Introduction

• Lice are tiny, wingless, parasitic insects that feed on your blood.
• Head lice infestation is very common. Children aged 3-10 years in preschool, elementary school or daycare centers are most likely to have lice. It is easily spread, especially by school children, through personal contact and by sharing personal belongings.
• Head lice die if they are away from a human’s head for more than 2 days.

Signs & Symptoms

• Intense itching.
• Lice on the scalp and lice eggs (nits) on hair shafts are easily seen at the nape of your neck and over your ears.
• Small, red bumps on the scalp, neck and shoulders.

Treatment

• If a child is younger than 2 years, comb to remove lice and nits but do not use anti-lice agents.
• Check all household members and treat only if lice or nits are seen.
• Hair conditioners may coat or cover the lice, so they should not be used before applying anti-lice agents.
• Use hot water to wash all bed linens and clothing that have been in contact with the infested person in the past 2 days.
• All non-washable items such as stuffed animals should be placed in plastic bags for 2 weeks.  Should then be opened outdoors. Dry cleaning may be an alternative.
• Disinfect combs and brushes in hot water or alcohol. Soak for more than 5 minutes in very hot water.
• Vacuum floors and furniture, especially couches and areas used by children. Throw away the vacuum bag immediately.
• If lice are seen in a school children, notify the school nurse or teacher in order to limit the spread. The children are advice not to share hats, combs and other personal belongings at school.

Treatment for head lice:

1. Gamma benzene hexachloride (Lindane Shampoo)

   In oil solution

   How to use?

   • Wash hair with regular shampoo at least 1 hour before applying lindane and dry it thoroughly.
   • Apply just enough lindane shampoo to make your hair, scalp and the small hair on the back of the neck wet.
   • Leave the lindane shampoo for exactly 4 minutes.
   • At the ends of 4 minute, use a small amount of warm water to lather the shampoo. Do not use hot water.
   • Wash all of the shampoo off of your hair and skin with warm water.
   • Dry your hair with a clean towel.

   Contraindications

   • Pregnant mother and premature baby
   • Breast feeding mother
   • Avoid in patient with a history of epilepsy
   • Low body weight

   Special precaution

   • Simultaneous use of lindane and other creams
   • Avoid contact with eyes and mucous membranes
   • Excoriated skin.
   • Do not apply lotion immediately after a hot, soapy bath.

1. Malathion

How to use?

1. Sprinkle the lotion on dry hair.
2. Rub gently until the scalp is thoroughly moistened
3. Pay special attention to the back of the head and neck.
4. Allow to dry naturally  don’ t use shampoo. Wash off after twenty-four hours.
5. Rinse and use a fine-toothed comb to remove dead lice and eggs.
6. If required, repeat with second application in 7-9 days. Applications of lotion repeated at intervals of less than 1 week or application for more than 3 consecutive weeks should be avoided since the likelihood of eradication of lice is not increased.
7. Further treatment is generally not necessary.

The risk of systemic effects associated with 1-2 applications of malathion is considered to be very low.

Malathion is flammable. So, keep it away from heat sources such as hair dryers, electric curlers and cigarettes.

Special precaution

1. Simultaneous use of lindane and other creams
2. Avoid eye contact
3. Do not use on broken or secondarily infected skin
4. Seek medical supervision for children under 6 months

Prevention

• Families are encouraged to have direct inspection of children routinely because it can recur.
• Wash clothes, bed linens, combs, and brushes to prevent recurrence.
• Preventive treatment with anti-lice agents is not recommended because it can lead to illness and persistent itching.
• Health education on the life history of lice, personal hygiene and other aspects is extremely valuable.