Second only to the common cold, head lice infestation is one of the most common health issues that affect school age children. The cost to the community is quite high when we take into consideration days lost at school by children and lost productivity by working parents. Misdiagnosis or simple ignorance only exacerbates the problem and is the primary cause of major outbreaks. Pharmacists and health care practitioners can do much to slow or halt outbreaks by using a standardised approach to controlling head lice.

Pediculosis is difficult to diagnose especially by someone who is new to the experience. Casual examination under poor light or the use of a normal comb or brush is not likely to show any evidence especially if the infestation is recent and the louse numbers are small. Also the mistaken expectation of seeing millions of black flea sized lice scurrying around the scalp is not going to allow for accurate diagnosis so it important to educate parents exactly what theya re looking for. Here are some important “dos” and a few “don’ts” that will assist accurate diagnosis.

Before advising on a treatment it is important to ensure that the diagnosis is accurate. In the absence of the patient you may need to advise a parent or carer how to identify an infestation.

Examine the scalp under bright light.

Lice are about the size of a sesame seed and semi translucent when unfed and reddish brown after a blood meal. They will generally move away from a light source unless they are feeeding. They travel at about 100mm per minute so they are not so fast that they can be easily missed.

Look for nits as well as live lice

Viable eggs are oval, yellowish white to grey and are usually attached about a centimetre from the scalp. White ”eggs” that are more than a centimetre from the scalp are probably empty shells from which lice have already hatched. Viable eggs can be found further along the hair shaft so they should not be ignored.

The most effective way of detecting lice is with the use of a nit comb.

Quit Nits Combing Solution will offer good visual contrast to make detection easier and make the process pain free by lubricating the hair. It is especially helpful for children with thick or long hair. Wipe the nit comb on a white tissue to give the best visual contrast.

Educate patients and parents in the difference between normal hair debris and lice and nits.

Desquamated epithelial cells (dandruff) are bright, white and often confused with louse eggs. The difference can determined by the fact that dandruff moves easily when disturbed while eggs are firmly cemented onto the shaft.

Look at areas immediately adjacent to the scalp for evidence also.

Head lice and their eggs are normally found on or near the scalp but may also be on the nape of the neck of behind the ears

Advise patients that routine screening and early diagnosis is the best preventative.

Be mindful that some parents will assume that their child is infested if they hear of an outbreak. This is good reason to screen but not a good reason to treat, especially with chemical pesticide based products.