Just in time
for the back-to-school season, Contemporary Pediatrics has published
new guidelines for the treatment of resistant head lice in a
supplement to its August issue.
The guidelines emerged from a working group conference held at the
Harvard School of Public Health. Members of the conference included
physicians, entomologists and representatives from the Centers for
Disease Control and Prevention (CDC), the National Association of
School Nurses, American Pharmaceutical Association, the National
Association of County and City Health Officials and the Association of
State and Territorial Health Officials.
The long-awaited treatment guidelines may help health care
professionals and parents cope with the problem of head louse
infestations. More than six million children are infested with head
lice each year. Diagnoses of infestation peak during the
"Based on research data, some head lice have become resistant to
certain treatments," says Richard J. Pollack, Ph.D., entomologist at
the Harvard School of Public Health. "The growing incidence of
resistance in the United States may be attributed to misdiagnosis and
misuse or inappropriate use of treatments. Following a consistent
approach to treatment, which incorporates parent education, may help
decrease the problem of resistance and ease parent anxiety."
Ronald C. Hansen, M.D., at the University of Arizona Health
Sciences Center agrees that lice phobia may be fueling the resistance
issue. "In an effort to get their children back to school sooner,
parents have been known to treat their children before obtaining an
accurate diagnosis," notes Dr. Hansen.
The new guidelines follow a simple approach to treatment:
1. Parents should not diagnose head louse infestations themselves.
Health care professionals must confirm the diagnosis to differentiate
louse infestation from conditions that may mimic it, such as eczema,
dermatitis or psoriasis. Dandruff, dry hair gel, scabs, dirt or even
insects that have blown into the hair are other common false positive
2. If a diagnosis has been confirmed, the first line of treatment
is the use of an FDA-approved, over-the-counter (OTC) product. Parents
should follow directions carefully to reduce the potential for product
misuse or injury.
3. A second treatment using the same OTC formulation is
recommended 8-10 days later to ensure that all surviving lice eggs (or
nits) are killed after hatching. A health care professional should
confirm if treatment was successful in eliminating the infestation.
4. If live lice are present after two OTC treatments, the panel
advises using a prescription product as second-line therapy. The panel
members' recommendation is the use of pharmaceutical-grade of
malathion, the active ingredient in OVIDE(R) (malathion) Lotion, 0.5%.
In addition to following directions for treatment, panel members
suggest the use of a metal nit comb to remove dead lice and nits.
The guidelines also address the following issues:
- Spraying of furniture, sealing stuffed animals in plastic bags
for weeks and excessive housecleaning efforts are unnecessary
because lice do not typically live off their human host for
more than a day. However, routine cleaning of recently used
items is recommended.
- School "no-nit" policies are not in the best interest of
children, families or schools. "No-nit" policies dictate that
louse-infested children may not return to the classroom until
they are free of lice and nits.
- Alternative therapies, such as the use of olive oil, mineral
oil or mayonnaise, should be avoided because they have not
been adequately studied. Gasoline, kerosene or
industrial-grade pesticides should never be used.