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O T C M O D U L E

tra

ining excellence

in association with C

IG

Quality Seal 2017

This module is suitable for all members of the pharmacy team who wish to increase their knowledge of common conditions, treatment options and communication skills . This module has been endorsed with the NPA’s Training Seal as suitable for use by pharmacy teams as part of their ongoing learning. This module can also form part of your Team Tuesday training.

Customers may be embarrassed talking about head lice, but an infection is very common and with regular checks and effective treatment, lice can be brought under control.

Have an understanding of the life cycle of head lice Be able to advise on detecting a head lice

infection

Know what treatment options are available.

OBJECTIVES

After studying this module, assistants will:

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THE PROFESSIONAL ASSISTANTLEARN & ADVISE

Head lice

Head lice are tiny, parasitic insects that live in human hair. They stay close to the scalp for warmth and feed on blood several times a day. When fully grown, they are about the size of a sesame seed and are grey/brown in colour, although they may appear darker in people with darker hair.

Lice can’t fl y, jump or swim, but they do walk around the scalp, holding onto hair shafts as they go. Each louse has six legs with claws to help it grip onto the hair.

The number of lice that may be present on an infected individual varies, but usually there are around 30. Head lice only live on humans, not on pets or animals, and do not carry diseases.

Head lice are tiny, parasitic insects that live in human

After seven to 10 days, the baby lice (“nymphs”) hatch, leaving their empty eggshells still attached to the hair. These empty shells, called “nits”, appear whiter in colour and are more noticeable, especially as the hair grows.

Newly-hatched lice can feed immediately but can’t reproduce until they have matured, a process that involves three moulting stages during which they get larger and look more like adult lice.

An adult female head louse lays around six to eight eggs a day, which she glues to hair shafts close to the

scalp. These eggs, each about the size of a pinhead, can be difficult to see

and may be confused with dandruff.

After around nine to 10 days, newly-matured

females start to lay their own eggs. Female lice have

a lifespan of three to four

weeks.

involves three moulting stages during which

The life cycle of head lice

01

03 02own eggs. Female lice have a lifespan of three to four

weeks.

own eggs. Female lice have a lifespan of three to four

weeks.

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After studying this module, assistants will:

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O T C M O D U L E

Phrases like “Feeling lousy”, “Nit wit” and “Nit picking” have all entered our language because of head lice infections.

DID YOU KNOW??

When recommending a head lice treatment, bear in mind that multiple family members may need to use it, so check all ages, especially of younger children, and remember to enquire about pregnancy and asthma (some products contain solvents which may not be suitable for people with asthma). Ask the WWHAM questions and refer to your pharmacist when necessary.

Check that your customer buys sufficient product (a small bottle for short/shoulder length hair or a larger bottle for longer/thicker hair) for every infected person to use at the same time and make sure that they understand how to use the product correctly. Are they, for instance, aware of how long the treatment should be left on the hair, and if they should reapply it?

Treatment options

Physical insecticidesThese contain ingredients such as cyclomethicone, isopropyl myristate and dimeticone, which kill lice by physical means (e.g. by blocking the tubes that lice use to breathe or by causing dehydration). Lice cannot become resistant to these products.

Physical insecticides are effective against live lice, but while some also target unhatched eggs, others require a second application after seven days to kill any lice that may have hatched since the first application. They are available in a range of formulations – lotion, mousse, solution, shampoo or spray gel. These products need to be applied thoroughly to cover all of the hair. Point out to customers any cautions relating to slippery surfaces or whether they may be flammable. OTC brands include Hedrin, Lyclear, Full Marks Solution and Vamousse.

Chemical insecticidesThese products contain chemicals that kill head lice, such as malathion (the active ingredient in Derbac-M). However, head lice have been known to develop resistance to them. As with all head lice treatments, customers should follow the manufacturer’s instructions carefully and repeat the application after seven days if indicated.

Wet combingWet combing is the systematic combing of hair with a comb specifically designed to remove lice and/or eggs. Due to the nature of their life cycle, this needs to be done over two weeks, on days one, five, nine and 13. Detection combing should be done again on day 17 to check all lice have been removed.

There are also products available that are designed to help with removal of eggs from the hair, such as Hedrin Stubborn Egg Removal kit.

Alternative optionsProducts based on natural ingredients, such as Puressentiel Anti-Lice treatment lotion, are also available.

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SIGNPOSTING

Use your Counter Intelligence Plus training guide Visit NHS Choices: nhs.uk/Conditions/Head-lice/

Pages/Introduction.aspx Visit the British Association of Dermatologists

website: bad.org.uk/for-the-public/patient-information-leafl ets/head-lice.

For more information, you can:

Head lice treatments should not be used “just in case”. Only people who have an active infection – shown by the presence of live, moving lice or unhatched eggs attached to hairs close to the scalp– should be treated.

Don’t forget!!

Who to referYou should refer to the pharmacist:

Infants under six months of age Women who are pregnant or breastfeeding

Anyone with asthma or allergies Rashes or sores suggesting a

secondary bacterial infection Customers who say that their

previous treatment didn’t work.

Preventing reinfectionOffer the following tips to customers: Tell close friends and family that head lice

have been found so that they too can be checked Children should avoid prolonged head-to-head

contact with friends and should not share hairbrushes, hats, etc Check the hair two to three days after

treatment to be sure that it was successful and then carry out weekly detection combing Use preventative products (e.g. Lyclear Head

Lice Repellent Spray, Vamousse Protective Shampoo, Vosene Kids Advanced Conditioning Defence Spray, Hedrin Protect and Go). These may be used during known head lice outbreaks or immediately after having successfully completed head lice treatment to help avoid reinfection.

Physical insecticides are effective against live lice, but while some also target unhatched eggs, others require a second application after seven

You should refer to the pharmacist: Infants under six months of age

Women who are pregnant or breastfeeding

Anyone with asthma or allergies Rashes or sores suggesting a

There are also products available that are designed to help with removal of eggs from the hair, such as

Alternative optionsProducts based on natural ingredients, such as Puressentiel Anti-Lice treatment lotion,

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O T C M O D U L E

Head lice

detectionHead lice can be diffi cult to spot just by looking in the hair, especially considering their size, colour and the fact that they move quickly. Plus, head lice don’t usually cause any symptoms. Some people complain of an itchy scalp, but itching only develops if the person is allergic to the lice and their droppings. An itchy scalp may be due to other conditions such as eczema, psoriasis or dandruff.

Other possible symptoms of head lice include: A crawling sensation on the scalp A rash on the back of the neck Pillows that appear dirtier than usual.

Nits can be easier to spot – they look like dandruff, but stick strongly to the hair and can’t be removed easily by brushing. However, the presence of nits

only really shows that the person has had head lice at some point – it is not proof that they are

currently infected.

Head lice are most common among school children aged four to 11 years

Girls are more likely to be affected than boys, probably because of the way they play together

Head lice are not a reflection of poor hygiene and they don’t prefer long rather than short hair

Up to one in three children in the UK may get head lice at some point during the year, most often at the start of the school year

Head lice can only survive for about 24 hours if they are not on a scalp.

Fast facts

The only way to determine if live lice are present is to fi nd them by detection combing. This can be done on dry or wet hair, but when lice are wet, they remain still, so wet detection combing is easier. It requires a fi ne-toothed detection comb with teeth about 0.2-0.3mm apart.

Advise customers to: Wash the hair using ordinary shampoo and apply conditioner.

Use a regular comb to detangle and straighten the hair Switch to a detection comb and, ensuring that the edges of the

teeth touch the scalp, comb down to the ends of the hair After each stroke, check the comb for lice. Wipe or rinse the

comb before combing through again Work methodically, section by section, until the whole head

has been checked. This may take 10-15 minutes Areas to check carefully include close to the scalp, the back

of the neck and behind the ears Rinse out the conditioner and repeat the combing on the

rinsed hair. If live lice are found, everyone else in the home should be checked and those infected treated at the same time.

Remember that an infected child does not need to be kept away from school but the school should be informed so that other parents can be vigilant.

Detection combing

Head lice are most common among school

Girls are more likely to be affected than boys, probably because of the way they play together

Head lice are not a reflection of poor hygiene and they don’t prefer long rather than short hair

Up to one in three children in the UK may get head lice at some point during the year, most often at the start of the school year

Head lice can only survive for about 24 hours

rinsed hair. If live lice are found, everyone else in the home should be checked and those infected treated at the same time.

Remember that an infected child does not need to be kept away from school but the school should be informed so that other parents can be vigilant.

Girls are more likely to be affected than boys, probably because of the way they play together

Head lice are not a reflection of poor hygiene and they don’t prefer long rather than short hair

Up to one in three children in the UK may get

Head lice can only survive for about 24 hours

An itchy scalp is not a sure sign of head lice. Some people don’t experience an itch and, if they do, it may take up to three months to develop.

DID YOU KNOW??

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O T C M O D U L E

GOOD PRACTICE KNOWLEDGE IS IMPORTANT WHEN ADVISING CUSTOMERS

Questions Scenario?

TEST YOURSELF ONLINE

Paul asks for your advice. His son James had a play-date a couple of days ago and the parents of the child he played with have since confirmed that their son has a head lice infection. As a precaution, Paul wants to buy a product to treat his son’s hair.

1) Which of the following statements about the head louse

life cycle is FALSE?

a) An adult female louse lays 10 eggs a dayb) After around seven days, baby lice hatchc) The maturing process involves three moulting stagesd) Female lice live for three to four weeks

2) Which of the following statements is TRUE?

a) Head lice can jump from one head to anotherb) A nit is an empty egg casec) A nit is a young louse, before it lays eggsd) Head lice can carry Lyme disease

3) Which of the following customers should NOT be treated

for head lice?

a) A six-month-old with a live louse detected using a combb) A girl whose four-year-old brother has a head louse infectionc) A five-year-old in whose hair a small nymph has been foundd) An adult who has found an adult louse and several nits in their own hair

4) Which of the following is NOT a physical insecticide?

a) Cyclomethiconeb) Dimeticonec) Isopropyl myristated) Malathion

5) Which of the following statements is FALSE?

a) Up to one in three children in the UK may get head lice at some point b) Girls are more likely than boys to be affected by head licec) Head lice prefer long haird) Head lice are more common in children aged four to 11

6) A mum has been told that there is an outbreak of head

lice at her children’s school. Which of the following is NOT

suitable advice to help prevent an infection?

a) Carry out regular weekly detection combingb) Apply insecticide weekly c) Ask her children to avoid head-to-head contact with friendsd) Use products designed to act as repellents

For each part of this scenario, think about the decision you would make and, importantly, why you would choose that option. In addition, for each decision

that you make, think about how you would talk to the customer and provide the necessary advice. You can discuss this with your team and your pharmacist.

What if?

Paul returns to the pharmacy saying that he has found a few live lice on

his son’s hair.

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Recommend continuing regular wet combing to remove the lice.

Explain that wet detection combing should be done on his son’s hair to

check for live lice before a treatment is used, and explain the process to him.

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Paul should use a repellent product on his son’s hair.

What would you recommend?

What if?Paul tells you that his son has asthma.

Ask the WWHAM questions to identify a suitable product to kill the lice.

Refer to the pharmacist.

Recommend a repellent spray.

Recommend continuing regular wet combing to

remove the lice.

Go to www.tmmagazine.co.uk to submit your answers to these questions. When you pass, you’ll be able to download a certifi cate to showcase your learning. You can also add this to

your online, personalised learning log.

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