Download presentation
1 -

ClinicalReportHeadLice


Headliceinfestationisassociatedwithlimitedmorbiditybutcausesahighlevelofanxietyamongparentsofschool-agedchildrenSincethe2002clinicalreportonheadlicewaspublishedbytheAmericanAcad-emyofPediatricspattern

stella's Recent Documents

Grant of a Principal Practising Certificate
Grant of a Principal Practising Certificate

Policy VLSBC D-17-223250Page 1of 6PolicyGrant of a Principal Practising CertificatePurpose11This policy outlines the Victorian Legal Services Board and Commissioners VLSBC approach to grantingan Austr

published 0K
GEOLOGICAL
GEOLOGICAL

Artesian Prepared Artesian Water By G and P CONTRIBUTIONS Prepared UNITED UNITED UDALL SecretaryGEOLOGICAL DirectorFor CONTENTSPageAbstract ILLUSTKATIONSPLATE TABLESPage artesian CONTRIBUTIONS ARTESIA

published 0K
FHFA PROPOSED RULE FOR NEW ENTERPRISE PRODUCTS AND ACTIVITIES
FHFA PROPOSED RULE FOR NEW ENTERPRISE PRODUCTS AND ACTIVITIES

Approval Processes for New Acx00740069vix00740069es and FEDERAL HOUSING FINANCE AGENCY 149 FHFAGOVStartNew PoductNoNew ctivity an proceed with possible onditionsYesEnterprise submts otice f New cti

published 0K
NikolayAAtanasovContactInformation
NikolayAAtanasovContactInformation

AtkinsonHall6127Phone858534-4105UniversityofCaliforniaSanDiegoE-mailnatanasovucsdedu9500GilmanDriveMC0450WebnatanasogithubioLaJollaCA92093AcademicAppointmentsAssistantProfessorJul2017-PresentDepartmen

published 0K
Technical Guidance for Site Investigation and Remediation
Technical Guidance for Site Investigation and Remediation

Citation and Page Number Current TextDateTable 15 Document 9 SMPs Certification column Certified by NYSPE Certification 15b 2 since SMP is considered to Section 41f2i restricted residential use is t

published 0K
DOCUMENTRESUMEED 022 225CC 002 774A Trauv rhArles BGROUP COUNSELING WI
DOCUMENTRESUMEED 022 225CC 002 774A Trauv rhArles BGROUP COUNSELING WI

4INNIIMpmrMIrARRTC 210GROUP COUNSELING WITH COLLEGE UNDERACHIEVERSCOMPARISONS WITK A CONTROL GROUP AND RELATIONSHIP TOEMPATHY WARMTH AND GENUINENESSSome of the controversy concerning the efficacy of p

published 0K
x0000x00001  xMCIxD 0 xMCIxD 0 THE HUMAN CONDITION CULTURES AND SOCI
x0000x00001 xMCIxD 0 xMCIxD 0 THE HUMAN CONDITION CULTURES AND SOCI

Proficiency 1 Describe key elements of their own identity as human beingscitizens of a republic and officerstatesmen in the United States Air ForceProficiency 2 Explain historical cultural societal an

published 0K
Understanding di31erential growth for students in special education
Understanding di31erential growth for students in special education

CENTER FOR SCHOOL AND STUDENT PROGRESSUnderstanding di31erential growth during school years and summers for students in special educationBy Angela Johnson and Elizabeth BarkerCENTER FOR SCHOOL AND STU

published 0K
Download Section

Download - The PPT/PDF document "" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.






Document on Subject : "ClinicalReportHeadLice"— Transcript:

1 ClinicalReport„HeadLice Headliceinfestat
ClinicalReport„HeadLice Headliceinfestationisassociatedwithlimitedmorbiditybutcausesahighlevelofanxietyamongparentsofschool-agedchildren.Sincethe2002clinicalreportonheadlicewaspublishedbytheAmericanAcad-emyofPediatrics,patternsofresistancetoproductsavailableover-the-counterandbyprescriptionhavechanged,andadditionalmechan-icalmeansofremovingheadlicehavebeenexplored.Thisrevisedclinicalreportclari“escurrentdiagnosisandtreatmentprotocolsand GuidancefortheClinicianinRenderingPediatricCare FROMTHEAMERICANACADEMYOFPEDIATRICS developmentofnewproducts,manywithoutproofofef“cacyorsafety,callforincreasedphysicianinvolvementinthediagnosisandtreatmentofheadlice.Optimaltreatmentsaresafeandeffective,rapidlypediculicidal,ovi-cidal,easytouse,andaffordableandincorporatearesistance-preventionBecauseliceinfestationissobenign,treatmentsmustprovesafetoensurethattheadverseeffectsofther-apyarenotworsethantheinfestation.ETIOLOGICAGENTTheadultheadlouseis2to3mmlong(thesizeofasesameseed),has6legs,andisusuallytantograyish-whiteincolor.Thefemalelivesupto3to4weeksand,oncemature,canlayupto10eggsperday.Thesetinyeggsare“rmlyattachedtothebaseofthehairshaftwithinapproximately4mmofthescalpwithaglue-likesubstancepro-ducedbythelouse.Viableeggscamou-”agedwithpigmenttomatchthehaircoloroftheinfestedpersonoftenareseenmoreeasilyattheposteriorhair-line.Emptyeggcasings(nits)areeas-iertoseebecausetheyappearwhiteagainstdarkerhair.(NotethatsomeexpertsrefertoeggsŽascontainingthedevelopingnymphandusenitsŽtorefertoemptyeggcasings;othersusethetermnitsŽtorefertobotheggsandtheemptycasings.)Theeggsareincubatedbybodyheatandtypicallyhatchin8to9days,buthatchingcanvaryfrom7to12daysdependingonwhethertheambientclimateishotorcold.Onceithatches,anymphleavestheshellcasingandpassesthroughatotalof3nymphstages(instars)dur-ingthenext9to12daysandthenreachestheadultstage.Thefemalelousecanmateandbegintolayviableeggsapproximately1.5daysafterbe-cominganadult.Ifnottreated,thiscy-clemayrepeatitselfapproximatelyevery3weeks.Thelousefeedsbyin-jectingsmallamountsofsalivawithva-sodilatoryandanticoagulationproper-tiesandsuckingtinyamountsofbloodfromthescalpeveryfewhours.Itchingresultsfromsensitizationtocompo-nentsofthesaliva.Witha“rstcaseofheadlice,itchingmaynotdevelopfor4to6weeks,becauseittakesthatamountoftimeforsensitivitytoresult.Headliceusuallysurviveforlessthan1dayawayfromthescalpatroomtem-perature,andtheireggscannothatchatanambienttemperaturelowerthanthatnearthescalp.CLINICALDISEASEHeadlice,unlikebodylice,donottransmitanydiseaseagent.candevelopinasensitizedindividual.Rarely,scratchingmaycauseimpetigoorotherskininfection,whichcanleadtolocaladenopathy.IntheUnitedStates,headliceinfes-tationismostcommonamongpreschool-andelementaryschool-agedchildren.Caregiversandhouse-holdmembersofpeopleinfestedwithheadlicecanalsobeatincreasedrisk.Allsocioeconomicgroupsareaffected,andheadliceinfestationsarecommoninmanypartsoftheworld.InsomeremotecommunitiesinCentralandSouthAmerica,nearlyallinhabitantshaveatleastafewheadlice.InAus-tralia,theprevalenceinschoolchil-drenis13%,witharangebetweenschoolsof0%to28%;inBrazil,theprevalenceis43%inaslumand28%ina“shingvillage;inChina,thepreva-lenceis14%,witharangeof0%to;andintheUnitedKingdom,theprevalenceis2%,withanannualinci-denceof37%.Headliceinfestationisnotsigni“cantlyin”uencedbyhairlengthorbyfrequentbrushingorshampooing.However,intheUnitedStates,wheredailybrushingisroutineformany,infestedindividualsrarelyhavemorethanadozenlivelice,whereasindividualsincultureswithdifferentgroomingpracticesoftenhaveahundredormorelivelice.Licecannothopor”y;theycrawl.How-ever,therearereportsthatcombingdryhaircanbuildupenoughstaticelectricitytophysicallyejectanadultlousefromaninfestedscalpmorethan1m.Transmissioninmostcasesoccursbydirectcontactwiththeheadofaninfestedindividual.spreadthroughcontactwithpersonalbelongingsofaninfestedindividual(combs,brushes,hats)ismuchlesslikelybutmayoccurrarely.foundoncombsarelikelytobeinjuredordead,andahealthylouseisnotlikelytoleaveahealth

2 yheadunlessthereisaheavyinfestation.This
yheadunlessthereisaheavyinfestation.Thisisfurtherillustratedby2studiesfromAustralia.In1study,examinationofcarpetson118classroom”oorsfoundnolicedespitemorethan14000livelicefoundontheheadsof466childrenusingtheseclassrooms.Inasecondstudy,livelicewerefoundononly4%ofpillowcasesusedbyinfestedvolun-Thus,themajorfocusofcon-trolactivitiesshouldbetoreducethenumberofliceontheheadandtolessentherisksofhead-to-headThegoldstandardfordiagnosingheadliceis“ndingalivelouseonthehead,whichcanbedif“cultbecauseliceavoidlightandcancrawlquickly.Stud-ieshaverevealedthatdiagnosisofin-festationbyusingalousecombisquickerandmoreef“cient.Someex-pertshavesuggestedusingalubricant(water,oil,orconditioner)toslowdownŽthemovementofliceandelimi-natethepossibilityofstaticelectric-Thetinyeggsmaybeeasiertospot,especiallyatthenapeoftheneckorbehindtheears,within1cmofthescalp.Itisimportantnottoconfuseeggsornitswithdandruff,haircasts,FROMTHEAMERICANACADEMYOFPEDIATRICSPEDIATRICSVolume126,Number2,August2010 orotherhairdebris,allofwhichhavebeenmisdiagnosedasnits.Nitsaremoredif“culttoremove,becausetheyare“rmlyattachedtothehairshaft.Itisalsoimportantnottoconfuseliveeggswithdeadoremptyeggcases(nits).ManypresumedliceŽandnitsŽsubmittedbyphysicians,nurses,teachers,andparentstoalaboratoryforidenti“cationwerefoundtobear-tifactssuchasdandruff,hairspraydroplets,scabs,dirt,orotherinsects(eg,aphidsblownbythewindandcaughtinthehair).Ingeneral,eggsfoundmorethan1cmfromthescalpareunlikelytobeviable,althoughsomeresearchersinwarmerclimateshavefoundviableeggsfartherfromthescalp.AviableeggwilldevelopaneyespotŽthatisevidentonmicro-scopicexaminationseveraldaysafterbeinglaid.Itisprobablyimpossibletopreventallheadliceinfestations.Youngchildrencomeintohead-to-headcontactwitheachotherfrequently.Itisprudentforchildrentobetaughtnottoshareper-sonalitemssuchascombs,brushes,andhats.However,nooneshouldrefusetowearprotectiveheadgearbe-causeoffearofheadlice.Inenviron-mentswherechildrenaretogether,adultsshouldbeawareofthesignsandsymptomsofheadliceinfestation,andinfestedchildrenshouldbetreatedpromptlytominimizespreadtoothers.Neverinitiatetreatmentunlessthereisacleardiagnosisofheadlice.Theidealtreatmentforlicewouldbecom-pletelysafe,freeofharmfulchemicals,readilyavailablewithoutaprescrip-tion,easytouse,andinexpensive.Whenrecommendingatreatment,pe-diatriciansshouldtakeintoaccountef-fectivenessandsafety,localpatternsofresistance(ifknown),easeofuse,andcost.Publishedreviewsofavail-ableef“cacystudiesandcomparativetrialsofpediculicideshaveuseddiffer-entinclusioncriteriaandreacheddif-ferentconclusions.ACochranere-viewconcerningpediculicideswaspublishedin1999andupdatedinbutwaswithdrawnin2007,andasubstantialupdateisunderway.Manyofthecitedstudieswerecom-pletedbeforethedevelopmentofre-sistancetoavailablepediculicidesorwereconductedinareaswherethelicewerenaivetopediculicides.TherapycouldbeinitiatedwithOTCpermethrin1%orpyrethrinswhenre-sistancetotheseproductsisnotsus-pected.Malathion0.5%canbeusedinpeoplewhoare24monthsofageorolderwhenresistancetopermethrinorpyrethrinsisdocumentedorwhentreatmentwiththeseproductsfailsde-spitetheircorrectuse.Othertreat-mentscanbeconsideredforpeoplewhocannotaffordorwhowishtoavoidpediculicides.Thepediatrician(orsomeoneinthecommunity,suchastheschoolnurse)shouldbeskilledintheidenti“cationofanactiveinfes-tationwithheadlicetoavoidtreatingpatientsunnecessarilyorfalselyiden-tifyingresistanceŽinthecommunitytoacertainproduct.Improperapplica-tionofthepediculicideshouldbeconsid-ered“rstasacauseoftreatmentfailure.Finally,itshouldbenotedthattheserecommendationsareintendedforusebypediatriciansandotherpracti-tionersintheUnitedStates.MalathionisnotavailableinCanada,andtheCa-nadianPaediatricSocietyrecentlyup-dateditspositionstatementonheadliceinfestation.Pediatricianswhoworkinothercountries,especiallyde-velopingcountriesinwhichheadlicearenaivetopediculicides,shoulduseproductsormethodsthataremosteconomical,effective,andsafe.Thefol-lowingproductsandmethodscanbeeffectivefortreatin

3 gheadlice.Permethrin(1%)Permethrinhasbee
gheadlice.Permethrin(1%)PermethrinhasbeenthemoststudiedpediculicideintheUnitedStatesandistheleasttoxictohumans.in1986asaprescription-onlytreat-ment,1%permethrinlotionwasap-provedforOTCusein1990andismar-ketedasacre`merinseŽ(Nix[P“zerConsumerHealthCareGroup,NewYork,NY]).Onepercentpermethrinlo-tioniscurrentlyrecommendedasoneofthedrugsofchoiceforheadlice.Permethrinisasyntheticpyrethroidwithextremelylowmammaliantoxic-ity.Reportedadverseeffectsincludepruritus,erythema,andedema.Per-methrinislessallergenicthanpyre-thrinsanddoesnotcauseallergicreactionsinindividualswithplantal-lergies.Theproductisappliedtodamphairthatis“rstshampooedwithanonconditioningshampooandthentoweldried.Itisleftonfor10minutesandthenrinsedoff.Permethrinleavesaresidueonthehairthatisdesignedtokillnymphsemergingfromthe20%to30%ofeggsnotkilledwiththe“rstHowever,conditionersandsilicone-basedadditivespresentinalmostallcurrentlyavailablesham-poosimpairpermethrinadherencetothehairshaftandreduceitsresidualTherefore,itissuggestedthattheapplicationberepeatedin7to10daysifliveliceareseen.Manyexpertsnowrecommendroutinere-treatment,preferablyonday9.Analternatetreatmentscheduleondays0,7,and13to15hasbeenproposedfornonovi-cidalproducts.Resistanceto1%per-methrinhasbeenreported,buttheprevalenceofthisresistanceisnotPyrethrinsPlusPiperonylButoxideManufacturedfromnaturalextractsfromthechrysanthemum,pyrethrinsareformulatedwithpiperonylbutox-ide(RID[Bayer,Morristown,NJ],A-200FROMTHEAMERICANACADEMYOFPEDIATRICS [HogilPharmaceuticalCorp,Purchase,NY],R&C[GlaxoSmithKline,Mid-dlesex,UnitedKingdom],Pronto[DelLaboratories,Uniondale,NY],ClearLiceSystem[CareTechnologies,Darien,CT]).Pyrethrinsareneurotoxictolicebuthaveextremelylowmamma-liantoxicity.Pyrethrinsshouldbeavoidedinpeoplewhoareallergictochrysanthemums.Thelabelswarnagainstpossibleallergicreactioninpatientswhoaresensitivetoragweed,butmodernextractiontechniquesminimizethechanceofproductcon-tamination,andreportsoftruealler-gicreactionshavebeenrare.productsareavailableinshampooormousseformulationsthatareappliedtodryhairandleftonfor10minutesbeforerinsingout.Noresidualpedicu-licidalactivityremainsafterrinsing.Inaddition,noneofthesenaturalpyre-thrinsaretotallyovicidal(newlylaideggsdonothaveanervoussystemforseveraldays);20%to30%oftheeggsremainviableaftertreatment,necessitatesasecondtreatmenttokillnewlyemergednymphshatchedfromeggsthatsurvivedthe“rsttreatment.Previousrecommendationshavebeentore-treatin7to10days;however,newevidencebasedonthelifecycleoflicesuggeststhatre-treatmentatday9isoptimal.Analternatescheduleof3treatmentswithnonovicidalproductsondays0,7,and13to15hasbeenAlthoughpyrethrinswereextremelyeffectivewhenintroducedinthemid-1980s,recentstudyresultshaveindicatedthatef“cacyhasde-creasedsubstantiallybecauseofde-velopmentofresistance.Thepreva-lenceofresistancehasnotbeensystematicallystudiedbutseemstobehighlyvariablefromcommunitytocommunityandcountrytocountry.Malathion(0.5%)Theorganophosphate(cholinesteraseinhibitor)0.5%malathion(Ovide[TaroPharma,Hawthorne,NY])wasreintro-ducedforthetreatmentofheadliceintheUnitedStatesin1999afterbeingtakenoffthemarkettwice,mostre-centlyin1986,becauseofproblemsre-latedtoprolongedapplicationtime,”ammability,andodor.Itisavailableonlybyprescriptionasalotionthatisappliedtodryhair,lefttoairdry,thenwashedoffafter8to12hours,al-thoughsomestudyresultshavesug-gestedeffectivenesswhenleftonforasshortatimeas20minutes.liceintheUnitedKingdomandelse-wherehaveshownresistancetomala-thionpreparations,whichhavebeenavailablefordecadesinthosecoun-ThecurrentUSformulationofmalathion(Ovidelotion,0.5%)differsfromthemalathionproductsavailableinEuropeinthatitcontainsterpineol,dipentene,andpineneedleoil,whichthemselveshavepediculicidalproper-andmaydelaydevelopmentofre-sistance.Malathionhashighovicidalandasingleapplicationisadequateformostpatients.However,theproductshouldbereappliedin7to9daysiflivelicearestillseen.Acon-cernisthehighalcoholcontentoftheproduct(78%isopropylalcohol),whichmakesithighly”ammable.Pa-tie

4 ntsandtheirparents,therefore,shouldbeins
ntsandtheirparents,therefore,shouldbeinstructedtoallowthehairtodrynaturally;nottouseahairdryer,curlingiron,or”atironwhilethehairiswet;andnottosmokenearachildreceivingtreatment.Safetyandeffec-tivenessofmalathionlotionhavenotbeenestablishedinchildrenyoungerthan6years,andtheproductiscon-traindicatedinchildrenyoungerthan24months.Becausemalathionisacholinesteraseinhibitor,thereisathe-oreticalriskofrespiratorydepressionifaccidentallyingested,althoughnosuchcaseshavebeenreported.BenzylAlcohol5%Benzylalcohol5%(Ules“a[ScielePharma,Atlanta,GA])wasapprovedbytheUSFoodandDrugAdministration(FDA)inApril2009fortreatmentofheadliceinchildrenolderthan6months.Theproductisnotneurotoxicandkillsheadlicebyasphyxiation.Twostudiesdemonstratedthatmorethan75%ofthesubjectstreatedwerefreeoflice14daysafterinitialtreatment.Themostcommonadversereactionsaftertreatmentincludedpruritus,ery-thema,pyoderma,andocularirrita-tion.Benzylalcoholisavailablebypre-scriptionandisnotovicidal:packageinstructionsstatethatitistobeap-pliedtopicallyfor10minutesandre-peatedin7days,althoughaswithothernonovicidalproducts,consid-erationshouldbegiventoretreatingin9daysorusing3treatmentcycles(days0,7,and13…15),asmentionedLindane(1%)Onthemarketsince1951forthemed-icaltreatmentofliceandscabies,lin-dane(Kwell[Reed&Carnick,JerseyCity,NJ])isanorganochloridethathascentralnervoussystemtoxicityinhu-mans;severalcasesofsevereseizuresinchildrenusinglindanehavebeenre-Forthetreatmentofheadlice,itisavailableonlybyprescriptionasa1%lindaneshampoothatshouldbeleftonfornomorethan4minutes,andarepeatapplicationshouldbeperformedin9to10days.Ithaslowovicidalactivity(30%…50%ofeggsarenotkilled),andresistancehasbeenreportedworldwideformanyyears.Forthesereasons,itshouldbeusedTheFDAhaswarnedthatlindaneshampooshouldonlybeusedforpatientswhocannottolerateorwhoseinfestationhasfailedtore-spondto“rst-linetreatmentwithsafermedicationsforthetreatmentofheadlice.TheFDAhasissuedapublichealthadvisoryconcerningtheuseoflin-dane,whichemphasizedthatitisasecond-linetreatment,iscontraindi-catedforuseinneonates,andshouldbeusedwithextremecautioninchil-FROMTHEAMERICANACADEMYOFPEDIATRICSPEDIATRICSVolume126,Number2,August2010 drenandinindividualswhoweighlessthan50kg(110lb)andinthosewhohaveHIVinfectionortakecertainmed-icationsthatcanlowertheseizureLindaneisnolongerrec-ommendedbytheAmericanAcademyofPediatrics(RedBook)ortheMedicalLetterforuseasapediculi-cide.TheuseoflindanehasbeenbannedinCalifornia.RemovalofTopicalPediculicidesAlltopicalpediculicidesshouldberinsedfromthehairoverasinkratherthanintheshowerorbathtolimitskinexposureandwithwarmratherthanhotwatertominimizeabsorptionat-tributabletovasodilation.TopicalReactionsItchingormildburningofthescalpcausedbyin”ammationoftheskininresponsetotopicalpharmaceuticalagentscanpersistformanydaysafterlicearekilledandisnotareasonforre-treatment.Topicalcorticosteroidsandoralantihistaminesmaybebene-“cialforrelievingthesesignsandScabicidesUsedOff-labelforLicePermethrin(5%)Fivepercentpermethrin(Elimite[Al-lergan,Irvine,CA])isavailablebypre-scriptiononlyasacream,usuallyap-pliedovernightforscabiesforinfantsasyoungas2months.Ithasanecdot-allybeenrecommendedforthetreat-mentofheadlicethatseemtobere-calcitranttoothertreatments.randomizedcase-controlstudieshavereportedef“cacytodate.Theresultsof1studysuggestedthatliceresistantto1%permethrinwillnotsuccumbtohigherconcentrations.5%isnotcurrentlyapprovedbytheFDAforuseasapediculicide.Crotamiton(10%)Thisproductisavailablebyprescrip-tiononlyasalotion(Eurax[Westwood-SquibbPharmaceuticals,Buffalo,NY]),usuallyusedtotreatscabies.Onestudyshowedittobeeffectiveagainstheadlicewhenappliedtothescalpandleftonfor24hoursbeforerinsingOtherreportshavesuggestedthat2consecutivenighttimeappli-cationssafelyeradicatelicefromSafetyandabsorptioninchil-dren,adults,andpregnantwomenhavenotbeenevaluated.CrotamitonisnotcurrentlyapprovedbytheFDAforuseasapediculicide.OralAgentsUsedOff-LabelforLiceThisproduct(Stromectol[Merck&Co,WestPoint,PA])isananthelminticagentstructu

5 rallysimilartomacrolideantibioticagentsb
rallysimilartomacrolideantibioticagentsbutwithoutantibac-terialactivity.Asingleoraldoseof200g/kg,repeatedin10days,hasbeenshowntobeeffectiveagainstheadMostrecently,asingleoraldoseof400g/kgrepeatedin7dayshasbeenshowntobemoreeffectivethan0.5%malathionlotion.tinmaycrosstheblood/brainbarrierandblockessentialneuraltransmis-sion;youngchildrenmaybeathigherriskofthisadversedrugreaction.Therefore,ivermectinshouldnotbeusedforchildrenwhoweighlessthan15kg.Ivermectinisalsoavailableasa1%topicalpreparationthatisap-pliedfor10minutesandhasshownpromisingresultsthatwarrantfur-thertesting.However,neitherformofivermectiniscurrentlyapprovedbytheFDAasapediculicide.Theoralantibioticagentsulfamethoxazole-trimethoprim(Septra[GlaxoSmith-Kline],Bactrim[RocheLaboratories,Nutley,NJ],andgenericcotrimox-azole)hasbeencitedaseffectiveagainstheadlice.Itispostulatedthatthisantibioticagentkillsthesymbi-oticbacteriainthegutofthelouseorperhapshasadirecttoxiceffectonthelouse.Theresultsof1studyindi-increasedeffectivenesswhensulfamethoxazole-trimethoprimwasgivenincombinationwithpermethrin1%whencomparedwithpermethrin1%orsulfamethoxazole-trimethoprimalone;however,thetreatmentgroupsweresmall.Raresevereallergicre-actions(Stevens-Johnsonsyndrome)tothismedicationmakeitapotentiallyundesirabletherapyifalternativetreatmentsexist.Itisnotcurrentlyap-provedbytheFDAforuseasaNaturalŽProductsEssentialoilshavebeenwidelyusedintraditionalmedicinefortheeradica-tionofheadlice,butbecauseofthevariabilityoftheirconstitution,theef-fectsmaynotbereproducible.eralproductsaremarketedfortreat-mentofheadliceandareinwideuse.Asnaturalproducts,theyarenotre-quiredtomeetFDAef“cacyandsafetystandardsforpharmaceuticals.Hair-Clean1-2-3(QuantumHealth,Eugene,OR)[anise,ylang-ylang,coconutoils,andisopropylalcohol]wasfoundtobeatleastaseffectiveasthepermethrinproductNixby1investigator.thoughmanyplantsnaturallyproduceinsecticidesfortheirownprotectionthatmaybesynthesizedforusebyhu-mans,suchaspyrethroids,someoftheseinsecticidalchemicalsproducetoxiceffectsaswell.Thesafetyandef-“cacyofherbalproductsarecurrentlynotregulatedbytheFDAthesameasOcclusiveAgentsOcclusiveagentsappliedtosuffocatethelicearewidelyusedbuthavenotbeenevaluatedforeffectivenessinrandomized,controlledtrials.Apetro-latumshampooŽconsistingof30to40gofstandardpetroleumjellymas-sagedontheentiresurfaceofthehairandscalpandleftonovernightwithaFROMTHEAMERICANACADEMYOFPEDIATRICS showercaphasbeensuggested.Dili-gentshampooingisusuallynecessaryforatleastthenext7to10daystoremovetheresidue.Itisthoughtthattheviscoussubstanceobstructstherespiratoryspiraclesoftheadultlouseaswellastheholesintheoper-culumoftheeggsandblocksef“cientairexchange.Anotherinterpretationisthattheintense,dailyattentiontohairgroomingresultsinremovalofalltheliceandnits.Hairpomadesareeasiertoremovebutmaynotkilleggs,andtreatmentshouldberepeatedweeklyfor4weeks.Otherocclusivesubstanceshavebeensuggested(mayonnaise,tubmargarine,herbaloils,oliveoil),buttodate,onlyanec-dotalinformationisavailablecon-cerningeffectiveness.OnestudythatexaminedseveralhomeremediesŽ(vinegar,isopropylalcohol,oliveoil,mayonnaise,meltedbutter,andpetro-leumjelly)revealedthattheuseofpe-troleumjellycausedthegreatesteggmortality,allowingonly6%tohatch.A2004studyreporteda96%cureŽratewithasuffocation-basedpediculi-cidelotionappliedtothehair,driedonwithahand-heldhairdryer,leftonovernight,andwashedoutthenextmorning.Theprocessmustbere-peatedonceperweekfor3weeks.Theproductcontainednoneurotoxinsanddidnotrequirenitremovalorexten-sivehousecleaning.Thestudywascriticizedforbeinguncontrolled,withnoblinding,randomization,orcom-parisongroup.Thelotionusedinthestudywaslateridenti“edasCetaphilcleanser[GaldermaLaboratories,FortWorth,TX],andinstructionsforitsuseareavailableontheInternet.hasnotbeenapprovedbytheFDAforuseasapediculicide.Dimethiconelotion(4%long-chainlin-earsiliconeinavolatilesiliconebase)intwo8-hourtreatments1weekaparteradicatedheadlicein69%ofpartici-pantsintheUnitedKingdom.theUnitedStates,theOTCproductLiceM

6 D(CombeInc,WhitePlains,NY)containsdimeth
D(CombeInc,WhitePlains,NY)containsdimethicone.Isopropylmyris-tate50%(Resultz[NycomedCanadaInc,Oakville,Ontario,Canada]),ahairrinsethatdissolvesthewaxyexoskele-tonofthelouse,whichleadstodehy-drationanddeathofthelouse,hasre-centlybecomeavailableinCanada.TheLouseBusterisacustom-builtma-chine(availablecommerciallyinlate2009)thatusesone30-minuteapplica-tionofhotairinanattempttodesic-catethelice.Onestudyshowedthatsubjectshadnearly100%mortalityofeggsand80%mortalityofhatchedThemachineisexpensive,andtheoperatorrequiresspecialtraininginitsuse.Aregularblow-dryershouldnotbeusedinanattempttoaccom-plishthisresult,becauseinvestigatorshaveshownthatwindandblow-dryerscancauselivelicetobecomeairborneand,thus,potentiallyspreadtoothersinthevicinity.OtherAgentsFlammableortoxicsubstancessuchasgasolineorkeroseneshouldneverbeused.Productsintendedforanimaluseshouldnotbeusedtotreatheadliceinhumans.ManualRemovalRemovalofnitsimmediatelyaftertreatmentwithapediculicideisnotnecessarytopreventspread,becauseonlylivelicecauseaninfestation.Indi-vidualsmaywanttoremovenitsforaestheticreasonsortodecreasediag-nosticconfusion.Becausenoneofthepediculicidesare100%ovicidal,man-ualremovalofnits(especiallytheoneswithin1cmofthescalp)aftertreat-mentwithanyproductisrecom-mendedbysome.Nitremovalcanbedif“cultandtedious.Fine-toothednitcombsŽareavailabletomakethepro-cesseasier.Studieshavesug-gestedthatliceremovedbycombingandbrushingaredamagedandrarelyIntheUnitedKingdom,com-munitycampaignshavebeenlaunchedusingbug-busterŽcombsandordi-naryshampoo,witheveryonebeinginstructedtoshampoohairtwiceperweekfor2weeksandtovigorouslycomboutwethaireachtime.Thewethairseemstoslowdownthelice.Combingdryhairdoesnotseemtohavethesameeffect;astudycon-ductedinAustraliainwhichchildrencombedtheirhairdailyatschoolwithanordinarycombdeterminedthatitwasnoteffective.Somehavepostu-latedthatvigorousdrycombingorbrushinginclosequartersmayevenspreadlicebymakingthemairborneviastaticelectricity.Onestudyshowedthatmanualremovalisnotaseffectiveaspediculicidesanddoesnotimproveresults,evenwhenusedasanadjuncttopediculicidetreatment.Therearebattery-poweredelec-tronicŽlousecombswithoscillatingteeth(QuantumMagiComb)thatclaimtoremoveliveliceandnitsaswellascombsthatresemblesmallbugzap-persŽ(LiceGuardRobi-Comb[ARRHealthTechnologies,Needham,MA])thatclaimtokilllivelice.Norandom-ized,case-controlledstudieshavebeenperformedwitheithertypeofcomb.Theirinstructionswarnnottouseonpeoplewithaseizuredisorderorapacemaker.SomeproductsareavailablethatclaimtoloosentheglueŽthatat-tachesnitstothehairshaft,thusmak-ingtheprocessofnit-pickingŽeasier.Vinegarorvinegar-basedproducts(ClearLiceEggRemoverGel[CareTechnologies])areintendedtobeap-pliedtothehairfor3minutesbeforecombingoutthenits.Noclinicalbene-“thasbeendemonstrated.producthasnotbeentestedwithandisnotrecommendedforusewithper-methrin,becauseitmayinterferewithFROMTHEAMERICANACADEMYOFPEDIATRICSPEDIATRICSVolume126,Number2,August2010 permethrinsresidualactivity.Avari-etyofotherproducts,fromacetoneandbleachtovodkaandWD-40(WD-40Company,SanDiego,CA),haveprovedtobeineffectiveinlooseningnitsfromthehairshaftandpresentanunac-ceptablerisktothepatient.Itseemsthatnaturehasprotectedthelousebymakingthenitsheathsimilarincom-positiontothehair,sothatagentsde-signedtounravelthenitsheathcanalsodamagehumanhair.Althougheffectiveforremovingliceandeggs,shavingtheheadgenerallyisnotrecommended,becauseitcanbedistressingtoachildorparent.NewProductsAsnewproductsareintroduced,itisimportanttoconsidereffectiveness,safety,expense,availability,patientpreference,andeaseofapplication.Assessmentoftheseverityoftheinfes-tation,thenumberofrecurrences,thelocallevelsofresistancetoavailablepediculicides,andthepotentialfortransmissionarealsocriticalwhenrecommendingnewerproducts.PediculicideResistanceNocurrentlyavailablepediculicideis100%ovicidal,andresistancetolin-dane,pyrethrins,permethrin,andtheUKformulationofmalathionhasbeenThisresistanceisnotunanticipated,becauseinsectsde-velopresistancetoproducts

7 overtime.Theactualprevalenceofresistance
overtime.Theactualprevalenceofresistancetoparticularproductsisnotknownandcanberegional.Itisimportantthathealthcareprofessionalsrecommendsafeandeffectiveproducts.Whenfacedwithapersistentcaseofheadliceafterusingapharmaceuticalpe-diculicide,healthcareprofessionalsmustconsiderseveralpossibleexpla-nations,including:misdiagnosis(noactiveinfestationormisidenti“cation);lackofadherence(patientunableorunwillingtofollowtreatmentinadequatetreatment(notusingsuf“cientproducttosaturatehair);reinfestation(licereacquiredafterlackofovicidalorresidualkillingpropertiesoftheproduct(eggsnotkilledcanhatchandcauseself-reinfestation);and/orresistanceoflicetothepediculicide.Ifresistanceisproven,andanactiveinfestationisdocumented,benzylalco-hol5%canbeprescribedifthepatientisolderthan6months,ormalathion0.5%canbeprescribedifthepatientisolderthan24monthsifsafeusecanbereasonablyensured.Foryoungerpatients,oriftheparentcannotaffordordoesnotwishtouseapediculicide,manualremovalviawetcombingoranocclusivemethodmayberecommended,withempha-sisoncarefultechniqueandtheuseof2to4properlytimedtreatmentENVIRONMENTALINTERVENTIONSIfapersonisidenti“edwithheadlice,allhouseholdmembersshouldbecheckedforheadlice,andthosewithliveliceornitswithin1cmofthescalpshouldbetreated.Inaddition,itispru-denttotreatfamilymemberswhoshareabedwiththepersonwithinfes-tation,evenifnolivelicearefound.Fomitetransmissionislesslikelythantransmissionbyhead-to-headcon-;however,itisprudenttocleanhaircareitemsandbeddingusedbytheindividualwithinfestation.Onestudyrevealedthatheadlicecantransfertopillowcasesatnight,buttheincidenceislow(4%).Changingjustthepillowcasecouldminimizethisriskofheadlicetransmission.itemsthathavebeenincontactwiththeheadofthepersonwithinfestationinthe24to48hoursbeforetreatmentshouldbeconsideredforcleaning,giventhefactthatlousesurvivaloffthescalpbeyond48hoursisextremelyun-likely.Suchitemsmayincludeclothing,headgear,furniture,carpeting,andrugs.Washing,soaking,ordryingitemsattemperaturesgreaterthan130°Fwillkillstrayliceornits.Furni-ture,carpeting,carseats,andotherfabricsorfabric-covereditemscanbevacuumed.Althoughheadliceareabletosurviveforprolongedperiodsinchlorinatedwater,itisunlikelythatthereisasigni“cantriskoftransmis-sioninswimmingpools.Onestudyre-vealedthatsubmergedheadlicebe-cameimmobileandremainedinplaceon4peopleinfestedwithheadliceaf-ter30minutesofswimming.licidesprayisnotnecessaryandshouldnotbeused.Viablenitsareun-likelytoincubateandhatchatroomtemperatures;iftheydid,thenymphswouldneedto“ndasourceofbloodforfeedingwithinhoursofhatching.Althoughitisrarelynecessary,itemsthatcannotbewashedcanbebaggedinplasticfor2weeks,atimewhenanynitsthatmayhavesurvivedwouldhavehatchedandnymphswoulddiewith-outasourceforfeeding.Herculeancleaningmeasuresarenotbene“cial.CONTROLMEASURESINSCHOOLSScreeningfornitsaloneisnotanaccu-ratewayofpredictingwhichchildrenareorwillbecomeinfested,andscreeningforlivelicehasnotbeenproventohaveasigni“canteffectontheincidenceofheadliceinaschoolcommunityovertime.Inaddition,suchscreeninghasnotbeenshowntobecost-effective.Inaprospectivestudyof1729schoolchildrenscreenedforheadlice,only31%ofthe91chil-drenwithnitshadconcomitantlivelice.Only18%ofthosewithnitsaloneconvertedtohavinganactiveinfesta-tionduring14daysofobservation.FROMTHEAMERICANACADEMYOFPEDIATRICS Althoughchildrenwithatleast5nitswithin1cmofthescalpweresigni“-cantlymorelikelytodevelopaninfes-tationthanwerethosewithfewernits(32%vs7%),onlyone-thirdofthechil-drenathigherriskconvertedtohavinganactiveinfestation.Schoolexclusionofchildrenwithnitsalonewouldhaveresultedinmanyofthesechildrenmissingschoolunnecessarily.Inaddi-tion,headliceinfestationshavebeenshowntohavelowcontagioninclass-Usinganecdotalinformationthatdescribedtheimplementationofazero-toleranceŽprogramatanele-mentaryschool,1sourcereportedanaverageof20misseddaysperstudentdismissedforinfestation.studyevaluatedhowoftenschoolchil-drenwereinappropriatelydiagnosedandtreated.Childrenwithoutin-festationreceivedapplicationsofpyrethroid-basedOT

8 Cproductsalmostasoftenaschildrenwithacti
Cproductsalmostasoftenaschildrenwithactiveinfes-tations(62%vs70%).Noninfestedchil-drenwereexcludedfromschoolbe-causeofpresumedliceinfestationmorefrequentlythanwerechildrenwhowereinfested.Theresultsofsev-eraldescriptivestudieshavesug-gestedthateducationofparentsindi-agnosingandmanagingheadlicemaybehelpful.Becauseofthelackofevidenceofef“cacy,routineclass-roomorschool-widescreeningshouldbediscouraged.Itmaybeusefultoprovideinformationperiodicallyaboutthediagnosis,treat-ment,andpreventionofheadlicetothefamiliesofallchildren.Parentsshouldbeencouragedtochecktheirchildrensheadsforliceregularlyandifthechildissymptomatic.SchoolscreeningsdonottaketheplaceofthesemorecarefulparentalItmaybehelpfulfortheschoolnurseorothertrainedpersontocheckastudentsheadifheorsheisdemonstratingsymptoms.ManagementontheDayofBecauseachildwithanactiveheadliceinfestationlikelyhashadtheinfes-tationfor1monthormorebythetimeitisdiscoveredandposeslittlerisktoothersfromtheinfestation,heorsheshouldremaininclassbutbediscour-agedfromclosedirectheadcontactwithothers.Ifachildisdiagnosedwithheadlice,con“dentialitymustbemain-tained.Thechildsparentorguardianshouldbenoti“edthatdaybytele-phoneorbyhavinganotesenthomewiththechildattheendoftheschooldaystatingthatprompt,propertreat-mentofthisconditionisinthebestinterestofthechildandhisorherclassmates.Commonsenseshouldprevailwhendecidinghowconta-giousŽanindividualchildmaybe(achildwithhundredsversusachildwith2livelice).Itmaybeprudenttocheckotherchildrenwhoweremostlikelytohavehaddirecthead-to-headcontactwiththeinfestedchild.Inanelementaryschool,1waytodealwiththeproblemistonotifytheparentsorguardiansofchildreninaninfestedchildsclassroom,encouragingallchildrentobecheckedathomeandtreated,ifappropriate,beforereturn-ingtoschoolthenextday.Someex-pertsarguethatbecauseoftherela-tivelyhighprevalenceofheadliceinyoungschool-agedchildren,itmaymakemoresensetoalertparentsonlyifahighpercentageofchildreninaclassroomareinfested.OtherexpertsfeelstronglythatthesealertlettersŽcauseunnecessarypublicalarmandreinforcethenotionthataheadliceinfestationindicatesafailureontheschoolspartratherthanacommunityHowever,studiesexamin-ingtheef“cacyofalertlettersarenotavailable;consequently,someschoolschoosetodesignguidelinesthattheybe-lievebestmeettheneedsoftheirstudentpopulation,understandingthatalthoughaheadliceinfestationmaynotposeapublichealthrisk,itmaycreateapublicrelationsdilemmaforaschool.CriteriaforReturntoSchoolAchildshouldnotberestrictedfromschoolattendancebecauseoflice,be-causeheadlicehavelowcontagionwithinclassrooms.Someschoolshavehadno-nitŽpoliciesunderwhichachildwasnotallowedtoreturntoschooluntilallnitswereremoved.However,mostresearchersagreethatno-nitpoliciesshouldbeabandoned.Internationalguidelinesestablishedin2007fortheeffectivecontrolofheadliceinfestationsstatedthatno-nitpol-iciesareunjustandshouldbediscon-becausetheyarebasedonmisinformationratherthanobjectiveTheAmericanAcademyofPe-diatricsandtheNationalAssociationofSchoolNursesdiscourageno-nitpoli-cies.However,nitremovalmaybecon-sideredforthefollowingreasons:nitremovalcandecreasediagnos-ticconfusion;nitremovalcandecreasethepossibil-ityofunnecessaryre-treatment;andsomeexpertsrecommendremovalofnitswithin1cmofthescalptodecreasethesmallriskofAknowledgeableschoolnurse,ifpresent,canperformavaluableser-vicebyrecheckingachildsheadifre-questedtodosobyaparent.Inaddi-tion,theschoolnursecanofferextrahelptofamiliesofchildrenwhoarere-peatedlyorchronicallyinfested.Inrareinstances,itmaybehelpfultomakehomevisitsorinvolvepublichealthnursestoensurethattreat-mentisbeingconductedeffectively.Nochildshouldbeallowedtomissvalu-ableschooltimebecauseofheadlice.Numerousanecdotalreportsexistofchildrenmissingweeksofschoolandevenbeingforcedtorepeatagradebecauseofheadlice.FROMTHEAMERICANACADEMYOFPEDIATRICSPEDIATRICSVolume126,Number2,August2010 ReassuranceofParents,Teachers,andClassmatesTheschoolcanbemosthelpfulbymak-ingavailableaccurateinformationaboutthediagnosis,treatment,andpreventionofhead

9 liceinanunder-standableformtotheentiresc
liceinanunder-standableformtotheentireschoolcommunity.Informationsheetsindif-ferentlanguagesandvisualaidsforfamilieswithlimitedliteracyskillsshouldbemadeavailablebyschoolsand/orlocalhealthdepartments.Ifpe-diatriciansandschoolstaketheleadandreactcalmly,parentswillbeabletofocusonappropriatetreatmentwithoutbecomingundulyupset.ChildCareandSleepoverŽCampsLittleinformationisavailableonthein-cidenceandcontrolofheadliceout-sideoftheschool-agedpopulationandoutsideofschool.Becauseheadlicearemostreadilytransmittedbydirecthead-to-headcontact,childcarecen-tersandcampswherechildrensharesleepingquartersmayallowforeasierspread.Remindingparentsoftheimportanceofcarefullycheckingachildsheadbeforeandafterasleep-overexperiencemaybehelpful.SUMMARYOFKEYPOINTS1.Nohealthychildshouldbeexcludedfromorallowedtomissschooltimebecauseofheadlice.No-nitpoliciesforreturntoschoolshouldbeabandoned.2.Pediatriciansshouldbeknowledge-ableaboutheadliceinfestationsandtreatments;theyshouldtakeanactiveroleasinformationre-sourcesforfamilies,schools,andothercommunityagencies.3.Unlessresistancetotheseprod-uctshasbeenproveninthecommu-nity,1%permethrinorpyrethrinscanbeusedfortreatmentofactive4.Instructionsontheproperuseofproductsshouldbecarefullycom-municated.Becausecurrentprod-uctsarenotcompletelyovicidal,ap-plyingtheproductatleasttwice,atproperintervals,isrecommendedifpermethrinorpyrethrinproductsareusedorifliveliceareseenaftermalathiontherapy.Manualremovalofnitsimmediatelyaftertreatmentwithapediculicideisnotnecessarytopreventspread.Intheschoolset-ting,nitremovalmaybeconsideredtodecreasediagnosticconfusion.5.IfresistancetoavailableOTCprod-uctshasbeenproveninthecommu-nity,ifthepatientistooyoung,orifparentsdonotwishtouseapedic-ulicide,considerrecommendingwet-combingŽoranocclusivemethod(suchaspetroleumjellyorCetaphil),withemphasisoncarefultechnique,andrepeatingforatleast2weeklycycles.6.Benzylalcohol5%canbeusedforchildrenolderthan6months,ormalathion0.5%canbeusedforchil-dren2yearsoldorolder,inareaswhereresistancetopermethrinorpyrethrinshasbeendemonstratedorforapatientwithadocumentedinfestationthathasfailedtore-spondtoappropriatelyadminis-teredtherapywithpermethrinor7.Newproductsshouldbeevaluatedforsafetyandeffectiveness.8.Schoolpersonnelinvolvedindetec-tionofheadliceinfestationshouldbeappropriatelytrained.Theim-portanceanddif“cultyofcorrectlydiagnosinganactiveheadlicein-festationshouldbeemphasized.Schoolsshouldexamineanylice-relatedpoliciestheyhavewiththisinmind.9.Headlicescreeningprogramshavenotbeenproventohaveasigni“canteffectovertimeontheincidenceofheadliceintheschoolsettingandarenotcost-effective.Parenteducationpro-gramsmaybehelpfulintheman-agementofheadliceintheschoolLEADAUTHORSBarbaraL.Frankowski,MD,MPHJosephA.Bocchini,MDCOUNCILONSCHOOLHEALTHEXECUTIVECOMMITTEE,2006…2010RobertD.Murray,MD,ChairpersonBarbaraL.Frankowski,MD,MPH,ImmediatePastChairpersonLindaM.Grant,MD,MPHHaroldMagalnick,MDMicheleM.Roland,MDCynthiaMears,MDRaniS.Gereige,MD,MPHJeffreyH.Lamont,MDGeorgeJ.Monteverdi,MDEvanG.PattishallIII,MDLaniS.M.Wheeler,MDCynthiaDiLauraDevore,MDStephenE.Barnett,MDWendyAnderson,MDJeffreyOkamoto,MDMarkMinier,MDBreenaHolmes,MDMoniqueCollier,MD…SectiononResidentsAlexB.Blum,MD…SectiononResidentsSandiDelack,RN,MEd,NCSN…NationalAssociationofSchoolNursesLindaDavis-Alldritt,RN,MA,PHN,FNASNNationalAssociationofSchoolNursesDonnaMazyck,MS,RN…NationalAssociationofSchoolNursesMaryVernon-Smiley,MD…CentersforDiseaseControlandPreventionRobertWallace,MD…IndependentSchoolHealthAssociationMadraGuinn-Jones,MPHCOMMITTEEONINFECTIOUSDISEASES,2006…2010JosephA.Bocchini,MD,ChairpersonMichaelT.Brady,MD,Vice-chairpersonRobertS.Baltimore,MDHenryH.Bernstein,DOJohnS.Bradley,MDCarrieL.Byington,MDPenelopeH.Dennehy,MDMargaretC.Fisher,MDRobertW.FrenckJr,MDMaryP.Glode,MDMaryAnneJackson,MDHarryL.Keyserling,MDDavidW.Kimberlin,MDJuliaA.McMillan,MDWalterA.Orenstein,MDLorryG.Rubin,MDFROMTHEAMERICANACADEMYOFPEDIATRICS GordonE.Schutze,MDRodneyE.Willoughby,MDBethP.Bell,MD,MPH…CentersforDiseas

10 eControlandPreventionRobertBortolussi,MD
eControlandPreventionRobertBortolussi,MD…CanadianPaediatricRichardD.Clover,MD…AmericanAcademyofFamilyPhysiciansMarcA.Fischer,MD…CentersforDiseaseControlandPreventionBruceG.Gellin,MD,MPH…NationalVaccineProgramOf“ceRichardL.Gorman,MD…NationalInstitutesofLuciaLee,MD…FoodandDrugAdministrationR.DouglasPratt,MD…FoodandDrugJenniferS.Read,MD,MS,MPH,DTM&HNationalInstitutesofHealthJeffreyR.Starke,MD…AmericanThoracicJackT.Swanson,MD…AAPCommitteeonPracticeandAmbulatoryMedicineEXOFFICIOCarolJ.Baker,MD…RedBookAssociateEditorSarahS.Long,MD…RedBookAssociateEditorH.CodyMeissner,MD…VisualRedBookAssociateEditorLarryK.Pickering,MD…RedBookEditorEdgarO.Ledbetter,MDJenniferFrantz,MPH1.JonesKN,EnglishJC3rd.ReviewofcommontherapeuticoptionsintheUSforthetreat-mentofpediculosiscapitis.ClinInfectDis.2.MeinkingTA.Infestations.CurrProblDer-3.BurgessIF.Humanliceandtheirmanage-AdvParasitol.4.GratzNG.HumanLice:TheirPrevalence,ControlandResistancetoInsecticides„AReview,1985…1997.Geneva,Switzerland:WorldHealthOrganization,DivisionofCon-trolofTropicalDiseases,WHOPesticideEvaluationScheme;19975.HansenRC,OHaverJ.Economicconsider-ationsassociatedwithPediculushumanusClinPediatr(Phila).6.BurkhartCG.Relationshipoftreatment-resistantheadlicetothesafetyandef“cacyofpediculicides.MayoClinProc.661…6667.PollackRJ,KiszewskiAE,SpielmanA.Over-diagnosisandconsequentmismanage-mentofheadlouseinfestationsinNorthPediatrInfectDisJ.689…6938.MeinkingTL,SerranoL,HardB,etal.Com-parativeinvitropediculicidalef“cacyoftreatmentsinaresistantheadlicepopula-tionontheUS.ArchDermatol.220…2249.MeinkingT,TaplinD.Infestations.In:SchachnerLA,HansenRC,eds..2nded.NewYork,NY:ChurchillLivingstone;1995:1347…139210.ElstonDM.DrugsusedinthetreatmentofJDrugDermatol.11.BurgessIF,PollackRJ,TaplinD.Cuttingthroughcontroversy:specialreportonthetreatmentofheadlice.In:TheTreatmentofHeadLice.Englewood,CO:PostgraduateIn-stituteforMedicine;2003:3…1312.CounahanM,AndrewsR,ButtnerP,etal.HeadliceprevalenceinprimaryschoolsinVictoria,Australia.JPaediatrChildHealth.2004;40(11):616…61913.HeukelbachJ,WilckeT,WinterB,etal.Epi-demiologyandmorbidityofscabiesandpe-diculosiscapitisinresource-poorcommu-nitiesinBrazil.BrJDermatol.150…15614.FanCK,LiaoCW,WuMS,etal.PrevalenceofPediculuscapitisinfestationamongschoolchildrenofChineserefugeesresidinginmountainousareasofnorthernThailand[publishedcorrectionappearsinungJMedSci.2004;20(6):followingtableofKaohsiungJMedSci.15.HarrisJ,CrawshawJG,MillershipS.Inci-denceandprevalenceofheadliceinadis-tricthealthauthorityarea.CommunDisPublicHealth.2003;6(3):246…24916.ChungeRN,ScottFE,UnderwoodJE,ZavarellaKJ.Areviewoftheepidemiology,publichealthimportance,treatmentandcontrolofheadlice.CanJPublicHealth.1991;82(3):196…20017.BurkhartCN,BurkhartCG.Fomitetransmis-sioninheadlice.JAmAcadDermatol.56(6):1044…104718.ChungeRN,ScottFE,UnderwoodJE,ZavarellaKJ.Apilotstudytoinvestigatetransmissionofheadlice.CanJPublic19.MaunderJW.Humanlice:somebasicfactsandmisconceptions.BullPanAmHealthOr-1985;19(2):194…19720.SpeareR,ThomasG,CahillC.Headlicearenotfoundon”oorsinprimaryschoolclass-AustNZJPublicHealth.208…21121.SpeareR,CahillC,ThomasG.Headliceonpillows,andstrategiestomakeasmallriskevenless.IntJDermatol.626…62922.MumcuogluKY,FrigerM,Ioffe-UspenskyI,Ben-IshaiF,MillerJ.Lousecombversusdi-rectvisualexaminationforthediagnosisofheadlouseinfestations.PediatrDermatol.2001;18(1):9…1223.BurgessI.Detectioncombing.NursTimes.24.VanderSticheleRH,DezeureEM,BogaertMG.Systematicreviewofclinicalef“cacyoftopicaltreatmentsforheadlice.311(7005):604…60825.DoddCS.Interventionsfortreatinghead-CochraneDatabaseSystRev.26.DoddCS.Withdrawn:interventionsfortreatingheadlice.CochraneDatabaseSyst27.CanadianPaediatricSociety.Headlicein-festations:aclinicalupdate.PaediatrChild2008;13(8):692…69628.AbramowiczM,ed.Drugsforparasiticin-MedLettDrugsTher.29.MeinkingTL,TaplinD,KalterDC,EberleMW.Comparativeef“cacyoftreatmentsforpe-diculosiscapitisinfestations.ArchDerma-30.HansenRC;WorkingGroupontheTreat-mentofResistantPediculosis.Gu

11 idelinesforthetreatmentofresistantpedicu
idelinesforthetreatmentofresistantpediculosis.ContempPediatr.31.LebwohlM,ClarkL,LevittJ.Therapyforheadlicebasedonlifecycle,resistance,andsafetyconsiderations.32.MumcuogluKY,HemingwayJ,MillerJ,etal.PermethrinresistanceintheheadlousediculuscapitisfromIsrael.MedVetEnto-1995;9(4):427…432,44733.RupesV,MoravecJ,ChmelaJ,LedvinkaJ,´J.Aresistanceofheadlice(diculuscapitis)topermethrininCzechRe-CentEurJPublicHealth.30…3234.PollackRJ,KiszewskiA,ArmstrongP,etal.DifferentialpermethrinsusceptibilityofheadlicesampledintheUnitedStatesandFROMTHEAMERICANACADEMYOFPEDIATRICSPEDIATRICSVolume126,Number2,August2010 ArchPediatrAdolescMed.153(9):969…97335.YoonKS,GaoJR,LeeSH,ClarkJM,BrownL,TaplinD.Permethrin-resistanthumanheadPediculuscapitis,andtheirtreatment.ArchDermatol.2003;139(8):994…100036.RasmussenJE.Pediculosis:treatmentandAdvDermatol.1986;1:109…12537.MeinkingTL,VicariaM,EyerdamDH,VillarME,ReynaS,SuarezG.Ef“cacyofare-ducedapplicationtimeofOvidelotion(0.5%malathion)comparedtoNixcre`merinse(1%permethrin)forthetreatmentofheadlice.PediatrDermatol.670…67438.DownsAM,StaffordKA,HarveyI,ColesGC.Evidencefordoubleresistancetoper-methrinandmalathioninheadlice.BrJ1999;141(3):508…51139.BaileyAM,ProcivP.Persistentheadlicefol-lowingmultipletreatments:evidenceforin-secticideresistanceinPediculushumanushumanusAustralasJDermatol.40.MeinkingTL,VillarME,VicariaM,etal.Theclinicaltrialssupportingbenzylalcohollo-tion5%(Ules“a):asafeandeffectivetopicaltreatmentforheadlice(pediculosishuma-nuscapitis).PediatrDermatol.19…2441.TenenbeinM.Seizuresafterlindanether-JAmGeriatrSoc.1991;39(4):394…39542.FischerTF.Lindanetoxicityina24-year-oldAnnEmergMed.43.ShacterB.Treatmentofscabiesandpedic-ulosiswithlindanepreparations:anevalu-JAmAcadDermatol.44.RasmussenJE.Theproblemoflindane.JAmAcadDermatol.45.KucirkaSA,ParishLC,WitkowskiJA.Thestoryoflindaneresistanceandheadlice.JDermatol.46.USFoodandDrugAdministration.FDApublichealthadvisory:safetyoftopicallindaneprod-uctsforthetreatmentofscabiesandlice.Availableat:www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/UCM052201.Ac-cessedJuly20,200947.AmericanAcademyofPediatrics.Pediculo-siscapitis(headlice).In:PickeringLK,BakerCJ,KimberlinDW,LongSS,eds.RedBook:2009ReportoftheCommitteeonIn-fectiousDiseases.28thed.ElkGroveVillage,IL:AmericanAcademyofPediatrics;2009:495…49748.ChesneyPJ,BurgessIF.Lice:resistanceandContempPediatr.49.AbramowiczM,ed.Drugsforheadlice.LettDrugsTher.1997;39(992):6…750.KaracicI,YawalkerSJ.Asingleapplicationofcrotamitonlotioninthetreatmentofpa-tientswithpediculosiscapitis.IntJDerma-1982;21(10):611…61351.BurkhartC,BurkhartC,BurkhartK.Anas-sessmentoftopicalandoralprescriptionsandover-the-countertreatmentsforheadJAmAcadDermatol.979…98252.GlaziouP,NyguyenLN,Moulia-PelatJP,Car-telJL,MartinPM.Ef“cacyofivermectinforthetreatmentofheadlice(pediculosisca-pitis).TropMedParasitol.1994;45(3):53.DourmishevAL,DourmishevLA,SchwartzRA.Ivermectin:pharmacologyandapplica-tionindermatology.IntJDermatol.54.ChosidowO,GiraudeauB,CottrellJ,etal.Oralivermectinversusmalathionlotionfordif“cult-to-treatheadlice[publishedcor-rectionappearsinNEnglJMed.2010;NEnglJMed.896…90555.BurkhartKM,BurkhartCN,BurkhartCG.Ourscabiestreatmentisarchaic,butivermec-tinhasarrived[letter].IntJDermatol.37(1):76…7756.BurkhartCN,BurkhartCG.Anotherlookativermectininthetreatmentofscabiesandheadlice[letter].IntJDermatol.57.ShashindranCH,GandhiIS,KrishnasamyS,GhoshMN.Oraltherapyofpediculosiscapi-tiswithcotrimoxazole.BrJDermatol.98(6):699…70058.HipolitoRB,MallorcaFG,Zuniga-MacaraigZO,ApolinarioPC,Wheeler-ShermanJ.Headliceinfestation:singledrugversuscombinationtherapywithonepercentpermethrinand2001;107(3).Availableat:www.pediatrics.org/59.PriestleyCM,BurgessIF,WilliamsonEM.Lethalityofessentialoilconstituentsto-wardsthehumanlouse,Pediculushuma-,anditseggs.60.SchachnerLA.Treatmentresistantheadlice:alternativetherapeuticapproaches.PediatrDermatol.1997;14(5):409…41061.BurkhartCN,BurkhartCG,PchalekI,Arbo-gastJ.Theadherentcylindricalnitstruc-tureanditschem

12 icaldenaturationinvitro:anassessmentwith
icaldenaturationinvitro:anassessmentwiththerapeuticimplica-tionsforheadlice.ArchPediatrAdolesc62.Takano-LeeM,EdmanJD,MullensBA,ClarkJM.Homeremediestocontrolheadlice:assessmentofhomeremediestocontrolthehumanheadlouse,Pediculushuma-nuscapitisJPediatrNurs.63.PearlmanDL.Asimpletreatmentforheadlice:dry-on,suffocation-basedpediculicide.2004;114(3).Availableat:www.64.RobertsRJ,BurgessIF.Newhead-licetreatments:hopeorhype?365(9453):8…1065.PearlmanD.Cetaphilcleanser(Nuvolotion)curesheadlice[comment].66.PearlmanD.Nuvotreatmentforheadlice.Availableat:www.nuvoforheadlice.com/explained.htm.AccessedMarch1,67.BurgessIF,BrownCM,LeePN.Treatmentofheadlouseinfestationwith4%dimethiconelotion:randomizedcontrolledequivalence68.BurgessLF,LeePN,BrownCM.Randomised,controlled,parallelgroupclinicaltrialstoevaluatetheef“cacyofisopropylmyristate/cyclomethiconesolutionagainstheadlice.PharmaceutJ.69.KaulN,PalmaKG,SilagySS,GoodmanJJ,TooleJ.NorthAmericanef“cacyandsafetyofanovelpediculiciderinse,isopropylmy-ristate50%(Resultz).JCutanMedSurg.70.GoatesBM,AtkinJS,WildingKG,etal.Aneffectivenonchemicaltreatmentforheadlice:alotofhotair.71.IbarraJ,HallDM.Headliceinschoolchil-ArchDisChild.1996;75(6):471…47772.BainbridgeCV,KleinGL,NeibartSI,etal.Comparativestudyoftheclinicaleffec-tivenessofapyrethrin-basedpediculi-cidewithcombingversusapermethrin-basedpediculicidewithcombing[publishedcorrectionappearsinClinPe-diatr(Phila).1998;37(4):276].ClinPediatr73.BurkhartCN,ArbogastJ.Headlicetherapyrevisited[letter].ClinPediatr(Phila).74.MaunderJW.Updatedcommunityapproachtoheadlice.JRSocHealth.75.PlastowL,LuthraM,PowellR,etal.Headliceinfestation:bugbustingvs.traditionalJClinNurs.76.MonheitBM,NorrisMM.Iscombingthean-swertoheadlice?JSchHealth.158…15977.MeinkingTL,ClineschmidtCM,ChenC.Anobserver-blindedstudyof1%permethrinFROMTHEAMERICANACADEMYOFPEDIATRICS `merinsewithandwithoutadjunctivecombinginpatientswithheadlice.JPedi-2002;141(5):665…67078.OBrienE.Detectionandremovalofheadlicewithanelectroniccomb:zappingtheJPediatrNurs.79.BurkhartCN,BurkhartCG.Headlice:sci-enti“cassessmentofthenitsheathwithclinicalrami“cationsandtherapeuticop-JAmAcadDermatol.129…13380.KoCJ,ElstonDM.Pediculosis.JAmAcad2004;50(1):1…12;quiz13…481.HunterJA,BarkerSC.Susceptibilityofheadlice(Pediculushumanuscapitis)topedicu-licidesinAustralia.ParasitolRes.90(6):476…47882.MeinkingTL,EntzelP,VillarME,VicariaM,LemardGA,PorcelainSL.Comparativeef“-cacyoftreatmentsforpediculosiscapitisinfestations:update2000.ArchDermatol.83.BartelsCL,PetersonKE,TaylorKL.Headliceresistance:itchingthatjustwontstop.2001;35(1):109…11284.CanyonD,SpeareR.Doheadlicespreadinswimmingpools?IntJDermatol.85.WilliamsLK,ReichertA,MacKenzieWR,High-towerAW,BlakePA.Lice,nits,andschool86.HootmanJ.Qualityimprovementprojectsrelatedtopediculosismanagement.JSch2002;18(2):80…8687.MathiasRG,WallaceJF.Controlofheadlice:usingparentvolunteers.CanJPublic1989;80(6):461…46388.CloreER,LongyearLA.Comprehensivepedic-ulosisscreeningprogramsforelementaryJSchHealth.89.DonnellyE,LipkinJ,CloreER,AltschulerDZ.Pediculosispreventionandcontrolstrate-giesofcommunityhealthandschoolnurses:adescriptivestudy.JCommunityHealthNurs.90.BrainerdE.Fromeradicationtoresistance:“vecontinuingconcernsaboutpediculosis.JSchHealth.1998;68(4):146…15091.CloreER.Dispellingthecommonmythsaboutpediculosis.JPediatrHealthCare.1989;3(1):28…3392.AstonR,DuggalH,SimpsonJ,BurgessI.Headlice:evidence-basedguidelinesbasedontheStaffordReport.JFamHealthCare.2002;12(5suppl):1…2193.MumcuogluKY,MeinkingTA,BurkhartCN,BurkhartCB.Headlouseinfestations:thenonitŽpolicyanditsconsequences.IntJ2006;45(8):891…89694.MumcuogluKY,BarkerSC,BurgessIF,etal.Internationalguidelinesforeffectivecon-trolofheadlouseinfestations.JDrugsDer-2007;6(4):409…41495.NationalAssociationofSchoolNurses.tionStatement:PediculosisintheSchool.SilverSpring,MD:NationalAs-sociationofSchoolNurses;1999(Revised2004).Availableat:www.nasn.org/Default.237.AccessedonMarch1,FROMTHEAMERICANACADEMYOFPEDIATRICSPEDIATRICSVolume126,Number2,A