Head lice

test4

For dose, refer to BNF for Children.

Prescribing Notes:

Dimeticone coats head lice and interferes with water balance in lice preventing the excretion of water; it is less active against eggs and treatment should be repeated after 7 days.
During treatment with dimethicone 4% lotion, keep away from fire, especially naked flames and burning cigarettes, hair can burn readily if ignited.
Head lice should be treated with lotion or liquid. Products with short application times e.g. cream rinse and mousse formulations, are not recommended. Shampoos are diluted too much during use to be effective and should not be used.
Aqueous formulations are preferred in severe eczema, asthmatic patients and small children.
Malathion should not be applied at intervals of less than 1 week or for more than 3 consecutive weeks since effectiveness is not increased.
In pregnancy, dimeticone or wet combing are preferred. If malathion is required, the liquid in aqueous base should be used.
Permethrin is not recommended for the treatment of head lice since currently available formulations are diluted too much during use.
Routine treatment of family members is unnecessary, but contacts should have detection combing for live lice and then treatment if positive.
Nit combs and devices are available via Pharmacy First.

31/05/2024

East Region Formulary content agreed.

Dose according to age and product licence.

NICE guidance can be found on the CKS website.
Wet combing can be used as a treatment or to check for effectiveness in combination with an insecticide. Wet combing method, is four sessions spaced over 2 weeks (days 1, 5, 9 and 13.)
Head lice should be treated with lotion, liquid or cream rinse formulations; shampoos are diluted too much during use to be effective and should not be used.
During treatment with dimeticone 4% lotion keep away from fire, especially naked flames and burning cigarettes, hair can burn readily if ignited.
A rotational policy for insecticides is outmoded; a mosaic strategy is suggested whereby if a course of treatment fails then a different insecticide is used for the next course.
Malathion should not be applied at intervals of less than 1 week or for more than 3 consecutive weeks since effectiveness is not increased.
For head lice, only those with confirmed infection should be treated. Patients should be advised to follow the product instructions carefully. Treatment should be repeated after 7 days.
If a course of treatment (two applications, one week apart) fails to cure, a different insecticide should be used for the next treatment. Refer to NICE guidelines for treatment and management advice.

27/10/2020

Content migrated from ‘East Region Formulary: Pharmacy First - supporting minor ailments’ document.