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Management of head louse infection
Public concern about head lice has increased in recent years. Although they are found on both clean and dirty hair, head louse infection is still falsely associated with uncleanliness and social stigma.
Community nurses are in an ideal position to promote the need to detect and treat head lice, while ensuring treatment is both appropriate and effective. This bulletin explores these issues and discusses the treatment options available.
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Key Points • Head lice treatment should not be prescribed unless a living, moving louse is detected. • Good quality published evidence on the treatment of head lice is limited. While there is some evidence that insecticides are effective, at present there are no published evaluations of mechanical methods of louse clearance (for example, Bug Busting). • Each case should be assessed individually within a `mosaic' model of treatment to avoid prolonged use of the same agent. A treatment course consists of two applications of insecticide, used one week apart. Shampoo formulations are not recommended and cannot be prescribed by nurses. • Detection combing should be done 2-3 days after the final application of insecticide to check whether or not treatment was successful. • All related cases of confirmed infection should be treated at the same time, using the same insecticide. • Thorough tracing of contacts over the previous month is essential to prevent reinfection. • Regular detection combing and thorough treatment of confirmed cases with an appropriate insecticide, is the best way to prevent head louse infection. Insecticides must not be used for the prophylaxis of head louse infection. |
How prevalent is head louse infection?
The prevalence of infection with Pediculus humanus capitis (the head louse) is difficult to estimate, but is probably lower than common perception.1 Prevalence has not been monitored nationally since 1989, although some areas keep their own statistics.
While it is most common in children aged 4-11, all members of the community are at risk of infection. Head lice can infect short, long, clean or dirty hair, although spread may be easier in those with short hair.1 Generally, it is more common in girls than boys,2 and in children from urban rather than rural areas.3
What is the life cycle of the head louse?
Understanding the life cycle of lice is important to ensure their elimination, even if an effective insecticide is used. The female louse lays about six to eight eggs a day, glued onto the hair shaft. They tend to be close to the scalp as head lice need warmth to thrive. The eggs take seven to ten days to hatch, with the empty egg shell or `nit' remaining attached to the hair.
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