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Supplements Definitive Management of Head Lice in the Era of Pediculicide Resistance
Clinical Update on Resistance and Treatment of Pediculosis capitis
Terri L. Meinking, BA
Head Lice Treatment Costs and the Impact on Managed Care
Dennis P. West, PhD, FCCP
Overview: The State of Head Lice Management and Control
Ronald C. Hansen, MD
American Academy of Pediatrics Guidelines for the Prevention and Treatment of Head Lice Infestation
Barbara L. Frankowski, MD, MPH
Faculty Discussion: Definitive Management of Head Lice in the Era of Pediculicide Resistance
PARTICIPATING FACULTY
Clinical Update on Resistance and Treatment of Pediculosis capitis
Terri L. Meinking, BA
Treating and Managing Head Lice: The School Nurse Perspective
Sally Z. Schoessler, BSN, RN, SNT
Faculty Discussion: Definitive Management of Head Lice in the Era of Pediculicide Resistance
American Academy of Pediatrics Guidelines for the Prevention and Treatment of Head Lice Infestation
Barbara L. Frankowski, MD, MPH
PARTICIPATING FACULTY
Head Lice Treatment Costs and the Impact on Managed Care
Dennis P. West, PhD, FCCP
Currently Reading
Overview: The State of Head Lice Management and Control
Ronald C. Hansen, MD

Overview: The State of Head Lice Management and Control

Ronald C. Hansen, MD

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.

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