Permethrin Shampoo: A Comprehensive Guide to Treating Head Lice

Head lice are a common nuisance, especially among school-aged children and their families. These tiny insects, about the size of a sesame seed, live on the human scalp and feed on blood. While they don't transmit diseases, they can cause itching and irritation. Permethrin shampoo is a widely used treatment for head lice infestations. This article provides a comprehensive guide on how to use permethrin shampoo effectively, covering everything from application instructions to preventive measures.

Understanding Head Lice

Head lice are crawling insects that cannot jump, hop, or fly. The primary mode of transmission is close, prolonged head-to-head contact. They can attach to anyone's hair, regardless of cleanliness. Lice lay eggs, called nits, on the hair shaft close to the scalp. These nits are tiny, oval-shaped, and shiny, ranging in color from creamy white to brown. Nits typically hatch in 7 to 10 days.

Identifying Head Lice Infestation

The most common symptom of head lice is itching, which may take 4 to 6 weeks to develop after initial infestation. The itching is a reaction to the louse saliva and is most often felt behind the ears or at the back of the neck. Regular checks for head lice are crucial for early detection.

To check for head lice:

1. Seat the child in a brightly lit room.
2. Part the hair into sections.
3. Look for crawling lice and nits on the scalp, section by section. Live lice are hard to find because they avoid light and move quickly.
4. Nits appear as small white or yellow-brown specks firmly attached to the hair near the scalp. They are commonly found at the hairline at the back of the neck or behind the ears.
5. Use a fine-tooth comb (louse or nit comb) to search the scalp section by section.

Nits can be mistaken for dandruff, dirt particles, or hair spray droplets. The key difference is that nits are firmly attached to the hair, while dandruff and other particles are not.

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Permethrin Shampoo: An Overview

Permethrin is a synthetic pyrethroid, an insecticide that kills lice and mites. It is available over-the-counter (OTC) as a 1% lotion and is used to treat head lice in adults and children 2 months of age and older. Permethrin works by disrupting the nerve cell function of the lice, leading to paralysis and death.

Brand Names

Permethrin lotion is sold under various brand names, including:

• Nix Creme Rinse
• Acticin
• Elimite
• Nix

How Permethrin Shampoo Works

Permethrin acts as a pediculicide, meaning it kills lice. However, it does not reliably kill nits. For this reason, a second treatment is often recommended 7-9 days after the first application to kill any newly hatched lice.

Step-by-Step Instructions for Using Permethrin Shampoo

Follow these instructions carefully to ensure effective treatment:

Step 1: Preparation

1. Wash Hair: Wash the hair with a shampoo without conditioner. Avoid using shampoos that contain conditioners or conditioners alone, as they may decrease the activity of permethrin lotion.
2. Rinse and Towel Dry: Thoroughly rinse the shampoo out with water and towel dry the hair until it is damp but not dripping.

Step 2: Application of Permethrin Lotion 1%

1. Shake Well: Shake the permethrin lotion well before applying.
2. Saturate Hair and Scalp: Completely saturate the hair and scalp with permethrin lotion 1%. Ensure coverage behind the ears and at the back of the neck.
3. Protect Eyes: Keep permethrin lotion out of the eyes. Use a washcloth or towel to protect the eyes. If the product gets into the eyes, immediately flush them with large amounts of water.
4. Leave-in Time: Leave the lotion on the hair and scalp for 10 minutes. Use a timer to ensure accurate timing.

Step 3: Rinsing and Drying

1. Rinse Thoroughly: Rinse the hair and scalp thoroughly with warm water. Avoid using a shower or bathtub to rinse, as this can spread the lotion to other parts of the body.
2. Towel Dry: Towel-dry the hair and comb out any tangles.

Step 4: Removing Nits (Combing)

1. Use a Nit Comb: Remove lice and eggs (nits) by combing the hair with the special small-tooth comb provided.
2. Section Hair: Part the hair into 4 sections. Work on one section at a time.
3. Comb Through: With one hand, lift a 1-2 inch wide strand of hair. Comb through the strand from the scalp to the end of the hair.
4. Clean the Comb: Clean the comb completely as you go. After each comb-through, wipe the comb on a wet paper towel to remove lice and nits.
5. Inspect Thoroughly: Inspect the full head of hair thoroughly for any stray nits.

Step 5: Repeat Treatment (If Necessary)

1. Second Application: If live lice are seen 7 days or more after the first treatment, repeat the entire process.

Important Considerations

Dosage

• Adults and Children 2 Months and Older: Apply permethrin lotion 1% to the hair and scalp one time, following the instructions above.
• Children Under 2 Months: Use and dose must be determined by a doctor. Permethrin shampoo is generally considered safe and effective for children two months of age and older. Safety and effectiveness in children less than two months of age have not been established.

Warnings and Precautions

• Allergies: Do not use if allergic to permethrin, synthetic pyrethroids, pyrethrin, or chrysanthemums. Ask a doctor before use if allergic to ragweed, as it may cause breathing difficulty or an asthmatic episode.
• Eyes: Avoid contact with the eyes. If the product gets into the eyes, immediately flush with large amounts of water.
• Scalp Irritation: Do not use this product if the scalp is already very irritated or injured.
• Pregnancy and Breastfeeding: If pregnant or breastfeeding, ask a health professional before use.
• Keep Out of Reach of Children: Ensure the product is stored out of reach of children.
• External Use Only: For external use only. Do not use near the eyes, inside the nose, ear, mouth, or vagina. Do not use on lice in eyebrows or eyelashes; see a doctor for treatment in these areas.

Potential Side Effects

In clinical studies, occasional itching has been known to occur. This is usually a consequence of the head lice infestation itself but may be temporarily worsened following treatment with permethrin. Other less frequent reactions include:

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• Stinging/burning
• Tingling
• Numbness or discomfort
• Redness
• Swelling or rash of the scalp

Stop use and see a doctor if:

• Breathing difficulty occurs
• Eye irritation occurs
• Skin or scalp irritation continues or infection occurs

Cleaning and Preventing Reinfestation

Cleaning personal articles and the home is an important part of head lice management and may help prevent reinfestation.

Cleaning Personal Items

• Wash Clothing and Linens: Machine wash all recently worn clothing, towels, and bed linens in hot water and dry them using the hot cycle of the dryer for at least 20 minutes.
• Dry Clean or Seal: Personal articles of clothing or bedding that cannot be washed may be dry cleaned or sealed in a plastic bag for a period of two weeks.
• Wash Hair Accessories: Wash all brushes and hair accessories in hot, soapy water or soak them in rubbing alcohol.

Cleaning the Home

• Vacuum: Vacuum the floor and furniture, focusing on areas that have been in contact with the head of the infested person 24 to 48 hours prior to treatment.
• Avoid Fumigant Sprays: Do not use fumigant sprays, as they are not effective and can be toxic.

Preventing Reinfestation

• Avoid Sharing: Do not share brushes, hats, hair accessories, or pillows with others.
• Proper Storage: Encourage children to put their coats inside their backpacks at school rather than hang them on a hook with classmates. Tuck hats inside the sleeves of coats or in the pocket.
• Hairstyles: Consider having children wear long hair back in a braid or ponytail while at school.
• Regular Inspection: Take a few minutes once a week to visually inspect children’s hair and scalp for signs and symptoms of lice.

Alternative Treatments

If OTC permethrin treatments are ineffective, a doctor can prescribe stronger medications, including:

• Malathion lotion (0.5%)
• Benzyl alcohol lotion (5%)
• Ivermectin lotion (0.5%)
• Spinosad topical suspension (0.9%)

Lindane shampoo is another prescription option but is not recommended as a first-line treatment due to potential toxicity.

Addressing Common Misconceptions

• Head lice are not a sign of poor hygiene: Anyone can get head lice, regardless of cleanliness.
• Head lice do not jump or fly: They crawl from one person to another through close contact.
• Nits stick to the hair: Unlike dandruff, nits are firmly attached to the hair shaft.

Returning to School

Children may return to school once they have completed the initial shampoo treatment and no longer see live bugs. The American Academy of Pediatrics does not endorse a "no nit" policy, meaning children do not have to be completely free of nits to return to school.

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tags: #permethrin #shampoo #head #lice #instructions

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