Like scabies, the presence of
one patient with lice should prompt the search for other cases
involving personnel who are billeted nearby. Look around, you might
be surprised what you discover. The washing of involved clothing in
water greater than 50 degrees celsius will kill the lice and any nits.
Use Kwell, Nix or Rid shampoos, or
similar products. Adequate pre-cleaning followed by adequate
medication contact time is the key. The hair should be routinely
shampooed clean and toweled dry (i.e. moist but not dripping wet)
before the application of the pediculocide shampoo.
The pediculocide shampoo should
be directly applied from the bottle onto the affected areas and worked
into lather without the addition of water. Kwell shampoo should have
at least 4-5 minutes and other products about 10 minutes of contact
time before rinsing off with water. Retreat one week later.
Treatment failure is not due to resistant lice. The pediculocides
available today do not kill nits as well as they kill live lice.
Treatment failure is most frequently due to reinfestation or
inadequate contact time.
If treating the scalp, be sure to
treat behind the ears and the base of the neck. It is very easy to
inadequately treat patients with long hair. Longer haired patients
should use a plastic shower cap to insure coverage. Avoid the eyes.
Nits can be removed with a nit
comb or picked off with tweezers (see figure 8). Rinsing the hair
with a 2:1 dilution of table vinegar before combing will help loosen
the nits. Combs and brushes should be soaked in the pediculocide
shampoo for about an hour or heated to about 65 degrees Celsius for
5-10 minutes.
The treatment of crab lice should
not just involve the pubic hair. It should also cover the hairy skin
from the umbilicus down to mid thigh. In particularly hairy
individuals, check the axilla and chest for involvement.
Lice on the eyelashes can be treated by
thickly applying Vaseline 2-3 times a day for a week. This treatment
smothers the lice. Ammoniated Mercury ointment 0.1% applied to the
lids is also quite effective. The nits can then be mechanically
removed.
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Written and revised by CAPT Dennis
A. Vidmar, MC, USN, Department of Military and Emergency
Medicine, and Department of Dermatology, Uniformed Services University
of the Health Sciences, Bethesda, MD (1999).
Additional images provided by CAPT Vidmar in
June, 2000, subsequent to the initial publication of this manual.
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