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2017 HCHB_digital

Head Lice Head lice

Head Lice Head lice (pediculosis capitis) are small, brownish-grey, wingless insects, about the size of a sesame seed (2–3mm), which feed on blood from the scalp. They are most common in children, but can also spread to adults. Their stumpy legs make them incapable of jumping and they cannot fly, instead they use their single claw and “opposing thumb” on their legs to grasp the hair shaft and quickly crawl from head to head. Most are grey, although some may look black and after feeding their body may take on a reddish colour. They spread easily among people in close contact, such as family members and school friends. Head lice only feed on human blood and only infect the scalp – they are a different species to body lice and pubic lice and in the natural environment will not interbreed. Unlike body lice, they do not carry disease, and apart from a risk of secondary infection from scratching, are unlikely to cause medical harm. Some experts regard head lice as more of a cosmetic, rather than a medical, problem. An itchy scalp is the most common symptom of head lice, caused by a delayed allergic reaction to the lice’s saliva or faeces. This reaction may take between a week and three months to develop which means that many customers may have been infested for some time without knowing. Some people may not actually itch at all. Female head lice can lay up to eight eggs per day. These egg cases are brown and hard to see until the louse nymph hatches seven to 10 days later. By this time the empty egg case has moved up the hair shaft as the hair has grown and now appears white, so is much more easy to detect. When people talk about nits, they are actually referring to the empty egg cases. The nit is stuck on the hair shaft close to the scalp with a strong, highly insoluble cement which makes it hard to get off, but easy to distinguish from flakey bits of skin, dried hairspray or dandruff. Females may lay 50–100 eggs during their lifespan of around 30–40 days. It takes about 10 days for a nymph to mature and be able to breed, and each louse lives for about a month on the scalp, but for only 48 hours off it. Optimum conditions and a moderate temperature and humidity are required for hatching which explains why head lice are more prevalent over summer. TREATMENT OPTIONS Category Examples Comments Egg removal products and combs Products to detect head lice Products with a physical action Products with a neurological action Products with both a physical and neurological action (usually contain essential oils) Preventive products [GENERAL SALE] eg, NeutraLice Conditioner Shampoo Lice Egg Remover*, Neutralice Nitcomb, Parasidose Long Tooth Comb, Robi Comb Pro [GENERAL SALE] eg, Moov Combing Conditioner for Head Lice Detection [GENERAL SALE] eg, benzyl alcohol 5% (eg, NeutraLice Advance Lotion*) biococidine (eg, Parasidose Lice-Nits Treatment), isopropyl myristate (eg, Moov Head Lice Treatment Sensitive) [GENERAL SALE] eg, permethrin (Lice Clear*), d-Phenothrine (Parasidose Extra-Strength Shampoo) [GENERAL SALE] eg, combination of essential oils (Moov Head Lice Solution*, NeutraLice Natural Spray*, Nit- Enz Organic) eg, neem oil (Licener Single Treatment) eg, anise oil, cinnamon leaf, citronella, eucalyptus oil, geranium, lavender oil, mint, tea-tree oil, thyme [GENERAL SALE] eg, Ladibugs Mint Spray, Moov Head Lice Defence Spray, Nit-Enz Head Lice Repellant, Parasidose Lice Repellant Spray Egg removal products allow eggs to be brushed out easily from the hair. Fine metal-toothed combs with rounded teeth are used to detect and remove head lice. Use on wet hair with conditioner. Not usually 100% effective if used without treatment products. Electric combs stun or kill lice and are used on dry hair. Hard to use on very thick and curly hair or on young children. Combing conditioners stun lice and help detect the presence of head lice and eggs. These products do not kill lice or nits. Benzyl alcohol suffocates lice by affecting their respiratory spiracles; dimeticone coats the louse, disrupting its ability to manage air and water exchange across its body surface; and isopropyl myristate kills lice by dehydrating them. Biococidine claims to suffocate and dehydrate head lice; however, the actual active ingredient is undisclosed, making it impossible to check for allergies. Some may be used in children as young as three months and in pregnant women. Most are suitable for asthma sufferers. Permethrin, phenothrin, and malathion are all neurological agents, each with a slightly different mode of action, although the end result is usually paralysis of the louse, preventing it from feeding. Resistance is common. Products with both a neurological and physical effect include most products that contain essential oils, including neem oil. Neem oil interferes with the growth and reproduction of head lice, and also suffocates their eggs. Essential oils such as eucalyptus, tea tree, lavender, and clove oil can also be toxic if misused, and strong evidence for their effectiveness at killing head lice or their eggs is lacking, although combinations with vegetable oils may be more effective. Either contain essential oils that repel lice or coat the hair making it difficult for lice to attach. Usually used every two to three days or weekly to keep lice from infesting hair. Will not treat already established infestations. Other products Air Alle (www.nitcrew.co.nz) Controlled heated air is directed onto dry hair by a trained technician. Process takes 30 minutes and effectively kills head lice and nits. May need to be repeated. Products with an asterisk have a detailed listing in the Head Lice section of OTC Products, starting on page 243. Page 90 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Initial assessment If a customer asks you to check their head for head lice, move them to a private area, put on gloves, and start by looking for nits which are more commonly found behind the ears, under the fringe, and at the nape of the neck. Advise customers who wish to do their own checking that the most reliable way to check for head lice is by using a conditioner and a fine-toothed nit comb, especially in children with curly hair. The conditioner should be applied to the hair for 10 minutes before combing through. The conditioner stuns the lice, forcing them to let go of the hair, and they readily show up against the white conditioner. Theoretically, if done meticulously (every three days until no lice are seen for three consecutive sessions), this method can be used as a non-pharmacological way to remove head lice; however, in practice, failure rates are high because of the heavy commitment involved. Advise use of a treatment product if lice or a viable egg (solid in colour and within 1cm of the scalp) is found and reassure customers that head lice are not a sign of dirty hair or poor hygiene, and are just as likely to be found in clean hair. Girls with long hair are more likely to get head lice if their hair is not tied back. Advice for customers • Ensure the hair is free of conditioner and completely dry before applying treatment products. • Apply products strictly as directed on the label. Many products are not 100% effective on nits and need repeating after seven days. Note that some products are flammable and treated hair should be kept away from heat sources. • Use all products with a fine-toothed nit comb to improve success. »» Combing (or regular brushing) damages their legs and other body parts which prevents them gripping onto the hair shaft to lay their eggs. • Wash bed linen, head coverings, and clothes in a hot wash; soak combs and grooming aids in hot water for 10–15 minutes; and vacuum furniture and floors. • Never use fly spray or pet treatment products to treat head lice. • Avoid washing the hair or using a hairdryer for 24 hours after applying chemical treatment products. • Parents or caregivers should inform their child’s teacher and friends that their child has head lice so that other close contacts can be checked at the same time. »» Outbreaks can continue for months because of one untreated head. • Presence of empty egg cases (translucent in colour and found further than 1cm from the scalp) does not mean treatment failure since most treatment products do not remove the egg cases from the hair. »» Grasp each case between thumb and forefinger and slide off the hair shaft. • Hair straighteners can be effective at “popping” eggs but must be used regularly and as close to the scalp as possible. • Shaving the head is effective but not usually necessary and won’t prevent reinfestation. Some hairdressers may refuse to cut infested hair. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. Refer all pregnant women and babies to a pharmacist as they should not be treated with, nor exposed to, chemical insecticides or certain essential oils. • Does the person have any other health conditions (eg, lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Are there any sores on the scalp (may indicate a secondary bacterial infection)? • Does the person have a particularly heavy infestation or matted hair? • Could there be another reason for the itching (skin conditions, eg, dandruff and psoriasis may be confused with head lice)? • Have products been tried before without apparent success? • Does the person have any allergies to topical medicines? Prevention • Hair should be kept short, if possible, or tied back and plaited if long. • Regular brushing can help prevent head lice since they have no defence against disease or injury, and can be damaged by combing or brushing. » » Encourage children not to share hats and combs, although the chances of catching head lice from objects is remote. • A couple of drops of tea-tree or lavender oil added to conditioner or on a hair brush before brushing may deter lice from settling on the hair. Page 91

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