HEADLICE

1. HEADLICE How to detect and treat head lice and nits

2. What you need to know What are head lice How head lice spread Methods to detect head lice Products to treat head lice How to prevent re-infestation

3. What are head lice? Small, wingless insects Feed on the scalp, often found behind ears and near base of neck Females lay up to 8 eggs (nits) per day Not dangerous • do not carry disease • are not “caught” from pets

4. Life cycle of a louse

5. Who gets head lice? Can occur in people of all ages, genders, race and backgrounds Not a sign of poor hygiene Most common in primary school aged children (5 -11 years) More common in girls than boys

6. How do head lice spread? Do NOT fly or jump Crawl from head to head by direct contact Can be transferred on objects i.e. Hairbrushes, hats, scarfs May infest bedding, clothing etc.

7. Symptoms of infestation Itchy scalp Sensation of something moving in hair Red sores on the scalp cause by scratching

8. Detecting head lice Detection of a live louse is best way to confirm infestation • Check dry hair first • Live adult lice most commonly found at crown of head • “Conditioner and comb method” Presence of eggs or “nits” on hair shaft can also indicate infestation • Eggs most commonly found a nape of neck and behind ears • Eggs found within 6mm of scalp likely to indicate active infestation • Egg found more than 1cm from scalp are hatched or dead

9. “Conditioner and Comb” method Apply conditioner to dry, brushed hair Divide hair into 3-4 cm sections, and comb each section using a fine tooth “nit” comb After each stroke wipe comb with tissue or paper towel, and look for live lice and eggs on the comb and towel Comb each section several times until no further lice or eggs are found

10. Head lice treatments Only treat if sign of active infestation are found Several treatment methods available • Insecticide treatments • Herbal products • Physical methods

11. Insecticide treatments Several products available • Pyrethrin (Banlice Mousse, Pyrenel Foam, Orange Medic Plus) • Permethrin (Pyrifoam Lice Breaker, Quellada) • Maldison (KP 24 Lotion and Shampoo, HL 7) Recommended contact time • 10-30 minutes for shampoos and foams • Overnight for lotions Adverse effects include contact dermatitis and anaphylaxis Refer • children <2 • pregnant or breastfeeding women Repeat treatment is required after 7-10 days

12. How to apply a head lice treatment

13. Insecticides- WHAT, STOP, GO Who is the patient? How long have the head lice been present? Actual symptoms? Treatment for this or other conditions? Allergies? Symptoms of side effects of other medications? Totally sure? Overuse/abuse? Pharmacist only? GO

14. Insecticides- CARER • R – RESPOND • Recommend therapy if appropriate • Refer if uncertain • Reconsider if medication inappropriate • E – EXPLAIN • Verbal directions • Written support • What to do if not improved • Reasons for referral • R – RECORD • If legally required • Provide ongoing care • If referred • If misuse/abuse suspected C – CHECK • Who is the patient • What are the symptoms • What has been tried • How long have symptoms been present • Other medications • Other conditions A – ASSESS • Diagnosis clear • Medication therapy most appropriate • Possible interactions • Trained and confident

15. Insecticides - What to tell the customer Do not treat unless active infestation is confirmed Always check the directions on the label before use Ensure bedding, clothing, brushes etc are treated with heat Always retreat in 7-10 days In between treatment use the “conditioner and comb” method to remove eggs Itching may persist for several days after lice have been eliminated Consult the pharmacist if there is a history of adverse reaction

16. Herbal treatments More than 20 herbal head lice products available in Australia • Tea tree oil • Eucalyptus oil • Lavender oil • Rosemary oil Only MOOV Head Lice Solution has been proven effective • Contact time: 10 Minutes • Repeat treatment TWICE after 7 and 14 days

17. Physical methods “Conditioner and Comb” method • May be effective if less than 5 lice are found in initial inspection • Complete every 2nd day until no lice are found for 10 consecutive days • Recommended treatment for children under 2 years of age Heat • Use hair dryer to apply heat to small section of hair for 1-3 minutes • More effective at killing eggs than lice Electronic Combs (RobiComb, Licetec Opticomb) Suffocating Agents • Do not use Kerosene

18. Treatment Failure Inadequate application • Every hair not covered • Too short contact time Failure to re-treat • Second treatment after 7-10 days necessary to kill newly hatched lice Insecticide resistance • Increasingly common due to ineffective product use • Should retreat with different product or use physical method Reinfestation

19. When to refer to the pharmacist Children <2 years of age Pregnant or breastfeeding women People with asthma, skin rashes or allergies People with previous adverse reaction to treatment Persistence infestations despite appropriate treatment People with symptoms but unconfirmed diagnosis Severe infestations Eyelash infestations

20. Preventing recurrence Notify school if head lice are found Ensure all family and close contacts are checked and treated if infestation is confirmed Wash all bedding, towels, clothing etc in hot water or place in a clothes dryer Soak all brushes and combs in hot water (>60ºC) for 30 seconds Keep long hair tied back Avoid sharing hats, hats, hairbrushes and accessories, towels or pillows Carry out regular head checks using conditioner and comb method • Weekly on regular basis • After sleep overs • Daily during outbreaks at school

21. Case Study Mrs Smith, a regular customer, comes into the pharmacy to purchase two bottles of KP 24 shampoo. When asked, she tells you that her 7 year old daughter Sarah has come home from school with “nits”. This is the third time this year Sarah has had nits, and Mrs Smith is very upset and embarrassed. She also plans to treat her 1 year old son James to be sure that she gets rid of the problem once and for all. How should you respond to Mrs Smith request for KP 24? What concerns might you have about the frequency of Sarah’s head lice? What advice can you give Mrs Smith about preventing reinfestation?

22. Summary Head lice is a common condition, especially in school aged children, and is not a sign of poor hygiene Customers requesting head lice products should be advised to confirm infestation before treating WHAT STOP GO or CARER protocols can be used to respond to treatment requests All insecticide treatments need to be repeated after 7-10 days Recurrence is common, especially if measures to prevent reinfestation are not taken Severe or recurrent cases or treatment of children <2 or pregnant or breastfeeding women require referral to the pharmacist

23. Further reading Head Lice (Victorian Government) http://www.health.vic.gov.au/headlice/ http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Head_lice_treatment_and_control?OpenDocument Head Lice Fact Sheet (WA Government) http://www.health.wa.gov.au/docreg/Education/Diseases/Communicable/Parasitic/HP0149_head_lice_FS.pdf Head Lice (Qld Government) http://access.health.qld.gov.au/hid/InfectionsandParasites/Parasites/headLice_fs.asp 23