We gets to grips with the different treatment options for head lice and how pharmacy staff can help parents navigate this category

Head lice and other parasites, are highly emotive issues for the children they tend to affect, and their families. Hard to get rid of, head lice, worms and other parasites have evolved to be highly contagious and hard to treat, which adds to the overall frustration parents and healthcare professionals will experience during an outbreak.

The days of children coming home with a letter informing them that someone in their class has head lice are dreaded by parents. The alert heralds the beginning of weeks of battles with a nit comb and various lice-busting products for many families. So which treatments should pharmacies advise parents to use to make eradicating head lice as stress-free as possible?

Spotting head lice

Head lice are very small grey-brown insects about the size of a sesame seed that live on the human scalp. Their eggs are yellow or white, and the size of a pinhead and are usually found behind the ears or at the back of the neck.

Treatment options

Most pharmacies will sell a range of treatments for head lice but there is actually a significant variation between the treatments and how well they work.

  •  Chemical insecticides

Chemical insecticide treatments have been widely used for decades but their effectiveness has been on the decline since the emergence of insecticide resistance in the mid-90s. The effectiveness of insecticide-containing treatments can be as low as 15 per cent, warns Ian Burgess, director of Insect Research and Development Limited. The two active ingredients that are commonly used to eradicate head lice include permethrin and malathion.

  • Physical insecticides

Head lice products containing dimeticone and isopropyl myristate kill head lice through a physical action, which means lice can’t become resistant to them. These treatments should be used according to instructions and applied twice with seven days between applications in order to kill any lice that may have hatched after the first treatment.

  • Natural remedies

Natural oils have long been thought to have pesticide-like properties and more research is being done into their effectiveness against head lice, however it is generally thought that this is dependent on the combination, concentration and quality of oils used. Essential oils are thought to have an effect on head lice include tea tree, lavender, eucalyptus and coconut. Head lice products containing these oils can be used alongside a detection comb.

  • Combing

Wet combing removes head lice and their eggs without the use of chemicals. It should be done regularly for at least two weeks. The hair should be washed with ordinary shampoo and rinsed, before applying conditioner to the hair and working a fine-toothed comb through the hair, checking and removing any lice from the comb after each stroke.

Though this regimen is tried and tested, user error can lead to it failing and Dr Burgess says it can be difficult for people to adjust to it. “They give up too soon as they think they have done enough or they don’t get enough lice off in each session,” he says.

He says a lot of the time people are using the wrong comb. Often that is because the wrong types are sold in pharmacy or in the packs of head lice treatment solution, Dr Burgess warns.

He advises that a comb used for head lice treatment should ideally:

  • Be plastic, as these are better at holding the lice than a metal comb
  • Be rigid
  • Have teeth 0.3mm apart
  • Have teeth with one flat face (this is the face point towards the tips of the hair so they pick up the legs of the lice).

Though wet combing can be an “onerous” process, Joanna Barra, programme adviser for Community Hygiene Concern says it makes sense for families to be in charge of the situation and see if it works for them.

Fast facts

Aromatherapy brand Puressentiel commissioned a survey of 1,000 parents, which found some surprising facts:

  • Two out of three parents have had to deal with head lice
  • Families face, on average, three or four head lice infections while children are at school
  • Just over half of parents thought head lice problems peaked when children go back to school but more than a quarter believe it to be a year-round problem
  • More than half of parents said they felt ashamed if their children had head lice and 57 per cent said their child also felt shame
  • A quarter of parents still believe that poor hygiene increases the risk of getting head lice
  • Nearly two out of 10 parents (16 per cent) admitted they wouldn’t tell anyone if their child had head lice
  • 32 per cent of parents wrongly thought it was impossible to have head lice and not know it and almost half of parents thought head lice always caused an itchy head.

Prevention better than cure?

There are some repellents on the market, though there is little research done into how effective these are on human heads warns Dr Burgess. Experts recommend the “once a week, take a peek” approach to catch head lice early, which helps with eradication.

Empowering patients to take control

There is also a strong role for pharmacy staff to empower their patients to use the treatments effectively. “We need to deal with them with empathy when someone comes in when they have head lice, says Joanna. Pharmacy staff “must empower that person to see it is nothing to do with them being dirty and also that there is nothing to be ashamed of if we fail to control them as shown many times by the evidence; they are hard to get rid of,” she adds.

Other parasites

  • Scabies

What they are: A form of burrowing mite that enters the skin.
Symptoms: Intense itching of the skin that gets worse at night.
Transmission: Prolonged skin-to-skin contact. Sexual transmission of genital scabies is also possible, as well as through sharing towels.
Who gets them: People who reside, study or work in places with lots of people in them, such as care homes or nursery schools.
Treatment: Permethrin 5% cream is usually recommended as the first treatment. Malathion 0.5% lotion is used if permethrin is ineffective.

  • Threadworm

Also known as pinworms.
What they are: Small, white thread-like worms that live in the rectum and anus.
Symptoms: Parents may see worms around their child’s anus or when they go to the toilet. They cause itching that’s worse at night.
Transmission: The eggs are ingested either when they get on the hands or under the fingernails from scratching.
Who gets them: They are common in children and their parents/carers.
Treatment: Worms are highly contagious and if one person has it then the entire household will need to be treated with a single dose of mebendazole to kill the worms.


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