skin disorders
Lice Infestation
Treatment of Lice Infestation
For head and pubic lice, shampoos and creams Removal of nits from hair and eyelashes Thorough laundering or dry cleaning or replacement of clothing and linens For all lice, replacing or decontaminating affected clothing and linens by thorough laundering or dry cleaning is recommended. Items that cannot be washed may be placed in airtight plastic bags for 2 weeks to kill the lice. Several effective prescription and nonprescription (over-the-counter) medications are available to treat head lice. Nonprescription shampoos and creams containing pyrethrins plus piperonyl butoxide are applied for 10 minutes and are then rinsed out. Prescriptionpermethrin(a synthetic form of pyrethrin), applied as a liquid or as a cream, is also effective. Spinosadsuspension (liquid) can be used in people 4 years of age and older and is rubbed into a dry scalp and applied to dry hair, left on for 10 minutes, and then thoroughly rinsed off with warm water. Contact with the eyes should be avoided. If live lice are seen after 7 days, a second treatment should be done. Prescriptionmalathionis highly effective at killing both adult lice and eggs, but it is not the first treatment doctors give because it is flammable, has an unpleasant odor, and must remain on the person for 8 to 12 hours. Lindane—a prescription medication that can be applied as a lotion or shampoo—also cures lice infestation but is no longer recommended because of widespread resistance and toxic side effects. All of these louse treatments are repeated in 7 to 10 days to kill newly hatched lice. Lice have started to become resistant to drugs and may be hard to kill.Ivermectinis usually given by mouth if lice resist standard treatment. Most drug treatments also kill nits but do not remove them. Dead nits do not have to be removed, but drugs do not always kill all nits. Because it is not usually possible to distinguish between living and dead nits, doctors recommend removing them. In addition, a very small percentage of children with nits in their scalp still have live lice. Removal requires a fine-tooth comb—which is often packaged with the lice removal products—and careful searching (hence the term “nit-picking”). Because the nits are so strongly stuck to the hair, several nonprescription preparations (shampoos, gels, and sprays) are available to loosen them. Thirty minutes under a hot hair dryer may also help kill nits (but not lice). Nits are carried away from the scalp as the hair grows. If there are no nits within ¼ inch of the scalp, the person does not have any live lice. For head lice, doctors do not have good evidence that it is necessary to clean or throw away people’s personal items or to exclude people from school or work. However, many experts recommend that clothing and bedding that is contaminated with the nits of lice be replaced or decontaminated by thorough laundering or dry cleaning. These items should probably be dried in a drying machine that reaches 130° F (54° C) for about 30 minutes. Pubic lice can be treated with nonprescription shampoos and creams containing pyrethrins plus piperonyl butoxide orlindane, as head lice are treated. Sex partners should also be treated. Lice that affect the eyelashes can be treated with petroleum jelly applied for 8 to 10 days,fluoresceineye drops,ivermectintaken by mouth, petrolatum salve,physostigmineointment, or careful removal of each louse with an instrument. Usually, no drug is used to eliminate body lice because body lice are in clothing and linens and not the person. Doctors treat a person's symptoms and recommend replacing or decontaminating affected clothing and linens by thorough laundering or dry cleaning. It is best to expose these items to heat of at least 149° F (65° C) during drying. 