Lice

Lice are flat, wingless blood-sucking insects that lay their eggs or nits on hairs and clothing. There are two species: body lice (includes head lice) and pubic lice. These are often very stigmatising conditions.

Body lice
The body louse is usually seen in people living in poor social conditions and is spread by infested bedding and clothing. Excoriation is common and lichenification and pigmentary changes may occur. The lice are seen on the clothing, not the person. It can be treated by washing clothing and bedding and topical application of maliathon or permethrin.

Head lice (Pediculosis capitis)
These are a worldwide phenomenon and affect people of all ages but are very common among children with those aged 4–11 years most affected (Wyndham, 2008). The itching usually starts at the side and back of the head and the scratching often results in secondary infection and matted hair. The nits or eggs are often easier to see than the lice (Gawkrodger, 2003). They are more common in girls and in urban areas and spread by head to head contact. For reasons which are unclear, some children experience persistent head lice infestations which last weeks, or even years (Gordon, 2007). For many of these children and their families, this is very problematic and the strain and difficulties which should not be underestimated are well documented by Gordon. The families she studied experienced ostracisation and social isolation and feelings of failure as parents. They sought help from a multitude of services while trying to keep the lice a secret from their communities and well demonstrated the ways in which head lice made them lose their sense of perspective.

Management
This needs to be with the pediculicide to which the lice are most likely to be sensitive and will vary from district to district. Maliathon, permethrin or carbaryl lotion are all commonly used. Shampoos are too weak to be effective so lotion or liquid preparations should be used. Alcoholic preparations are most effective but can be irritant (BNF, 2008).

1. Apply pediculicide to all areas of the scalp and to all the hairs from their roots to their tips.
2. Leave on for 12 hours before washing off and repeat after a week to kill any lice which have hatched out after the first application.
3. If lice are found after the second treatment, then treatment should start again with a different pediculicide.
4. Alcohol-based lotions can sting but shampoos which are on for a short time are less effective.
5. Hair should also be combed on a daily basis with the help of a good light and a magnifying glass. Combing (which can be very time consuming) should go on until no living lice have been found for 2 weeks. Using a conditioner to lubricate the hair make may combing easier. The comb should be washed regularly to remove lice and eggs (BAD, 2008).