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Question: Lice

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You are seeing an 18 month old girl with chief complaint of itchy scalp and rash at the nape of her neck just below her hairline. On examination, you note nits but do not see any live lice. The parents have not performed any treatments for lice. 

Which of the following would be appropriate management?

pemsou5_wp • September 20, 2022

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  1. Kelly October 1, 2022 - 2:45 pm Reply

    B) Reapply topical permethrin rinse in 9 days
    The first-line therapy for lice is pyrethroids (permethrin and pyrethrins). It should be applied to fully saturate dry hair and left on for 10 minutes, then rinsed off. A second treatment on day 9 will kill any unhatched lice that hatched after the first treatment. Pyrethroid resistance can be problematic in some geographic areas, and topical malathion, benzyl alcohol, spinosad, and ivermectin may be used, but malathion is not recommended in < 2 year olds. After topical treatment, combing to remove nits is often performed. Oral ivermectin has also been used when topical treatments fail but is not recommended in children weighing < 15 kg. Lice infestations are common and are not an indication for a CPS report if no other concerning factors for neglect are present.

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