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Taking a closer look at pediculosis capitis
By Susan Simmons, PhD, RN, APRN-BC
THE HEAD LOUSE (Pediculus humanus capitis) is a tiny, wingless parasitic insect that feeds on human blood.1,2 It’s one of three varieties of lice that are parasitic for humans.2 An infestation of head lice, called pediculosis capitis, is common worldwide and can lead to psychological stress in children and adults as well as missed days of school for children.1 This article provides an overview of pediculosis capitis and how it spreads, treatment options, and prevention measures. Looking at head lice A head louse is a gray-white insect about 3 to 5 mm in length. (See Head louse close up.) The female, with a lifespan of 30 days, is slightly longer than the male and lays 7 to 10 eggs, called nits, per day.2 Nits are less than 1 mm long.1 They hatch in 8 days, releasing nymphs that reach maturity in another 8 days. After hatching,
the nits become whiter and more visible. Adult lice feed on the scalp and adjacent areas of the face and neck. They don’t jump, fly, or use pets as vectors and can survive up to 55 hours without a host.2 Head lice are primarily spread via direct contact with the head of a person with pediculosis capitis. The degree to which indirect contact with an infested individual’s personal items contributes to the spread of head lice is controversial and needs additional study.2 Anyone can get pediculosis capitis, but children ages 3 to 11 are most commonly affected.1 Most lice infestations are asymptomatic, but itching of the scalp, neck, and ears may occur as an allergic reaction to lice saliva that’s injected while feeding. Enlarged cervical and nuchal lymph nodes as well as febrile episodes from a secondary staphylococcal infection may occur.2 June l Nursing2015 l 57
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Diagnosing pediculosis capitis An infestation of head lice can be diagnosed after a louse is found in the hair or on the scalp. Combing wet or dry hair with a fine-toothed nit comb aids in visualization. A lubricant such as hair conditioner is used to wet the hair before combing in both wet and dry hair. The hair is brushed or combed first to remove tangles, and the comb is placed near the crown of the head until it gently touches the scalp and drawn firmly down and systematically examined for lice after each stroke. This should be repeated at least once.2 A Wood’s lamp, which uses UV light, can be used to look closely at the skin and hair. It changes the color of the nits to a pale blue. Finding many nits within ¼ inch (6.5 mm) of the scalp indicates active infestation.2 Treatment options Head lice can be treated with pyrethroids, over-the-counter (OTC) pediculicide shampoos containing pyrethrin or permethrin.3 Other options if these treatments don’t work include malathion, benzyl alcohol, spinosad, and topical ivermectin.2 Many pediculicides are neurotoxic, so teach patients
(or their parents) to check age limitations on product labels and follow directions carefully. Women who are pregnant or breastfeeding should consult their healthcare provider before applying any treatment.3 To ensure success, repeat the treatment in 7 to 10 days as directed because resistance patterns have led to reduced ovicidal activity of pyrethoids.3 Tell patients that using conditioners on the hair before treatment with a pediculicide may reduce its effectiveness by preventing it from adhering to the hair shaft and scalp.2 Instruct them to contact their healthcare provider if they develop febrile episodes related to secondary staphylococcal infection or if an OTC product fails to eliminate the infestation.2 Because resistance to insecticides can vary according to geographic location, prescription treatment may be needed. Treatment also includes decontamination of clothing, bedding, towels, stuffed animals, and all personal items by washing them in hot, soapy water that’s at least 130˚ F (54 ˚ C) or drying on high heat for a minimum of 20 minutes. Combs and brushes should be soaked in rubbing alcohol for 1 hour.3 Nonwashable items such as pillows can be put in an airtight bag for
Head louse close up
a minimum of 2 weeks. Furniture should be covered in a nonbreathable material such as a plastic painter’s drop cloth for at least 2 weeks. If young children or animals are in the house and plastic is a choking hazard, place a cloth covering securely in place over the plastic, or vacuum frequently and thoroughly.3 Prevention measures Preventing pediculosis capitis can be difficult in school and daycare settings where close contact among the children is inevitable. The American Academy of Pediatrics has determined that children don’t need to be removed from class if pediculosis capitis is identified because the infestation has likely already been present for a month or more by the time of diagnosis. Nits may continue to be found for up to 2 weeks. Educate children to avoid direct contact with other children.4 In recent years, OTC products claiming to prevent lice infestation have been marketed, but research is currently lacking on their safety and effectiveness. Pesky problem Patient education is key in preventing pediculosis capitis. Remind patients that they can take measures to help prevent the spread of these pesky parasites—and effective treatment options are available if those measures don’t work. ■ REFERENCES 1. Guenther LCC. Pediculosis and pthiriasis (lice infestation). Medscape. 2015. http://emedicine. medscape.com/article/225013-overview. 2. Goldstein AO, Goldstein BG. Pediculosis capitis. UpToDate. 2015. http://www.uptodate.com. 3. Mayo Clinic. Lice. 2012. http://www.mayoclinic. org/diseases-conditions/lice/basics/definition/ con-20021627.
ARLINDO /iSTOCK
4. Frankowski B, Bocchini J. Clinical report—head lice. Am Acad Pediatrics. 2010;126(2):382-403. Susan Simmons is an NP at College Park Family Care Center in Overland Park, Kan. The author has disclosed that she has no financial relationships related to this article. DOI-10.1097/01.NURSE.0000464986.00187.3a
58 l Nursing2015 l June
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Taking a closer look at pediculosis capitis
By Susan Simmons, PhD, RN, APRN-BC
THE HEAD LOUSE (Pediculus humanus capitis) is a tiny, wingless parasitic insect that feeds on human blood.1,2 It’s one of three varieties of lice that are parasitic for humans.2 An infestation of head lice, called pediculosis capitis, is common worldwide and can lead to psychological stress in children and adults as well as missed days of school for children.1 This article provides an overview of pediculosis capitis and how it spreads, treatment options, and prevention measures. Looking at head lice A head louse is a gray-white insect about 3 to 5 mm in length. (See Head louse close up.) The female, with a lifespan of 30 days, is slightly longer than the male and lays 7 to 10 eggs, called nits, per day.2 Nits are less than 1 mm long.1 They hatch in 8 days, releasing nymphs that reach maturity in another 8 days. After hatching,
the nits become whiter and more visible. Adult lice feed on the scalp and adjacent areas of the face and neck. They don’t jump, fly, or use pets as vectors and can survive up to 55 hours without a host.2 Head lice are primarily spread via direct contact with the head of a person with pediculosis capitis. The degree to which indirect contact with an infested individual’s personal items contributes to the spread of head lice is controversial and needs additional study.2 Anyone can get pediculosis capitis, but children ages 3 to 11 are most commonly affected.1 Most lice infestations are asymptomatic, but itching of the scalp, neck, and ears may occur as an allergic reaction to lice saliva that’s injected while feeding. Enlarged cervical and nuchal lymph nodes as well as febrile episodes from a secondary staphylococcal infection may occur.2 June l Nursing2015 l 57
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Diagnosing pediculosis capitis An infestation of head lice can be diagnosed after a louse is found in the hair or on the scalp. Combing wet or dry hair with a fine-toothed nit comb aids in visualization. A lubricant such as hair conditioner is used to wet the hair before combing in both wet and dry hair. The hair is brushed or combed first to remove tangles, and the comb is placed near the crown of the head until it gently touches the scalp and drawn firmly down and systematically examined for lice after each stroke. This should be repeated at least once.2 A Wood’s lamp, which uses UV light, can be used to look closely at the skin and hair. It changes the color of the nits to a pale blue. Finding many nits within ¼ inch (6.5 mm) of the scalp indicates active infestation.2 Treatment options Head lice can be treated with pyrethroids, over-the-counter (OTC) pediculicide shampoos containing pyrethrin or permethrin.3 Other options if these treatments don’t work include malathion, benzyl alcohol, spinosad, and topical ivermectin.2 Many pediculicides are neurotoxic, so teach patients
(or their parents) to check age limitations on product labels and follow directions carefully. Women who are pregnant or breastfeeding should consult their healthcare provider before applying any treatment.3 To ensure success, repeat the treatment in 7 to 10 days as directed because resistance patterns have led to reduced ovicidal activity of pyrethoids.3 Tell patients that using conditioners on the hair before treatment with a pediculicide may reduce its effectiveness by preventing it from adhering to the hair shaft and scalp.2 Instruct them to contact their healthcare provider if they develop febrile episodes related to secondary staphylococcal infection or if an OTC product fails to eliminate the infestation.2 Because resistance to insecticides can vary according to geographic location, prescription treatment may be needed. Treatment also includes decontamination of clothing, bedding, towels, stuffed animals, and all personal items by washing them in hot, soapy water that’s at least 130˚ F (54 ˚ C) or drying on high heat for a minimum of 20 minutes. Combs and brushes should be soaked in rubbing alcohol for 1 hour.3 Nonwashable items such as pillows can be put in an airtight bag for
Head louse close up
a minimum of 2 weeks. Furniture should be covered in a nonbreathable material such as a plastic painter’s drop cloth for at least 2 weeks. If young children or animals are in the house and plastic is a choking hazard, place a cloth covering securely in place over the plastic, or vacuum frequently and thoroughly.3 Prevention measures Preventing pediculosis capitis can be difficult in school and daycare settings where close contact among the children is inevitable. The American Academy of Pediatrics has determined that children don’t need to be removed from class if pediculosis capitis is identified because the infestation has likely already been present for a month or more by the time of diagnosis. Nits may continue to be found for up to 2 weeks. Educate children to avoid direct contact with other children.4 In recent years, OTC products claiming to prevent lice infestation have been marketed, but research is currently lacking on their safety and effectiveness. Pesky problem Patient education is key in preventing pediculosis capitis. Remind patients that they can take measures to help prevent the spread of these pesky parasites—and effective treatment options are available if those measures don’t work. ■ REFERENCES 1. Guenther LCC. Pediculosis and pthiriasis (lice infestation). Medscape. 2015. http://emedicine. medscape.com/article/225013-overview. 2. Goldstein AO, Goldstein BG. Pediculosis capitis. UpToDate. 2015. http://www.uptodate.com. 3. Mayo Clinic. Lice. 2012. http://www.mayoclinic. org/diseases-conditions/lice/basics/definition/ con-20021627.
ARLINDO /iSTOCK
4. Frankowski B, Bocchini J. Clinical report—head lice. Am Acad Pediatrics. 2010;126(2):382-403. Susan Simmons is an NP at College Park Family Care Center in Overland Park, Kan. The author has disclosed that she has no financial relationships related to this article. DOI-10.1097/01.NURSE.0000464986.00187.3a
58 l Nursing2015 l June
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
