3 February: Q&A with Dr Mark Goodfield

My 8-year-old daughter has had severe problems with head lice over the past three months. Since she returned to school in September, she has had the symptoms on ten separate occasions. We have tried all the over-the-counter remedies and they don’t seem to cure the problem. I have spoken to the school to try and isolate the problem and that hasn’t worked. Apparently, no other child at my daughter’s school is suffering. I am now at the end of my tether and worried that the problem could be more severe. What should I do?

Dr Mark Goodfield, Consultant Dermatologist:

The first thing in any situation of this nature is to make sure that the diagnosis is correct. Absolute certainty of diagnosis relies on finding a live head louse, but finding the eggs of the lice (nits) attached to the bottom of the hair indicates that there has been, and may still be, active infection. If the diagnosis is correct, then the two reasons for treatment failure are either that the treatments themselves have been ineffective, through resistance or poor application, or that there has been re-infection.

Re-infection can occur from anyone else who has got the lice, and when a child is treated it is essential to treat all close contacts at home as well as to raise the issue at school or other areas where children come into close contact. It would be unusual for no other child at your daughter’s school to be suffering unless the source of infection is through home or relatives.

The various over the counter treatments that are available are usually effective although resistance can occur, and it may be that in this case that is what the problem is. There is a further prescribable treatment available from your GP, but I would suggest that this should not be used unless diagnosis has been absolutely confirmed.

The other well accepted way of treating head lice is with wet combing. This involves using a very fine-toothed comb and combing through wet hair (often a little bit of olive oil massaged into the hair and scalp is a good thing to do before wet combing), and doing this every four days for two weeks or so. You have to keep going until there have been three occasions on which no lice have been detected.

The symptoms of head lice infection are usually of itching and irritation in the scalp and sometimes of associated secondary infection, and so it is often necessary to treat these symptoms separately.

Secondary infection may need treating with antibiotics and the itching and irritation may need some further local treatments to the scalp and affected areas, and occasionally even a sedative antihistamine at night to try to prevent further damage to the scalp.

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