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Head lice (Clinical
presentation (Visible lice/eggs, Scalp itching,…
Head lice
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Complications
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Psychological
Anxiety, distress
Social stigma
Secondary bacterial infection
Due to excessive scratching
E.g. impetigo, furunculosis
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Pathophysiology
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Life cycle
Infests head hairs (pediculosis capitis)
Egg (ova) laid on scalp and attach; 7-10d to hatch; often translucent/white ('nits' are loose eggs/often empty shells)
Baby lice (nymphs) hatch; 7-10d to mature to adults
Adult lice size of sesame seed, brown/grey
Feeds on blood of scalp
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Diagnosis
Examination
Scalp examination
Louse eggs, live lice
MUST detect live lice to diagnose
Investigation
Bedside
Wet/dry detection combing using fine toothed comb,
attach lice to sticky tape and bring to GP
e.g. BugBuster comb (available on NHS), Hedrin (not on NHS)
History
DH
Current meds, allergies
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SH
School/nursery, living conditions
PC/HPC
Itching, eggs/lice in hair
Affected friends/family
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Management
Medical
Insecticide
Indication: confirmed lice
E.g. dimeticone gel (Hedrin), malathion liquid
MOA: physical insecticides (e.g. Hedrin) kill lice by coating and suffocating them; chemical insecticide poisons lice
(e.g. malathoin), but can get resistance
NB. wash hair and apply lots of conditioner; comb hair to detangle then use detection comb from scalp to tip, check for lice after each stroke with a magnifying glass; clean comb if lice found; wash out conditioner
Conservative
Information and advice
Information on head lice
Advise careful reading of kits
Treat whole family on same day
Check tx sucessful with combing
Children can still attend school
Wet combing
Indication: 1L preg/breastfeed, age 6m-2y, asthma/eczema
E.g. BugBuster kit
MOA: comb wet hair with detection comb to remove lice;
do 4 sessions over a period of 2 weeks
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