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OTC Case Study Presentation - Head Lice
1. OTC Case Study Presentation:
Head Lice
Presented by Dave Porter
2. Presentation Outline
• Case Study
– Case study text
– Patient overview
• Pathophysiology
– Lice life cycle
– Disease state overview
• OTC Pharmacological Options
• Nonpharmacological Options
• Prevention of Reoccurrence
• Conclusion
4. The Case
A mother comes to our pharmacy asking questions
about eradicating lice in her seven-year-old
daughter’s long hair. Her mother says her daughter
is very itchy. There is a younger daughter and an
older brother in the household as well.
What are some products we offer and what are the
counseling points that should be discussed with this
patient and her mother concerning these products?
5. The Patient
• Seven year old female with long hair
• HPI/CC
– Head lice in hair
– Itching
– In otherwise good health
• FH
– Mother, father, older brother and younger sister
• All in good health
• PMH non contributory
– No known drug allergies
• SH noncontributory
• No current medications
7. Species of Lice
• Pediculus humanus capitis
– Organism of interest
– Size of a sesame seed
• Pediculus humanus corporis
• Phthirus pubis
http://livingwithinsects.files.wordpress.com/2010/11/lice1199.jpg
http://www.naturalliceandmitebuster.ie/uploads/images
/head-lice-top.jpg
9. Life Cycle
• Mature lice can lay 50-150 eggs during life
– Lifespan of 30 days while on host
• Takes 7-10 days for the eggs (nits) to hatch
• Developing lice (nymphs) take about 21 days
to mature and lay eggs
• Lice are parasitic insects
– Must live on host to live, feed and breed
• Transmissible through direct contact!
10. Nits, Nymphs and Lice
http://www.liceremovallosangeles.com/nits1.jpg
11. Nits, Nymphs and Lice
http://www.headlice.org/images/louses.jpg http://www.redorbit.com/media/uploads/2004/10/40_32d5ec9b3b2b
3a93445c4765251bcd9b.jpg
13. Signs and Symptoms
• Intense Itching
– Possible allergic reaction to the saliva that lice inject
during feeding results in itching and redness on the
scalp, neck and shoulders
• Not always experienced during the first infection
– Irritation due to feeding
• Adult lice in hair and on scalp
– Usually located behind ears and back of neck
• Lice eggs
– Often mistaken for dandruff
– Directly attached to hair
• Cannot be removed easily by brushing hair
http://www.mayoclinic.com/health/head-lice/ds00953/dsection=symptoms
14. Signs and Symptoms
• Patients may not experience any symptoms
until weeks or even months after the lice
establish infection
• Oftentimes, the first symptom noticed are the
lice themselves
15. Diagnosing Our Case
• Information
– Adult lice visually confirmed on daughter’s hair
– Itching present
• Conclusion
– Lice infestation has been established
• Recommendations
– Pharmacological intervention
– Nonpharmacological prevention
17. Nix® Creme Rinse
• Ingredients
– Permethrin 1% shampoo
• Application
– Applied to dry hair, nape of neck and behind ears
until saturated and left on for 10 minutes, then
worked into a lather and rinsed with water
– 97-99% cure rate after 1 application
– Patient may repeat if lice present after 7-10 days
– Use nit comb daily and wash in hot water
http://www.clinicalpharmacology-ip.com/Forms/drugoptions.aspx?cpnum=1506&n=Permethrin
18. Nix® Creme Rinse
• MOA
– Permethrin
• Disrupts sodium channels on nerve cells, preventing or
delaying repolarization causing paralysis and death of lice
• Affects eggs
• ADRs/Interactions
– Generally well tolerated
• Mild stinging and itching with OTC strength
– No documented drug interactions
http://www.clinicalpharmacology-ip.com/Forms/drugoptions.aspx?cpnum=1506&n=Permethrin
19. Nix® Creme Rinse
• Additional counseling points
– Shake well before applying
– Do not self-treat if lice are present on eyebrows or
eyelashes
– Avoid getting Nix® in your eyes, nose or mouth
– For external use only
– Should not be used by patients with a ragweed or
chrysanthemum allergy
21. Rid® Complete Lice Elimination Kit
• Ingredients
– Pyrethrins 0.33%
– Piperonyl butoxide 4%
• Application
– Applied to dry hair, nape of neck and behind ears until
saturated, left for 10 minutes, worked into a lather
then rinsed off with water
– Towel dry and apply the Lice and Egg Comb-Out Gel to
one section of hair at a time, then comb out nits
• Use nit comb daily and wash in hot water
– Patient must repeat in 7-10 days
http://www.clinicalpharmacology-ip.com/Forms/drugoptions.aspx?cpnum=2528&n=Rid+Pediculicide
22. • MOA
– Pyrethrins
• Disrupts sodium channels on nerve cells, preventing or
delaying repolarization, causing paralysis and death
• Does not affect eggs
– Piperonyl butoxide
• inhibits metabolism of pyrethrins by lice and thus enhances
the effects of the pyrethrins
• Also reduces risk of pyrethrin resistance in lice
• ADRs/Interactions
– Generally well tolerated
• Mild localized itching, redness and swelling
– No documented drug interactions
http://www.clinicalpharmacology-ip.com/Forms/drugoptions.aspx?cpnum=2528&n=Rid+Pediculicide
Rid® Complete Lice Elimination Kit
23. • Additional Counseling Points
– Shake well before use if using the mousse
– Not ovicidal
• 20-30% of eggs will remain after the initial application
• Must repeat application in 7-10 days
– Do not self-treat if lice are present on eyebrows or
eyelashes
– Avoid getting Rid® in your eyes, nose or mouth
– Pyrethrin products may be flammable
– External use only
– Should not be used by patients with a ragweed or
chrysanthemum allergy
Rid® Complete Lice Elimination Kit
http://www.clinicalpharmacology-ip.com/Forms/drugoptions.aspx?cpnum=2528&n=Rid+Pediculicide
25. LiceMD™ Lice and Eggs Removal Kit
• Ingredients
– Dimethicone 4%
• Application
– Apply behind ears, to nape of neck and throughout
hair and massage until wet and leave on for 10
minutes
• Apply to dry hair only
– While hair is still wet, comb out nits
– May repeat as needed for 10 days
– For long hair, use 4 ounces per application
26. LiceMD™ Lice and Eggs Removal Kit
• MOA
– Coats the lice, nymphs and eggs and irreversibly
immobilizes them
– Allows for easier removal with nit comb
• ADRs/Interactions
– No ADRs
– No documented drug interactions
• Additional Counseling Points
– Keep out of eyes
– External use only
28. A-200 Lice Killing Shampoo®
• Ingredients
– Pyrethrins 0.33%
– Piperonyl butoxide 3%
• Same application directions,
MOA and ADRs as Rid®
– Only difference is a 3%
concentration of piperonyl
butoxide
– Wegmans does not carry this
http://www.clinicalpharmacology-ip.com/Forms/drugoptions.aspx?cpnum=2528&n=Rid+Pediculicide
http://ep.yimg.com/ca/I/physlabs_
2205_227793075
29. Additional Notes
• Nix® and Rid® products are equally effective if
used properly
– Rid® application must be repeated
• Contact MD if there are still lice or eggs
remaining after 2 applications of either Nix® or
Rid®
– Prescription options are available (Ovide®)
• Contact MD if severe skin reaction or allergy
occurs
• LiceMD™ may be used by patients who have a
known allergy to chrysanthemums or ragweed or
those with very sensitive skin
31. Cetaphil® Gentle Skin Cleanser
• Suffocation-based pediculicide treatment
• Method
– Apply Cetaphil® to scalp, using enough to coat
thoroughly
– Comb out excess lotion
– Blow dry hair with hair drier
• Dried lotion coats any lice in a shrink-wrap-like layer,
preventing movement and respiration
– The dry lotion must remain on the hair and scalp for
at least 8 hours
• Leave in place until bathing or showering the following day
http://www.nuvoforheadlice.com/method_explained.htm
33. Tea Tree Oil
• Proposed MOA
– Inhibits acetylcholinesterase enzyme in lice
– May also act as a repellent
• Application
– Do not take orally!
– Add 10 drops of tea tree oil to 4 tablespoons of
vegetable or olive oil
– Coat hair thoroughly with the oil mixture and leave on
for 3 hours
– Comb the dead lice and the nits out with a nit comb
– Wash the hair with a regular shampoo to remove the oil
http://headlicecenter.com/tea-tree-oil-lice-treatment/
http://acphs.naturalstandard.com/databases/herbssupplements/teatreeoil.asp
34. Tea Tree Oil
• ADR/Interactions
– Drying, redness, stinging, burning of the skin
– May interact with topical antibiotics and antifungals
– If absorbed systemically, may increase effectiveness of
antihistamines, NSAIDs and antihelminthics
– May increase drying effects of tretinoin
• Additional Counseling Points
– No significant clinical trials have been done, not a
recommended treatment
– Often used with lavender oil to diminish bloodsucking
– Store in a dark place
http://acphs.naturalstandard.com/databases/herbssupplements/teatreeoil.asp
36. Some Home Remedies
• Petroleum jelly or mayonnaise
– Supposedly decreases respiration but
really decreases the mobility of lice
– Poor efficacy
• Coconut oil
– No evidence of efficacy
• Vinegar
– No evidence of efficacy
– Offensive smell
• Gasoline or kerosene
– Extremely dangerous, ADRs likely
38. Prevention of Reoccurrence
• Use nit comb regularly
• Vacuum living areas regularly during treatment
– Includes furniture and especially anything with cloth
• Wash bed sheets, clothes, towels, hair brushes,
combs and stuffed animals in hot water
– > 130°F
• Objects unable to be washed should be stored in
plastic bag for 2 weeks
– If eggs are present, they will hatch and the nymph will
die
• Must feed within 24 hours
39. Conclusion
• Case Study
– 7 year old female with head lice and itching
• Recommendations
– Rid® Complete Lice Elimination Kit*
• Apply once as directed, repeat in 7-10 days if needed
– Use nit comb regularly
– Wash patients clothes and linens separately in
>130°F water
– Vacuum living areas regularly
– If desired, use Rid® Home Lice, Bed Bug and Dust
Mite Spray
40. Monitoring Criteria
• After application of pediculicide agent and
combing out nits, check daily for new lice and
new nits on the patient’s hair, linens and clothing
– Check daily
– Return to or call the pharmacy after a week to discuss
progress
• If lice keep appearing after treatment, contact the
pharmacy or the patient’s pediatrician
– If at any time they begin infesting the eyebrows or
eyelashes, contact MD
