporis - overcrowded sleeping quarters, Homelessness, Phthirus pubis - sexual contact, Immunosuppression, Sharing combs, hats, clothing, and bed linen, etc., Close personal contact, Poor personal hygiene
GENERAL MEASURES
. Nit removal:
. After treatment with shampoo or lotion, nits remain in scalp or pubic hair
. Nits are best removed with a wet, fi ne comb (nit comb)
. Repeat treatment periodically as needed for stubborn nits
. All family contacts possibly infested with head lice should be treated concomitantly
. Discarding the clothes or washing them in hot water
. Evaluate for other sexually transmitted diseases (for pubic lice)
DRUG(S) OF CHOICE
β’ Head lice - many topical preparations are effective. 1% lindane may be used but may have to be repeated
in one week. 1% permethrin or pyrethrin are effective. They should be applied and washed off after 10 minutes.
β’ Pubic lice - treatments available include synergized pyrethrins, or 5% permethrin. These can be used either
as the shampoo left on for 10 minutes or the lotion which can be left on for several hours for best results.
β’ Body lice - best treated with synergized pyrethrins lotion applied once and left on for several hours
β’ Eyelash infestation - treated by careful manual removal of lice and nits, or by application of petroleum jelly three or four times a day for 5 days
β’ In rare cases, oral TMP/SMX can be used
ALTERNATIVE DRUGS For resistant head lice, shaving the head or oral antibiotics may be indicated
PATIENT MONITORING As needed
PREVENTION/AVOIDANCE
β’ Proper hygiene
β’ Careful followup in schools by public health nurses
β’ Washing combs, brushes, hats, coats, collars, sheets, pillow cases, etc., will help to prevent reinfestation by
head lice
β’ Vacuum furniture
POSSIBLE COMPLICATIONS
β’ Persistent itching may be caused by too-frequent use of the pediculicide
β’ Secondary bacterial infections
EXPECTED COURSE/PROGNOSIS
β’ With appropriate treatment over 90% cure rate
β’ Recurrence common, mainly from reinfection, failure to comply with treatment