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Claire McCarthy, MD |
Head lice are incredibly common, with millions of infestations in the United States every year—and hundreds of millions of dollars spent in treatment. For the most part, the diagnosis and treatment of head lice happens outside the doctor's office. Parents, school nurses and other lay people make the diagnosis, and treatment that is usually effective is available over the counter.
Mostly, this is fineóbut the American Academy of Pediatrics (AAP) is concerned that some children are being misdiagnosed or overdiagnosed, and that treatments may be used inappropriately or incorrectly. To that end, they recently issued a clinical report on head lice, and encouraged pediatricians to get more involved in the diagnosis and treatment of this problem. Highlights of the report include:
The gold standard of diagnosis is spotting an actual live louse on the head (using a good lice comb can help). Too often, people mistake dandruff or debris for nits (lice eggs). Also, nits found more than 1 cm out from the scalp are likely to be hatched and dead, and are not necessarily an indication of an active infestation.
The AAP disagrees with the "No-Nit" policies held by many schools. Many children with nits don't actually have an active infestation—and even if they do, lice are not as contagious as people think.
Families often turn to home remedies, such as applying petroleum jelly or olive oil to the hair; there is no good evidence that any of these remedies work, and some (such as applying gasoline) can be dangerous.
The AAP recommends using over-the-counter permethrin (1 percent cream rinse, not 5 percent lotion) or pyrethrins as a first-line treatment. To use properly:
Shampoo first, using a shampoo without conditioner, and then follow package instructions carefully. Rinse out over a sink rather than in the tub or shower, so as not to expose other skin surfaces.
Repeat the treatment in seven to 10 days
Environmental measures are important, but don't have to be extensive.
Launder bedding, hats and clothing that touches the head in hot water (wash combs and brushes in hot water, too); put items that cannot be washed in the dryer or in a plastic bag for two weeks. Don't use furniture sprays; vacuuming is adequate.
Malathion 0.5 percent is a viable option when there is documented resistance or there is treatment failure of permethrin or pyrethrins with correct use.
— Claire McCarthy, MD, medical director of
Children's Hospital Boston's Martha Eliot Health Center
More information: See the report
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