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
Presenter notes:
Head lice are small, wingless insects that live, breed and feed on the human scalp. They suck blood and usually cause itching. Head lice are most commonly found behind the ears and near the neckline (at the back of the neck) where the environment is warm and moist. Head lice reproduce by laying their eggs (known as nits) on the hair shaft close to the scalp. A female louse can lay up to 8 eggs a day in the hair, usually at night. It is important to tell concerned customers that head lice are not dangerous; they do not carry diseases, and do not affect other animals.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

4. Life cycle of a louse Presenter notes:
(egg)
Nit
(newly hatched)
Nymph
(Adult)
Louse
Presenter notes:
Head lice have three stages of development: nit (egg), nymph (young louse) and adult louse. Adult lice can live for up to 30 days. Their life cycle must be completed on the human head.
The egg is referred to as the ‘nit’. The nit is laid by the female louse, who attaches it to the hair strand with a strong glue (like cement). A nit is very small, about mm long. They are pale and whitish-yellow in colour. Nits take 7−10 days to hatch and require conditions of at least 30 °C and 70% humidity. This may explain why there seems to be more nits around in summer than in winter. Nymphs then take 9−15 days to grow into mature lice. They are often a lighter brown and are about 1−2 mm long.
Both male and female lice crawl through the hair. The female louse is looking for a place to lay her eggs. Female lice are larger than males and grow to be the size of a pinhead (about 2−3 mm long).
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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
Presenter notes:
Head lice can be a source of embarrassment (especially for parents), so you can have a role in reassuring customers that it is a common condition. Head lice are often falsely associated with poor hygiene and low socioeconomic status, however it is important to note that anyone with a head (and hair!) can get head lice. There is no correlation with hygiene (head lice like clean hair too) , and infestation is not a sign of poor parenting.
Head lice are most commonly found in primary school aged children (the reason for this will be clear once we discuss how head lice are transmitted), and tend to affect girls more than boys.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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.
Presenter notes:
Head lice are very contagious, and can spread quickly (especially amongst children). As head lice do not have wings or jumping legs, they CANNOT fly or jump from head to head. However, they can crawl up to 23 cm in a minute and will crawl from one head to another in seconds. Head lice are spread by head-to-head contact with another person who has head lice, e.g. when doing group work at school, playing, or hugging. Head lice are unable to move on smooth surfaces like plastic. For this reason, head lice are rarely found on combs and hairbrushes. However, head lice can be present on these objects for up to 24 hours after use by an infested person. For this reason, objects that have come into contact with head lice, should be sterilised and not used on a non-infested person for at least 24 hours.
Head lice must feed on human blood every 6 hours to replenish their water supply or they will die from dehydration. The longer the lice are away from a human head, the weaker they become and the less likely they are to infest the next person. Head lice do not live or breed on animals, bedding, furniture, carpets, clothes or soft toys. However, they can lay eggs on most fabrics they come in contact with, and 50% of these eggs hatch. So washing of hats, clothes and bed linen is advised during a head lice infestation. Wash these items in hot water (at least 60 °C) or put them in a clothes dryer (hot or warm setting) for 10 minutes.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

7. Symptoms of infestation
Itchy scalp
Sensation of something moving in hair
Red sores on the scalp cause by scratching
Presenter notes:
The most obvious signs of head lice are:
Scalp itchiness – caused by allergic reaction to louse saliva and faeces. Itchiness can take weeks to develop. If you have had head lice more than once, the skin may become de-sensitised and there may be little or no itch.
Sensation of something moving in the hair - this can also result in itchiness.
Red sores on the scalp caused by scratching – vigorous scratching of the scalp, particularly at night, can cause skin lesions.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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
Presenter notes:
Commonly a customer will come into the pharmacy if they suspect their child has head lice. It is important to advise them to check for lice before they begin treatment. The best way to confirm infestation is to have a good look!
Always check for head lice in dry hair first. This involves looking through the hair at the scalp by parting the hair and looking particularly behind the ears, at the nape of the neck and under fringes. If there are numerous head lice they will be visible. However, it is not always possible to see head lice in dry hair due to the speed at which head lice can move.
The “conditioner and comb” method can also be used to detect head lice. We will discuss this method in the following slide.
You may also need to use a magnifying glass to check the hair for nits as eggs are ‘glued’ onto the hair shaft and usually cannot be removed by simply combing the hair. They look like small balls of white glue stuck to the hair strand. Remember to examine the hair close to the scalp particularly behind the ears and at the nape of the neck. Eggs can be harder to see in blond hair because of their whitish yellow colour. Only eggs found close to the scalp are live and indicate a active infestation. Eggs found more than 1 cm from the scalp are dead or hatched.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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
Presenter notes:
The conditioner and comb method can make it easier to detect live lice.
Apply conditioner to dry, brushed hair
Divide hair into 3-4 cm sections, and comb each section using a fine tooth “nit” comb
Metal combs with round teeth are best for removing lice and eggs
After each stroke wipe comb with tissue or paper towel, and look for live lice and eggs on the comb and towel
Eggs are often found behind the ears and at the back of the neck
Lice are more common at the crown of the head
Young lice (nymphs) can be difficult to identify with the naked eye, but appear as small insects on the tissue/paper towel
Comb each section several times until no further lice or eggs are found
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

10. Head lice treatments
Only treat if sign of active infestation are found
Several treatment methods available
Insecticide treatments
Herbal products
Physical methods
Presenter notes:
Only people with confirmed active head lice should be treated.
There are three methods:
Insecticide preparation- a product that kills insects including lice.
Herbal preparation- a natural product that kills lice.
Physical methods - remove lice and eggs from the hair and scalp.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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 days
Presenter notes:
There are several different topical insecticides used to treat head lice, Pyrethrin, Permethrin and Maldison. Each is available in a range of shampoos, foams and lotions.
The directions for use vary between products, so it is important advise the customer to check the instruction on the package. As a general guide contact time for shampoos and foams is minutes, whilst lotions should be left on overnight.
Adverse effects are rare, but contact dermatitis or anaphylactic reaction may occur.
Medical advice is required before use in children <2 years of ages or pregnant or breastfeeding women, always refer these customers to the pharmacist.
No insecticide is 100% effective at killing eggs or “nits”, therefore retreatment is necessary after 7-10 days to kill newly hatched lice.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

12. How to apply a head lice treatment
- Shampoo to wet hair
-Lotion to dry hair
Apply product
Massage well, ensuring every hair is coated
Leave product in the hair for the recommended time
Comb hair well with a fine tooth “nit” comb
Repeat treatment in 7 days
Check hair daily .
Presenter notes:
It is important to apply treatments for head lice correctly to allow them to work most effectively. This is an overall summary of how to apply a head lice treatment. Always read the specific product directions before applying and check with your pharmacist.
Head lice live in the hair and come down to the scalp for food, so head lice formulations must be applied to all parts of the hair. Apply the treatment formulation near the scalp and then use an ordinary comb to coat the hair shaft from root to tip. This is especially important for long hair. If any product is left on the comb after one sweep, it should be wiped onto the same or a new area of hair at the base and the process repeated. Do this several times to get even coverage of all hair on the person’s head.
If you are using a lotion, apply the product to dry hair.
If using a shampoo, wet the hair, but use the least amount of water possible as hair absorbs water and too much water will dilute the insecticide treatment.
Massage well into the hair as lice can escape by lodging in an air bubble.
Leave the preparation on the hair for the time recommended on the label, then wash out.
Section the hair again and comb through with a metal fine-tooth ‘nit’ comb to remove dead lice and eggs.
Check that the head lice are actually dead. Do this straight after the recommended treatment time and again the next morning. It may take a few hours for all the lice to die. Leave the hair to dry naturally rather than using a hair dryer as heat may affect how the chemical works. If dead lice are found, the product has worked. However, if any head lice are found still alive the next morning, re-treat the hair that very day with another type of insecticide, not a different brand of the same type of insecticide.
Not all unhatched eggs will be killed by this treatment so always treat again 7−10 days after the first treatment. Repeating the treatment is necessary to kill any lice that hatched after the first treatment, before they start laying eggs. You can use the same brand of head lice treatment that worked the first time.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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
Presenter notes
The WHAT STOP GO protocol should be used before supplying any pharmacy medicine head lice product.1
WHAT – Determine what is wrong, and assess the customers current medicines and health status
Who is the patient?
Requests for children <2 years of age or women who are pregnant or breastfeeding should be referred to the pharmacist.
How long have the head lice been present?
It is likely that the customer will not know precisely when infestation occurred, but this question can also prompt customers to mention frequent infestations that may indicate treatment failure. Persistent infestations should be referred to the pharmacist.
Actual Symptoms?
Has the patient been complaining of an itchy scalp?
Have live lice or eggs been detected? Only patients with live lice or eggs should be treated. If unconfirmed infestation, advise customer on detection method such as “Conditioner and Comb”
Treatment for this or other conditions?
Has a head lice treatment already been used? How long ago? All insecticide products require retreatment after 7-10 days. Recent treatment failure should be referred to pharmacist.
Did the patient experience any adverse reaction to treatment? Patients with previous adverse reaction should be referred to the pharmacist.
Could symptoms be due to another condition such as dandruff or eczema?
STOP – assess the situation
Symptoms or side effects of other conditions or medications?
Itching can persist for several days following head lice treatment, and does not always indicate treatment failure.
Totally sure – and special circumstances?
Could the itching be due to dandruff, Eczema, or irritation from a head lice product?
Refer customers who are pregnant or breastfeeding.
Refer children < 2 years of age.
Refer if you are unsure which product to recommend.
Overuse/abuse – how long has the patient been taking medicine?
Persistent infestation may indicate treatment failure, customers should be referred to the pharmacist.
Pharmacist only?
Head lice treatments are pharmacy medicines so referral to the pharmacist is not always required. The customer should be asked if they would like to speak with the pharmacist about treatment.
GO – supply medicine if appropriate and provide advice
Ask the patient if they have any further questions.
Would they like a CMI?
Provide advice on how to use the product, and measures to prevent reinfestation.
When asking the customer questions, it is important to use open questions, that encourage customers to provide further information. Open questions also help to prevent customers feeling interrogated.
For example, instead of ”Have you used this product before“ for which they might just respond “yes” , you could ask “How well has this product worked for you in the past?” This is less confrontational, and also encourages the customer mention previous treatment failure, potential adverse reactions etc.
For some questions, a straightforward yes/no is appropriate as a starting point, e.g. Do you have any allergies? You can then probe further information if required.
When asking a customer a question it can also be useful to prompt them in order to obtain the accurate information. For example when asking “Do you use any other medicines?”, it is important to remind them of any OTC, creams or herbal medicines, as they might forget to mention non-prescription items.
Reference:
1. Standards for the provision of Pharmacy Medicine and Pharmacist Only Medicines in Community Pharmacy. Version 3. Pharmaceutical Society of Australia

14. Insecticides- CARER C – CHECK R – RESPOND E – EXPLAIN A – ASSESS
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
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
Presenter notes:
The CARER protocol should be used before supplying any head lice product.1
CHECK
Who is the patient? – child <2, pregnant or breastfeeding? – REFER
What are the symptoms? – have live lice or eggs been detected? – If no, recommend detecting method such as “conditioner and comb”, and only treat if infestation confirmed.
What has been tried? – Recent treatment failure or Adverse reaction? – REFER
Does the patient take any other medicines? If yes, could they be the cause of symptoms (itching?) – REFER
How long have symptoms been present? – Persistent infestations may indicate treatment failure? – REFER
Does the patient have any other conditions? Could dandruff or eczema be the cause of symptoms? – REFER
ASSESS
- Is the diagnosis clear? – If live lice or eggs not detected in conditioner and combing – REFER
Is medication therapy most appropriate? – Consider physical removal methods for low infestation (<5 lice) or suspected treatment resistance.
Are there any possible interactions with other therapy? If yes – REFER
Are you trained and confident you know how to proceed? If unsure which product to recommend – REFER
RESPOND
Recommend therapy if appropriate
Refer to pharmacist if uncertain
Reconsider if medicine is not appropriate – What other options care available to manage infestation?
EXPLAIN
Give verbal instructions on how to use product
Give written product information if required or requested
Educate patient about how to proceed if head lice persists, and advise on measure to prevent reinfestation.
RECORD
Record supply if required
Make a record of any actions, i.e. Ongoing care or referral
Record if abuse or misuse suspected- REFER frequent requests
When asking the customer questions, it is important to use open questions, that encourage customers to provide further information. Open questions also help to prevent customers feeling interrogated.
For example, instead of ”What are you using this product for? “ for which they might just respond “pain” , you could ask “Can you describe your symptoms for me?” This is less confrontational, and also encourages the customer to think about and elaborate on their condition, i.e. Type of pain, location or pain and other concurrent symptoms such as fever.
For some questions, a straightforward yes/no is appropriate as a starting point, e.g. Do you have any allergies? You can then probe further information if required.
When asking a customer a question it can also be useful to prompt them in order to obtain the accurate information. For example when asking “Do you use any other medicines?”, it is important to remind them of any OTC, creams or herbal medicines, as they might forget to mention non-prescription items.
Reference:
1. Standards for the provision of Pharmacy Medicine and Pharmacist Only Medicines in Community Pharmacy. Version 3. Pharmaceutical Society of Australia

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
Presenter notes:
Successful eradication of head lice can be difficult. You can have an important role in educating customers and increasing the likelihood of treatment success. The following points should be discussed with customers before treatment.
Do not treat unless active infestation is confirmed
Preventative treatment is inappropriate and may contribute to the development of resistance
Always check the directions on the label before use
Application instructions and contact times vary between products
Ensure bedding, clothing, brushes etc are treated with heat
Eggs may survive on objects and contribute to treatment failure
Always retreat in 7-10 days
To ensure any newly hatched lice are eliminated
In between treatment use the “conditioner and comb” method to remove eggs
Itching may persist for several days after lice have been eliminated, so may not indicate treatment failure
Confirm continued infestation before second round of treatment
Consult the pharmacist if there is a history of adverse reaction
Insecticides may be similar, so cross reaction may occur between products.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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
Presenter notes:
Some customers are hesitant to use chemical treatments on their children, and so may be interested in natural alternatives. There are more than 20 herbal head lice treatments available in Australia, most contain combinations of tea tree, eucalyptus, lavender and rosemary oils. There is no conclusive scientific evidence to support the use of most of these products. Only one product, MOOV Head Lice Solution has been shown to be effective in scientific studies. However it is necessary to retreat TWICE after 7 and 14 days, as it does not kill eggs.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

17. Physical methods “Conditioner and Comb” method Heat
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
Presenter notes:
A number of physical methods can be used to treat head lice. Along with herbal products, physical methods are commonly used by customers who want to avoid using chemicals on their children. They can be time consuming and have varying levels of success. Using physical methods in combination with head lice products may increase the likelihood of successful eradication.
Conditioner and Comb
Recommended as a method of detection, but may be used as a treatment method if less than 5 lice are found on initial inspection.
Involves removing lice and eggs by combing conditioned hair
Repeat every 2nd day until no lice are found for 10 consecutive days
Reported success rate ~40%
Heat
Involves apply heat to small sections of hair with hairdryer
Each section should be dried for 1-3 minutes
Care required to avoid burning scalp, neck and ears
More effective at killing eggs than live lice.
Electronic Combs
RobiComb electrocutes live lice, but does not kill eggs
Should be used every day for at least 2 weeks
Not suitable for children under 3 years of age
Licetec Opticomb sweeps lice and eggs into a capture compartment where they are trapped on an adhesive strip
Suffocating Agents
Mayonnaise, Olive oil, petroleum jelly are applied to the scalp to suffocate lice
No information available on efficacy
Kerosene must not be used as it is toxic and highly flammable
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

18. Treatment Failure Inadequate application Failure to re-treat
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
Presenter notes:
There are a number possible reasons treatment may be unsuccessful. It is important to discuss with the customer how they used the product to help identify the cause of treatment failure, and ensure subsequent treatment is successful.
Inadequate application
Incorrect use of products may result in treatment failure, and can contribute to the development of resistance. As products may have different directions for use, it is important to read the instruction on the package before beginning treatment. Always ensure every hair is coated (coverage can be improved by combing the product through the hair) and that the product is left on for the correct amount of time.
Failure to retreat
No head lice treatment is 100% effective at killing eggs or “nits”. Therefore a second application is needed 7-10 days after the initial treatment to kill any newly hatched lice. Failure to retreat will result in ongoing infestation.
Insecticide resistance
Resistance to topical insecticides is becoming more common. Resistance usually results from ineffective or sub-therapeutic treatment. For this reason, head lice treatment should not be used to prevent infestations, only to treat confirmed cases of active head lice. If treatment failure occurs after proper application, resistance should be suspected. Customers should retreat with a different product. If resistance recurs, physical treatment methods can be used. Reinfestation
As head lice is highly contagious, reinfestation is common when there is contact with another infested person. This is can be a problem amongst school children if one or more children are not adequate treated, and can make head lice hard to manage. Occasionally reinfestation may occur if bedding and clothing are not adequately treated (will be discuss this shortly), but this is less common.
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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
Presenter notes:
In certain circumstances customers need to be referred to the pharmacist for appropriate management.
Children under 2 years of age
Chemical treatments and electronic lice combs no recommended without medical advice
Pregnant or breastfeeding women
Conflicting advice exists on appropriate treatment, professional judgement of the pharmacist is required
People with asthma, skin rashes or allergies
People with history of asthma, rashes or allergies may be at increased risk of contact dermatitis
People with previous adverse reaction to treatment
Cross sensitivity may occur between products
Persistence infestations despite appropriate treatment
People with symptoms but no confirmed diagnosis
Severe infestations
Eyelash infestations
Chemical products not suitable for use near eyes, therefore special management required
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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
Presenter notes:
As head lice are highly contagious, vigilance is required to prevent 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
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

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?
Presenter notes:
How should you respond to Mrs Smith’s request for KP 24 shampoo?
Mrs Smith should be reassured that head lice is common in school aged children, and is nothing to be embarrassed about.
It is important to establish that Mrs Smith has confirmed Sarah has an active infestation, by detecting a live louse or eggs close to the scalp. Often parents come into the pharmacy to buy head lice treatments when outbreaks occur at there children’s school, but it is important to only treat children with active infestations.
If Mrs Smith has confirmed the presence of lice or eggs, KP 24 solution can be used to treat Sarah’s head lice.
However KP 24 shampoo is not suitable for James as he is less than 2 years of age. If active infestation has been confirmed, you should refer Mrs Smith to the pharmacist to discuss treatment options.
What concerns might you have about the frequency of Sarah’s head lice
As this is the third time Sarah has had head lice this year, is important to establish the cause of treatment failure. Mrs Smith should be asked how she has used the product in the past, to eliminate the possibility of inadequate treatment.
KP 24 shampoo should be applied to dry hair for 30 minutes.
Mrs Smith should comb the shampoo through the hair to ensure the every hair is coated.
Retreatment is necessary after 7-10 days to kill any newly hatched eggs.
If she has followed directions, resistance or reinfestation should be considered.
What advice can you give Mrs Smith about preventing reinfestation?
Mrs Smith should check the hair of everyone in the family, and treat anyone with confirmed head lice appropriately.
Mrs Smith should be advised to treat all bedding, clothing, towels and brushes/hair accessories with hot water (>60ºC)
Sarah’s school should be informed, so the parents of other children can check for infestation.
Mrs Smith should try to keep Sarah’s hair tied back, and she should tell Sarah not to share her hats, scarfs, brushes or hair accessories with other children.
Mrs Smith should also check Sarah’s hair weekly for head lice, and more frequently during any outbreak at school.

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
Presenter notes:
Reference:
Gould L. InPHARMation-Head lice. Canberra (ACT):The Pharmaceutical Society of Australia; 2010

23. Further reading Head Lice (Victorian Government)
pages/Head_lice_treatment_and_control?OpenDocume nt
Head Lice Fact Sheet (WA Government)
Head Lice (Qld Government)
s/Parasites/headLice_fs.asp
Slide message
Here are some useful websites you could visit for more information which can provide further information about treating and managing head lice. 23 23