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Head Lice Treatment: Heading Off an Ancient Adversary Head Lice Treatment: Heading Off an Ancient Adversary Wendy L. Wright MS, RN, APRN, FNP, FAANP, FAAN American School @ASHAnews Health Association About ASHA • The only national organization dedicated to a coordinated, multidisciplinary approach to school health • ASHA membership • Administrators in health and education agencies at the local, state and federal levels • Health and education professionals in the PreK-12 school setting • Counselors, dieticians, nutritionists, health educators, physical educators, psychologists, school health coordinators, school nurses, school physicians, and social workers • Academics who conduct research that informs school health professionals • Journal of School Health (JOSH) Membership Benefits- Professional Level • 12 print and online issues of the Journal of School Health per year • Access to the School Health Listserv (CHEN) • Access to the weekly School Health Action e-newsletter • Discounts on the Annual School Health Conference • Free Continuing Education contact hours • Leadership opportunities to serve on the national board or as committee chairperson • Engagement opportunities to serve on various national committees www.ashaweb.org American School @ASHAnews Health Association Save the Date! • Administration, Coordination, and Leadership • Programs and Services • Research and Emerging Issues • Teaching and Learning The WSCC Framework The Whole School, Whole Community, Whole Child (WSCC) model requires us to take a systems-based approach to health promotion. Only when all members of the school and community work together can we address problems. Head Lice Treatment: Heading Off an Ancient Adversary Wendy L. Wright MS, RN, APRN, FNP, FAANP, FAAN American School @ASHAnews Health Association Centers for Disease Control and Prevention (CDC). Head Lice Treatment Heading Off an Ancient Adversary PP-SKL-US-0103 5/16 Presentation Outline I. Head Lice Are With Us II. Approaches to Head Lice Treatment III. The Role of HCPs in Head Lice Management IV. Educational Resources 2 Head Lice Are With Us “Lice occur wherever there are humans.”1 atology 1 CDC/Dr. DennisD. Juranek CDC/Dr. Reference: 1. Lice (pediculosis). In: Paller AS, Mancini AJ, eds. Hurwitz Clinical Pediatric Dermatology. A Textbook of Skin Disorders of Childhood and Adolescence. 4th ed. New York, NY: Elsevier Saunders; 2011:424-427. 3 Head Lice Infestation: A Common Pediatric Condition • Pediculosis is the most prevalent parasitic infestation among humans1 • Head lice infestations are pervasive among school-age children in the United States2,3 • ~6-12 million infestations occur each Photo Researchers year in children 3 to 11 years of age3 – More common in females4 • All socioeconomic groups are affected2,4 – Contrary to myth, “head lice prefer clean, healthy hosts”4 Getty Images/Peter Dazeley References: 1. Hodgdon HE, et al. Pest Manag Sci. 2010;66(9):1031-1040. 2. Devore CD, et al. Pediatrics. 2015;135(5):e1355-e1365. 3. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/parasites/lice/head/epi.html. Accessed April 29, 2016. 4. Meinking T, et al. Infestations. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1535-1583. 4 Pediculus Humanus Capitis: A Closer Look at the Critter1 • The adult louse is 2-3 mm long (size of a sesame seed) – Usually tan to grayish-white; color may vary (red when engorged with blood) • The louse feeds by injecting CDC. small amounts of saliva into the scalp and sucking tiny amounts of blood every few hours • Lice usually survive less than 1 day away from the scalp at room temperature Reference: 1. Devore CD, et al. Pediatrics. 2015;135(5):e1355-e1365. 5 The Life Cycle of the Head Louse1,2 Become adults Female lays first 9-12 days after egg 1 or 2 days hatching after mating 3 Lays ≤10 eggs per day Female lives 3-4 weeks Without treatment, the cycle may Eggs tightly repeat every attached to hair 3 weeks close to scalp 2 3 nymph Eggs hatch in stages 7-12 days 1 Illustration by Penumbra Design Inc. References: 1. Devore CD, et al. Pediatrics. 2015;135(5):e1355-e1365. 2. Meinking TL, et al. Infestations. In: Schachner LA, 6 Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1535-1583. Transmission: Think Head-to-Head • Transmission of lice typically occurs by direct head-to-head contact with an infested individual1,2 • Indirect spread via contact with personal items (combs, brushes, hats) is less 1,2 likely but can occur Getty Images/Westend61 • Itching is the most common symptom – It may take 4-6 weeks for itching to develop in someone infested for the first time1 • In those with previous episodes, itching may develop within 48 hours3 – Excoriation, crusting, secondary bacterial 1-3 infection may result from scratching Getty Images/Photodisc References: 1. Devore CD, et al. Pediatrics. 2015;135(5):e1355-e1365. 2. CDC. Head lice. http://www.cdc.gov/parasites/lice/head/epi.html. Accessed April 29, 2016. 3. Meinking TL, et al. Infestations. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1535-1583. 7 Careful Inspection Needed for Proper Diagnosis CDC/Dr. DennisD. Juranek. CDC/Dr. Unhatched egg of a head louse, firmly cemented to hair shaft. A 10-year-old girl complained of scalp pruritus for several weeks. Nits (within white circle) were visible on hairs above the ear. Note the brown scaly fecal material below the hair line (black circle). Photo © Bernard Cohen, MD. DermAtlas; http://www.dermatlas.org. 8 Nymphs, Nits, and Knowing What to Do • Definitive diagnosis is made by finding a live adult louse or nymph on the scalp or head1,2 • Eggs attached >1 cm from the scalp are usually non-viable1 – In some warmer climates, viable eggs may be found several inches from the scalp1,3 – Close inspection is needed1,2 • Nit casings with egg inside may be tan to coffee color or darker; white or yellowish shells are non-viable4 • Nits and eggs may be confused with dandruff, fibers, scabs, hair casts, droplets of hair spray, plugs of desquamated cells, 1,3,5 particles of dirt, or other insects References: 1. Devore CD, et al. Pediatrics. 2015;135(5):e1355-e1365. 2. CDC. http://www.cdc.gov/.parasites/lice/head/diagnosis.html. Accessed April 29, 2016. 3. Lice (pediculosis). In: Paller AS, Mancini AJ, eds. Hurwitz Clinical Pediatric Dermatology. A Textbook of Skin Disorders of Childhood and Adolescence, 4th ed. New York, NY: Elsevier Saunders; 2011:424-427. 4. Meinking TL, et al. Infestations. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. 4th ed. Mosby Elsevier; 2011:1535-1583. 5. American Academy of Pediatrics. Pediculosis capitis (head lice). In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:597-601. 9 Direct and Indirect Costs Associated with Head Lice Are High • Anecdotal reports from the 1990s estimated annual direct and indirect costs totaling $367 million, including consumer costs, lost wages, and school system expenses1 • Indirect costs include missed days from schools that use a “no nit” policy, lost wages for parents who must stay home with children, and costs of day care for parents who cannot miss work1,2 • Contributors to the expense of treating head lice include misdiagnosis leading to unneeded treatment; treatment failure due to misuse of pediculicides or other agents; and developing resistance, particularly to over-the-counter (OTC) pyrethroid agents1 • Twelve to 24 million school days are lost each year because of head lice3,4 • Some evidence suggests that parents treat an average of 5 times before seeking help from a health care professional5 References: 1. Hansen RC, et al. Clin Pediatr. 2004;43(6):523-527. 2. West DP. Am J Manag Care. 2004;10(suppl):S277-S282. 3. Price JH, et al. J Sch Health. 1999;69(4):153-158. 4. Sciscione P, et al. J Sch Nurs. 2007;23(1):13-20. 5. Meinking TL, et al. Arch Dermatol. 2002; 138(2): 220-224. 10 Approaches to Head Lice Treatment 11 Typical Treatment Paradigm for Head Lice1 Diagnosis: often by school nurse, parent, or caregiver 70% 30% of Households of Households Treat On Their Own Contact HCP • Availability and awareness of OTC products; limited parent knowledge, poor perception of Rx choices 46% are 54% receive a Immediate access to OTC • prescription for products (avoid delay in treating) instructed to try OTC first an OTC product Access to “trusted advisors”: • or traditional Rx school nurse or pharmacist Reference: 1. Arbor Pharmaceuticals. Data on file (ICR Research; Excel Omnibus Studies H8824-26, I8823), July 2009. 12 Treating Head Lice: Many Choices1,a OTC Prescription Nix®b (permethrin, 1%) Lindane Shampoo2,d 1% (recommended as second line treatment)d RID®c et al (pyrethrins with Ovide®e (malathion, 0.5% lotion) piperonyl butoxide) Other Ulesfia®f (benzyl alcohol, 5% lotion) Natroba®g (spinosad, 0.9% suspension) Sklice®h (ivermectin, 0.5% lotion) a For a review of treatment choices, see the American Academy of Pediatrics (AAP) 2015 clinical report.1 Please see Important Safety Information for Sklice on slide 33 b Nix® is a registered trademark of Insight Pharmaceuticals, LLC. c RID® is a registered trademark of Bayer HealthCare, LLC. d Lindane Shampoo is manufactured by Morton Grove Pharmaceuticals. Note: Lindane is currently recommended only as a second-line treatment.2 e Ovide® is a registered trademark of Taro Pharmaceuticals, U.S.A., Inc. f Ulesfia® Lotion is a registered trademark of Concordia Pharmaceuticals Inc. g Natroba® is a registered trademark of ParaPRO LLC. h Sklice Lotion is a registered trademark of Arbor Pharmaceuticals LLC. References: 1. Devore CD, et al. Pediatrics. 2015;135(5):e1355-e1365. 2. CDC. http://www.cdc.gov/parasites/lice/head/treatment.html.
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