1. Parent University Lice By Dr. Secory, The Iowa Clinic Katie Wittmer, Walnut Hills School Nurse

2. Head Lice: Basics Move only by crawling, cannot hop or fly. Head-to-head contact is most common source of transmission. –Younger ages most prevalent Sharing personal items discouraged, but less likely source of transmission. Not a true medical problem or public health hazard –Do not spread disease –Are annoying, can cause loss of sleep and secondary infections due to itching. No relationship to cleanliness of individual or home

3. 3 Stages of Head Louse Nit/Egg –Tiny oval shaped, yellow or white. –Cemented to hair shaft, near scalp. –Can be difficult to see and resemble dandruff or hair product build up. Unlike dandruff, will not flake loose –Take apx 1 week to hatch Nymph –Hatched, immature louse. –Nit shell will remain on hair shaft after nymph emerges and becomes more visible. –Looks like small adult. Adult Louse –Turn from nymph to adult louse after apx. 9 days. –Can live 30 days feeding on blood from head. Die w/in 2 days if fall off. –Females lay apx. 6 eggs/day.

4. OTC Treatment Options Kill only hatched louse, not eggs, so 2 nd treatment recommended between 7-9 days. By then all viable nits should have hatched, but louse will not mature into egg-laying adult. Pyrethrins –Brand name: Rid –Naturally occurring pyrethroid extracts from chrysanthemum flower. –Not to be used by persons with allergy to ragweed. –Approved for use on ages 2 years+ Permethrin Lotion – 1% –Brand name: Nix –Synthetic, but similar to naturally occurring pyrethrins. –May continue to kill newly hatched lice for several days after treatment. –Approved for use on ages 2 months+

5. Rx Treatment Options Permethrin, 5% –Brand name: Elimite –Same properties as OTC 1%, just stronger/more effective dosage Benzyl alcohol lotion, 5% –Brand name: Ulesfia –Kills hatched lice, not eggs (non-ovicidal) –2 nd treatment recommended 7 days after initial –Approved for ages 6 months+ –Can be higher tier Rx Ivermectin Lotion, 0.5% –Brand name: Sklice – Approved by FDA in 2012, newer treatment. Can be expensive –Approved for ages 6 months+ –Not ovicidal, but appears to prevent any hatched nymph from surviving to adulthood. Thus effective when given in single application. –Not to be used for retreatment

6. Rx Treatments, Cont. Malathion Lotion, 0.5% –Brand name: Ovide –Kills live lice, and partially ovicidal (killing nits) –2 nd treatment recommended only if live lice present 7-9 days after treatment. –Approved for ages 6 years+ –Flammable. Do not smoke or used heat devices such as hair dryers when applying or while hair is wet. Spinosad, 0.9% –Brand name: Natroba –Derived from soil bacteria –Brand new –Kills both hatched lice and nits. –Approved for ages 4 years+ –Repeat treatment only if live lice are found 7 days post treatment.

7. Treatment Considerations Do not treat an infested person more than 2 times with same medication w/o consulting PCP. May be using incorrectly or may be resistance. All treatments can be irritating to scalp –Use of Benadryl both to relieve itching and help sleep Similar treatments can have different instructions –OTC Permethrin (Nix) Wash hair, NO conditioner. Saturate hair with crème, leave 10 minutes. RINSE. –Rx Permethrin (Elimite) Apply crème to dry hair, leave OVERNIGHT.

8. Common Reasons for Treatment Failure: Failing to following specific treatment instructions –Failing to do a 2 nd treatment if indicated –Retreating too quickly before all nits are hatched. Common mistake. Remember, have apx. 9 days after louse hatches prior to egg-laying. Do not jump gun and treat before hatching is allowed to occur. –Shampooing too soon after applying permethin, which can eliminate residual killing effect on the lice. Do not rewash hair with shampoo for 1-2 days after application Applying treatment to hair that has been conditioned. Resistance to treatment used. –If failed, contact PCP to verify treatment was used correctly. If so, PCP may recommend different product. Reinfestation –From another individual –From improperly cleaned household and personal care items

9. Secondary Treatment Measures: Nit/egg removal –Often done for cleanliness/aesthetic reasons, and desire to not have lice hatch before retreatment. –If OTC/Rx medications are used correctly, no absolute need to remove all nits. Doing 2 treatments 7-9 days apart (as indicated) is designed to eliminate all live lice before laying more eggs. Can provide reassurance as nits are very difficult to see, especially in long/thick hair. –When attempting to remove nits, focus effort near scalp, especially behind ears and at nape of neck. Nits more than ¼’’ from scalp are generally non-viable. Makes combing process slightly more tolerable.

10. Secondary Treatment Measures, Cont. House Cleaning –Vacuum carpets, furniture, car seats and other fabric items unable to be laundered –Wash all linens, clothing and stuffed toys used by the infested person. Probably only necessary 2-3 times during course of treatment, but could do sheets daily in exercise of caution Freezing items –Freezing temps can kill lice and nits, but several days may be necessary so not recommended means to kill Bagging items –Although hatched lice survive less than 2 days if they fall off scalp, and nits usually die within 1 week if they are not near scalp, some experts recommend bagging any item that cannot be laundered for 2 weeks to prevent any chance of reinfestation. –Good excuse to bag up excess stuffed animals to see if they really miss them. Fumigation –Not recommended. –Fumigant sprays and fogs can be toxic if inhaled and are not necessary to control head lice.

11. Secondary Treatment Measures, Cont. At-home treatments such as olive oil, coconut oil, mayonnaise have not been proven in studies to be effective on their own. –However, can be good supportive measures to be used between the 2 medication treatments. –Helpful to loosen and remove nits –Condition itchy scalp

12. Prevention Instruct children to do their best to avoid head- to-head direct contact. Inform to avoid sharing hats/brushes/other personal items with scalp contact Use of tea tree oil has shown to have preventative value. –Can make own concoction, mainly water with essential oil, sprayed on scalp –Available in products such as Fairy Tales

13. If unsure of head lice infestation, diagnosis can be made by physician, local health department official, or other person trained to identify (school nurse).

17. FAQ’s Q: Can I send my student’s items in a plastic baggie. A: Yes you can. But remember head lice does not live more than 24 hours off the head and is spread thru head to head contact.

18. FAQs Q: Can student’s have individual lockers A: Unfortunately this is not available due to the abundance of students at the school. Q: Should I re-treat my student A: Not necessarily. Only re-treat if you still see a live bug present in the hair. Re-treatment can lead to resistance. Call the school nurse or your PCP if you have questions.

19. Helpful Websites www.cdc.gov/lice/head www.LiceMD.com www.headlice.org www.idph.state.ia.us/adper/common/pdf/e pi_manual/lice.pdfwww.idph.state.ia.us/adper/common/pdf/e pi_manual/lice.pdf