Supplements Definitive Management of Head Lice in the Era of Pediculicide Resistance
Overview: The State of Head Lice Management and Control
Lice infestation is viewed as a socially
repugnant condition, but it is not associated
with significant morbidity except for pruritus and occasional pyoderma. Among children,
who are most likely to become infested,
the primary negative effect of lice
infestation is absence from school. Well-meaning
but misguided school policies that
exclude children with lice infestation should
be revised or eliminated. Research has
demonstrated that misdiagnosis of lice infestation
is common, and a significant number
of children who are sent home do not have
active infestations.9 This, coupled with
resistance to commonly used pyrethroid
pediculicides, results in inappropriate and
unnecessary head lice treatment commonly
occurring among school-aged children.
The effects of misdiagnosis and resistance
are costly in terms of direct and indirect costs
to society. Direct costs include costs of treatment,
which may be repeated several times if
lice are resistant. Indirect costs are even
more substantial, including missed days from
school and parental work days missed to care
for a child who has been sent home from
school. Recommendations for improving
treatment include increasing the accuracy of
diagnosis, treating only those children who
have confirmed, active infestations, resisting
no-nit policies, and using pediculicides properly
to decrease overexposure to children and
the possibility of promoting treatment-resistant
lice. Ultimately, the development of new
pediculicides will be needed as resistance
increases. These topics will be described in
more detail in this supplement.
1. Recommendations for the treatment of pediculosis capitis (head lice) in children. University of Texas at Austin, School of Nursing, Family Nurse Practitioner Program. 2002. Available at: http://www.guideline.gov/guidelines/FTNGC-2451.html. Accessed on June 17, 2004.
2. Frankowski BL, Weiner LB; Committee on School Health the Committee on Infectious Diseases. American Academy of Pediatrics. Head lice. Pediatrics. 2002;110:638-643.
3. Meinking T, Taplin D. Infestations. In: Pediatric Dermatology. 3rd ed. Schachner LA, Hansen RC, eds. Edinburgh:Mosby; 2003:1141-1180.
4. Hansen RC. Guidelines for the treatment of resistant pediculosis. Contemporary Pediatrics (suppl). Montvale, NJ: Medical Economics; 2000:4-10.
5. Pollack J. Head lice information. Harvard School of Public Health. Available at: http://www.hsph.harvard.edu/headlice.html. Accessed on June 17, 2004.
6. Chunge RN, Scott FE, Underwood JE, Zavarella KJ. A review of the epidemiology, public health importance, treatment and control of head lice. Can J Public Health. 1991;82:196-200.
7. Meinking TL, Serrano L, Hard B, et al. Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States. Arch Dermatol. 2002;138:220-224.
8. FDA Public Health Advisory: Safety of Topical Lindane Products for the Treatment of Scabies and Lice. Center for Drug Evaluation and Research. Available at: http://www.fda.gov/cder/drug/infopage/lindane/default. htm. Accessed on June 17, 2004.
9. Pollack RJ, Kiszewski AE, Spielman A. Overdiagnosis and consequent mismanagement of head louse infestation in North America. Pediatr Infect Dis J. 2000;19:689-693.
10. Hansen RC, O'Haver J. Economic considerations associated with Pediculus humanus capitis infestation. Clin Ped. 2004;43:523-528.