The Child With Pediculosis Capitis

Robert J. Yetman, MD

Disclosures

J Pediatr Health Care. 2015;29(1):118-120. 

In This Article

Management

  • Many patients' diagnoses are made by a school nurse, parent, or caregiver, and others are made by another health care provider. Often a first-line, appropriately applied over-the-counter remedy is attempted in geographic areas with a low incidence of lice resistance. Unfortunately, the areas of "low resistance" are unknown, and generally high rates of resistance across the United States make the effectiveness of these over-the-counter medications highly suspect. In many areas of the United States, prescription medications are first-line therapies.

  • Over-the-counter options

    • Permethrin (Nix; CDC, 2013)

      • Approved for use in children older than 2 months

      • Application time is 10 minutes; retreatment in 14 days is recommended if new lice are seen

    • Pyrethrins with piperonyl butoxide (Rid; CDC, 2013)

      • For use in children older than 2 years

      • Application time is 10 minutes; retreatment is 7 to 10 days is required

        • Prescription options

    • Lindane 1% shampoo (Lindane, 2014)

      • To be used with caution in children who weigh less than 50 kg (110 lb)

      • Application time is 4 minutes; no retreatment is recommended

    • Malathion 0.5% lotion (Ovide; TaroPharma, 2011)

      • No safety data in children younger than 6 years

      • Application time is 8 to 12 hours with repeat treatment in 7 to 9 days if lice are present

    • Benzyl alcohol 5% lotion (Ulesfia; Concordia Pharmaceuticals, 2013)

      • Used in children 6 months and older

      • Application time is 10 minutes with retreatment after 7 days

    • Spinosad 0.9% (Natroba; ParaPRO LLC, 2011)

      • Approved for use in children older than 4 years

      • Application time is 10 minutes with retreatment in 7 days if lice are present

    • Ivermectin 0.5 lotion (Sklice; Sanofi Pasteur, 2012)

      • Approved for use in children 6 months and older

      • Application time is 10 minutes; retreatment is not recommended

  • Home remedies, the value of which have not been systematically evaluated

    • "Natural products"

      • Essential oils and plant extracts

      • Occlusive agents such as mayonnaise, petroleum jelly, tub margarine, or Cetaphil cleanser

      • Vinegar and vinegar-based products (Frankowski & Bocchini, 2010)

    • "Mechanical removal of nits and lice"

      • Demethicone gel (LiceMD, 2014), citric acid/isopropanol (Lycelle; Mission Pharmacal Company, 2011)

        • Does not kill lice or nits, but rather the mechanism of action is to allow easier removal of the nits and lice

      • Nitpicking salons

        • Usually a storefront location where the child with head lice is brought to have a franchise employee mechanically comb through the hair, identify each nit or louse, and remove it mechanically

        • Advertised as a natural approach to lice and nit removal that mechanically remove the live lice and nits

        • "Comb-out" process that might include application of natural oils and shampoos to hasten removal of nits, as well as controlled hot air applications to help identify live lice (Goats et al., 2006)

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