Head Lice: Diagnosis and Therapy

Gabriel J. Martinez-Diaz, MD; Anthony J. Mancini, MD


Dermatology Nursing 

In This Article

Patient Education

Since head lice are transmitted primarily person-to-person, avoidance of head-to-head contact is important. In addition, combs, brushes, hats, and other headgear can also transmit lice, so sharing of these items should be strongly discouraged, especially in places where close contact is likely, such as schools, camps, and daycare centers. Hair grooming items used by an infested person, if not discarded, should be de-infested by soaking them in hot water (of at least 130° F) for 5–10 minutes. Washable clothing and linens should be laundered with a minimum water temperature of 50° C or with a dry cycle for at least 40 minutes (West, 2004). Items that are not washable, such as stuffed animals, should be sealed in plastic bags for 2 weeks or dry cleaned. Upholstered furniture can be vacuumed. Fumigation of the household is not necessary, and these products can be toxic if inhaled or absorbed through the skin (AAP, 2009; CDC, 2008).

Children identified as having head lice should be referred for treatment and excluded from school only until the recommended treatment has been completed. According to the Committee on Infectious Diseases of the American Academy of Pediatrics, "no-nit" policies, whereby schools and child-care institutions require children be free of nits before they return, have not been effective in controlling pediculosis capitis transmission and are not recommended (AAP, 2009) Additionally, children should not be excluded or sent home early from school because of head lice. Instead, parents should be notified of the infestation and requested to have their child treated before returning to school on the day after treatment (AAP, 2009). School contacts should not be treated prophylactically, but should be notified and evaluated for infestation. Caregivers who have prolonged skin-to-skin contact with students infested with lice, though, may benefit from prophylactic treatment (CDC, 2008).


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