Head Lice

Presentation

• Often asymptomatic, although lice or nits (eggs) may be noticed during grooming or regular checks.

• Itching can occur, particularly around the occipital area and nape of the neck.

• Secondary bacterial infection (impetigo) may develop if scratching breaks the skin.

Diagnosis

• Confirm by finding live lice; best done via wet combing method:

  • Apply conditioner to damp hair

  • Use a fine-toothed comb to systematically comb sections, trapping lice on the comb

• Regular checks recommended in high-risk settings (e.g. schools, daycare centres).

Management

Non-Pharmacological

• Wet Combing:

  • Continue between treatments (e.g. every 2–3 days) to remove newly hatched lice.

• Wash Bedding, towels, hats in hot water (60°C) or seal in plastic bag for ~2 weeks to reduce re-infestation risk.

• Inspect/Treat Close Contacts: Household members, friends with close contact.

• School Notification: If live lice are found, the school should be informed. However, the child may return to school after the first proper treatment.

Pharmacological

• First-Line Treatments:

  1. Maldison 0.5% lotion

     • Apply for 8 hours (overnight), repeat on day 7.

     • Not recommended for infants <6 months (lack of data).

  2. Maldison 1% lotion

     • Apply for 30 minutes, repeat on day 7.

     • Not for <6 months.

  3. Permethrin 1% lotion

     • Apply for 10 minutes, repeat on day 7.

  4. Pyrethrins 0.165% + Piperonyl butoxide 1.65% lotion

     • Apply for 10 minutes, repeat on day 7.

• Treatment Failure:

  • Switch to an alternative topical agent.

  • Resistant Cases: Oral ivermectin 200 mcg/kg, repeat day 7 (consult product guidelines for age/weight restrictions).

Notes

• Follow instructions carefully for each topical product, as application time and re-treatment intervals can vary.

• Comb through hair after treatment to remove eggs/nits and check treatment efficacy.

• Reinfection often occurs if close contacts are not treated simultaneously or if bedding/clothes are not managed appropriately.