The first step is to identify the people who may be affected. Often there is an outbreak in children involving a class at school or in a family.
Handling hats, clothing and bed linen:
(1) Wash in soap and water.
(2) Heat treat (60°C for 40 minutes, 70°C for 30 minutes, ironing). Freezing may also be effective.
(3) Treat with an insecticide powder if control is a problem.
Treating the affected person:
(1) Bathe regularly with soap and water.
(2) Comb the hair carefully with a nit comb.
(3) Apply shampoo or lotion containing an insecticide.
(4) Change bedding and clothing regularly.
(5) Maintain surveillance.
An affected group of people should all be treated at the same time. Reinfection occurs if someone is not treated.
Head shaving is not recommended unless all other control measures fail.
Vaseline can be effective for control if the hair is short.
The parents may be distraught and require repeated reassurance, especially if the infestation is persistent or recurrent.
Insecticide resistance can be a problem with head lice. The lice should be tested for sensitivity to the insecticide if resistance is a problem in the community.
Insecticides:
(1) pyrethrin (natural) or pyrethroids (synthetic) - permethrin, others
(2) malathion (organophosphate)
(3) ivermectin (with retreatment in 1-2 weeks to kill any hatchlings)
Potentially toxic or hazardous insecticides that are avoided in children:
(1) lindane
(2) DDT
(3) carbaryl
(4) kerosene (risk of fire and burns)
