SCOTTSDALE, Ariz.--Aug. 31, 2000--Just in time for the back-to-school season, Contemporary Pediatrics has published new guidelines for the treatment of resistant head lice in a supplement to its August issue.
The guidelines emerged from a working group conference held at the Harvard School of Public Health. Members of the conference included physicians, entomologists and representatives from the Centers for Disease Control and Prevention (CDC), the National Association of School Nurses, American Pharmaceutical Association, the National Association of County and City Health Officials and the Association of State and Territorial Health Officials.
The long-awaited treatment guidelines may help health care professionals and parents cope with the problem of head louse infestations. More than six million children are infested with head lice each year. Diagnoses of infestation peak during the back-to-school season.
"Based on research data, some head lice have become resistant to certain treatments," says Richard J. Pollack, Ph.D., entomologist at the Harvard School of Public Health. "The growing incidence of resistance in the United States may be attributed to misdiagnosis and misuse or inappropriate use of treatments. Following a consistent approach to treatment, which incorporates parent education, may help decrease the problem of resistance and ease parent anxiety."
Ronald C. Hansen, M.D., at the University of Arizona Health Sciences Center agrees that lice phobia may be fueling the resistance issue. "In an effort to get their children back to school sooner, parents have been known to treat their children before obtaining an accurate diagnosis," notes Dr. Hansen.
The new guidelines follow a simple approach to treatment:
1. Parents should not diagnose head louse infestations themselves. Health care professionals must confirm the diagnosis to differentiate louse infestation from conditions that may mimic it, such as eczema, dermatitis or psoriasis. Dandruff, dry hair gel, scabs, dirt or even insects that have blown into the hair are other common false positive diagnoses.
2. If a diagnosis has been confirmed, the first line of treatment is the use of an FDA-approved, over-the-counter (OTC) product. Parents should follow directions carefully to reduce the potential for product misuse or injury.
3. A second treatment using the same OTC formulation is recommended 8-10 days later to ensure that all surviving lice eggs (or nits) are killed after hatching. A health care professional should confirm if treatment was successful in eliminating the infestation.
4. If live lice are present after two OTC treatments, the panel advises using a prescription product as second-line therapy. The panel members' recommendation is the use of pharmaceutical-grade of malathion, the active ingredient in OVIDE(R) (malathion) Lotion, 0.5%.
In addition to following directions for treatment, panel members suggest the use of a metal nit comb to remove dead lice and nits.
The guidelines also address the following issues:
-- Spraying of furniture, sealing stuffed animals in plastic bags for weeks and excessive housecleaning efforts are unnecessary because lice do not typically live off their human host for more than a day. However, routine cleaning of recently used items is recommended. -- School "no-nit" policies are not in the best interest of children, families or schools. "No-nit" policies dictate that louse-infested children may not return to the classroom until they are free of lice and nits. -- Alternative therapies, such as the use of olive oil, mineral oil or mayonnaise, should be avoided because they have not been adequately studied. Gasoline, kerosene or industrial-grade pesticides should never be used.
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Hansen RC, Brogdon WG, Dillenberg J, et al. Guidelines for the treatment of resistant pediculosis. Contemp Ped 2000; (suppl):1-10; sponsored by an educational grant from MEDICIS, The Dermatology Company.(R)
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