eMedicine Specialties > Dermatology > Parasitic Infections

Lice: Follow-up

Author: Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Contributor Information and Disclosures

Updated: Sep 4, 2009

Follow-up

Further Outpatient Care

  • Treatment of the patient environment (control measures) is important; reinfestation occurs if the problem is not addressed on a school-wide and community-wide basis.
    • Potential fomites (eg, towels, pillowcases, sheets, hats, children's stuffed animals) may benefit from laundering in hot water and machine drying (using the hottest cycle). Temperature exceeding 131°F (55°C) for more than 5 minutes kills eggs, nymphs, and mature lice.
    • Combs and brushes can be treated by soaking for longer than 5 minutes in very hot water (>131°F or 55°C).
    • Because adults cannot survive for long if separated from a host and eggs hatch in 6-10 days, carefully sealing potential fomites in plastic bags for 12-14 days can be effective. This technique works well for objects, such as stuffed animals, that do not tolerate laundering or dry cleaning.

Patient Education

  • In cases of school-wide infestations, the social stigma associated with infestation must be addressed. The community must address the problem honestly and openly, or the infestation will continue. Louse infestation is a community-wide problem.
  • Patients must realize that pediculicides are ineffective against young nits that lack a nervous system.
  • For excellent patient education resources, visit eMedicine's Parasites and Worms Center. Also, see eMedicine's patient education articles Lice and Crabs.

Miscellaneous

Medicolegal Pitfalls

  • Follow manufacturer's instructions for lindane treatment.35,36
    • It may not be suitable for use in patients with a defective cutaneous barrier.
    • Seizure may result from abnormal absorption or gross overuse of the product.
    • Many authors recommend that it not be used as a first-line therapy.
  • Pyrethrin products are contraindicated for patients with contact allergy to ragweed or turpentine.
  • Failure to recognize that pubic lice in children may be an indication of sexual abuse is a potential medical/legal pitfall.
    • Children with eyelash nits have been exposed to an adult with pubic lice. This is not proof of abuse, merely an indication that the child has had contact with an adult with pubic lice.
    • Pubic lice commonly infest the adult's body hair, as well as pubic hair.
    • Although lice can be transferred easily in the absence of abuse, examine patient for other signs of abuse.
 


More on Lice

Overview: Lice
Differential Diagnoses & Workup: Lice
Treatment & Medication: Lice
Follow-up: Lice
Multimedia: Lice
References
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Further Reading

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Keywords

lice, lice infestation, pediculosis, louse infestation, nits

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Contributor Information and Disclosures

Author

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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