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How To Handle Lice Infestations

How To Handle Lice Infestations

Head scratching that leads to the discovery of the dreaded nit is the bane of back-to-school rituals. Given the no-nit policies of schools and daycares, parents are often scrambling to figure out how to handle the infestation as quickly and painlessly as possible. Therefore, health care providers need to know the limitations of current treatments and how to advise patients on which treatments remain effective. To address that need, a group of experts collaborated on a detailed review of the most commonly used treatments in the United States. Here are some of the findings:

Out with the old: Due to genetic mutations of head lice over time in the United States, the most likely outcome of applications of pyrethrins or permethrin for head louse infestations is treatment failure.

New therapies show great promise: Spinosad (0.9%) was approved in 2011 for prescription use and in two parallel RCTs conducted across the United States, 68.1% of patients in one study and 75.9% in the other were free of lice 14 days after a single application. When data from single-application patients were combined with those receiving a second treatment, 84.6% and 86.7% were lice free. Topical ivermectin lotion containing olive oil and Shea butter was approved in 2012 for treatment of head lice. The effectiveness of 0.5% ivermectin 14 days after a single application, without nit combing, was found to be effective about 75% of the time.

Cut out the constant combing: Two recently approved products (spinosad and topical ivermectin) have been found to be effective without nit combing. Although combing removes dead lice and eggs, a rigorous removal of eggs is unnecessary other than for cosmetic purposes.

No nits is not necessary: Along with the American Academy of Pediatrics, the authors found no justification for “no nit” school policies that result in a loss of school days and caregiver time off work, or for routine screening of children for infestations, which have not been shown to reduce the risk of transmission.

Natural does not mean better: Home remedies such as petroleum jelly, olive oil, and mayonnaise have been found to be ineffective in most studies. Essential oils (such as melaleuca [tea tree] oil) have no clinical data to support their use in the United States.

Providers should understand how to manage head lice infestations, take an active role in the diagnosis of infections, and guide appropriate use of well-tested, proven, FDA-reviewed products.

 

Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: September 12, 2016

Source: Wiley Online Library
Adapted from the original article.

[Image: Pixabay / OlivierLevoux]

Summary: Head lice can be successfully treated with spinosad and topical ivermectin; home remedies have not been proven effective.

Key words: head lice, pyrethrins, permethrin, spinosad, ivermectin, nits, nit combing, sdpa, society of dermatology physician assistants, dermatology, DermPA