Super Lice: What Retail Clinicians Need to Know

Retail clinicians should be prepared to field questions about strains of so-called “super lice” that have spread throughout 25 US states thus far.

The US Centers for Disease Control and Prevention (CDC) estimates that head lice infects 6 to 12 million children primarily between the ages 3 and 11 each year.

Usually, parents can simply use OTC treatments and combs to kill and remove the lice within 1 day if used as directed. Currently, however, some strains of circulating lice have built a resistance to pyrethoid, the main pharmacologic agent in OTC lice treatments, so prescription treatment is needed to eradicate these “super lice.”

Parents who are unable to kill their children’s lice with OTC remedies may turn to a retail clinic for counseling on what to do next. Retail clinicians are well positioned to ensure that parents are aware of existing treatment options.

Permethrinis an alternative OTC lotion that doesn’t contain pyrethoid. Patients with lice using permethrin should wash their hair as normal with a shampoo that doesn’t contain conditioners, and then dry the hair, apply the lotion, and leave the product in for 10 minutes before rinsing.

Clinicians should recommend that parents try OTC remedies first because not every child with lice needs to receive prescription treatment. Unnecessary use of the prescription formulation could contribute to future resistance.

If parents’ efforts are fruitless and their child appears to have “super lice,” prescription treatmentsrecommendedby the American Academy of Pediatrics include malathion 0.5%, benzyl alcohol 5%, spinosad 0.9% suspension, and ivermectin 0.5% lotion. Parents should also take supplemental nonpharmacologic measures to prevent reinfestation.

According to the CDC, these measures include the following:

• Machine wash using hot water and dry using hot air any hats, scarves, pillow cases, bedding, clothing or towels worn or used by the infested individual in the 2-day period just before treatment was started. Lice and eggs are killed by exposure after 5 minutes to temperatures greater than 128 degrees Fahrenheit.
• Place non-washable items in a sealed plastic bag for 2 weeks.
• Vacuum furniture and floors to remove an infested individual’s hair that might have viable eggs attached.
• Soak all combs and brushes in hot water for 5 to 10 minutes at a temperature of at least 130 degrees Fahrenheit.