eMedicine Specialties > Emergency Medicine > Infectious Diseases

Lice: Follow-up

Author: Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Coauthor(s): Neil W Yoder, DO, Staff Physician, Department of Emergency Medicine, St Vincent Mercy Medical Center
Contributor Information and Disclosures

Updated: May 5, 2009

Follow-up

Further Outpatient Care

  • It may be beneficial to launder potential fomites (eg, towels, pillowcases, sheets, hats, children's stuffed animals) in hot water, followed by machine drying using the hottest cycle.
    • Temperatures exceeding 131 degrees Fahrenheit (55 degrees Celsius) for more than 5 minutes kill eggs, nymphs, and mature lice.
    • Dry cleaning may be an effective alternative.
  • Combs and brushes can be treated by soaking for more than 5 minutes in very hot water (>131 degrees Fahrenheit or 55 degrees Celsius).
  • Mechanical removal of nits and lice from hair may speed resolution in addition to treatment with medication.
  • Since adult lice cannot survive for long if they are separated from a host, and since 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.
  • Vacuuming selected areas of the home, including couches used by patients with infestation, is recommended by some as an adjunctive control measure.
  • Chemical insecticide sprays used in the home environment have not been shown to be effective in the control of head lice.
  • Some families may choose to enlist the help of a trained professional—a "lice nurse" can often be found who will come to the home, evaluate the family members, remove lice and nits from hair, and provide education and lice combs. This service may allow sooner return to school and useful counseling.

Deterrence/Prevention

  • To prevent reinfestation, consider treating contacts of a patient with infestation at the same time as treating the patient.
  • Launder bedlinens and other clothes at the same time as treatment with medication.
  • Washing combs, brushes, and other fomites reduces reinfestation.
  • Do not allow children to exchange or use another child's hat, comb, or brush. Some parents choose to extend this prohibition to use of "common" headwear such as is available in the dress-up area of various play spaces or public libraries.
  • Once an infestation has been identified and treated, ongoing vigilance with close, direct visualization of hair and scalp at periodic intervals is recommended. Sensitivity may be enhanced by use of a lice-specific comb.

Complications

Complications of lice infestation may include the following:

  • Frequent use of pediculicides may cause persistent itching.
  • Secondary bacterial infection may occur.

Prognosis

  • Treatments are highly effective in killing nymphs and mature lice but less effective in killing eggs.
  • Appropriate therapy produces a cure in more than 90% of cases.
  • After proper treatment, children may return to school, provided that repeat therapy is performed in 7-10 days.

Patient Education

  • Noncompliance is the most common cause of treatment failure. Therefore, time is well-spent providing patients with detailed instructions regarding the application and timing of medications used in the treatment of lice.
    • Most patients benefit from an understanding of the life cycle of lice and the limitations of medical therapy (eg, medications are incompletely ovicidal).
    • Compliance with retreatment in 7-10 days may be enhanced if patients understand the need for retreatment to kill newly hatched nymphs.
  • Poor hygiene is not a risk factor in acquiring pediculosis capitis.
  • 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

  • Lindane (Kwell) treatment is associated with seizures. Therefore, many authors recommend that it not be used as a first-line therapy.
  • Pyrethrin products are contraindicated for patients with allergy to chrysanthemums.

Special Concerns

  • Pubic lice have been associated with sexually transmitted diseases. Upon making this diagnosis, screening the patient for common sexually transmitted diseases is prudent.
  • Remember that pubic lice in children may be an indication of sexual abuse.
 


More on Lice

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

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  15. Kristensen M, Knorr M, Rasmussen AM, et al. Survey of permethrin and malathion resistance in human head lice populations from Denmark. J Med Entomol. May 2006;43(3):533-8. [Medline].

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Further Reading

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Keywords

lice, louse, nits, pediculosis capitis, head lice, pediculosis corporis, body lice, pediculosis pubis, pubic lice, crabs, Pediculus humanus capitis, Pediculus humanus corporis, Pthirus pubis, lice infestation

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Contributor Information and Disclosures

Author

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Neil W Yoder, DO, Staff Physician, Department of Emergency Medicine, St Vincent Mercy Medical Center
Neil W Yoder, DO is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Medical Editor

Edmond A Hooker II, MD, DrPH, FAAEM, Assistant Professor, Department of Health Services Administration, Xavier University; Associate Clinical Professor, Department of Emergency Medicine, University of Louisville; Assistant Clinical Professor, Department of Emergency Medicine, Wright State University
Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jeter (Jay) Pritchard Taylor III, MD, Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist
Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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