Lice

Louse infestation remains a major problem throughout the world, making the diagnosis and treatment of louse infestation a common task in general medical practice.

Pediculosis capitis results in significant psychological stress in children and adults and missed schooldays in children, particularly in areas with a no-nit policy. Lice are ectoparasites that live on the body. Lice feed on human blood after piercing the skin and injecting saliva, which may cause pruritus due to an allergic reaction. Lice crawl but cannot fly or hop.

Causative organisms include P humanus capitis (head louse), P humanus corporis (body louse), and P pubis (pubic louse).

Treatment & Management

Treatment of pediculosis has 2 aspects: medication and environmental control measures. Increasing emphasis is being placed on understanding the life cycle of lice in order to provide effective treatment. Not all treatment preparations are ovicidal. For weakly ovicidal or non-ovicidal pediculicides, routine retreatment is recommended typically 7-9 days after the first treatment. For strongly ovicidal pediculicides, retreatment is recommended only if live (i.e., crawling) lice are still present after treatment.

Pediculosis capitis (Head lice)

• Li - Care / Scabfree (Permethrin) lotion or Malathion lotion on dry hairs (leave it for 8-12 hours). Then rinse thoroughly.
• Decontaminate combs, headwear and bedding (wash 2 60 ° C / 30 min, iron or dry in the sun or, if not feasible, seal in a plastic bag for 2 weeks).
• Treat those contacts with lice and / or live nits, not those with dead nits alone (dull, white, > 1 cm from scalp) as above.
• It is recommended to repeat the application after 10 days.
• Topical ivermectin 0.5 % lotion, benzyl alcohol 5 %, Oxyphthirine lotion, spinosad 0.9 % suspension, dimethicone, and abametapir 0.74 % lotion are additional agents that appear to have efficacy against pediculosis capitis; of these agents, topical ivermectin is the most effective.
• Other than topical Ivermectin, topical therapies should be repeated 7-9 days after the initial treatment.
• For involvement of eyelashes, petrolatum is applied thickly twice daily for 8 days , and remaining nits are then plucked off.

Topical Treatment

• Tab Ivermite (ivermectin) 6mg, 2 tablets PO x stat ( 200 mcg / kg ) , then after 7 days ( for children older than 5 years and more than 15 kg )
• Tab - Septran - DS (MP - SMZ, 10 mg TMP / kg / day and 50 mg SMZ / kg / day ) PO x BD for 10 days.
• All infested persons in a household, school, or other facility should ideally be treated at the same time.

Systemic treatment

• Body lice are treated by disposing of the infested clothing and addressing the patient's social situation.
• In case of Mass treatment (outbreak) Apply 30 to 60 g ( 2 to 4 heaped soup spoons ) of Mite - free ( permethrin ) powder to the inside of the clothes and underclothes in contact with the skin ( front and back , neck and waistline , sleeves and socks ) in a fully clothed patient , then rub in the powder by hand . Leave it as such for 12 to 24 hours.
• Repeat in 8 to 10 days if the infestation persists.

Pediculosis corporis (Body lice )

• Shave and / or apply Mite - free (permethrin 1 %) rinse to hairy areas (as for head lice) for 10 minutes ' OR ' permethrin cream 5 % for 8 hours.
• Sexual contacts should be treated.
• Clothes and bedclothes should be washed and dried at high temperature.

Note: Treatment of secondary bacterial infection , if present , should begin 24 to 48 hours before local anti - parasitic treatment , local treatment is applied later when tolerated .