Treatment failure or re-infection?

If the problem won’t go away, the following points should be kept in mind to avoid inappropriate use of head lice treatments, particularly when considering a possible treatment failure:

  • Was there in fact a true infection before application?
  • Is there in fact a current active infection now?
  • Has a second application been used (if specified in the pack instructions)? Are the detected lice simply those that have hatched after a first application? If this is the case any lice found should be young nymphs less than 3 millimetres long
  • Did the first head lice treatment fail? If it did then why? Possible reasons might include not using enough lotion, not applying it properly or problems with resistance if it was a pesticide treatment
  • Is it more likely that the first infection was cleared but re-infection has occurred? Any lice found are likely to be young adults, approximately 3 to 4 millimetres in size

It is also worth noting that some parents will seek treatment for perceived cases of head lice infection, which are not actually current infections but due to factors such as:

  • Itching scalp due to other skin problems such as eczema or impetigo
  • Other conditions, such as dandruff, mistaken for head lice
  • Psychogenic itch on hearing of other cases in the school
  • Treated infection but with nits still being found
  • Treated infection but with itch persisting
  • For parents experiencing repeat infections, recommend a head lice protection product which is supported with clinical evidence

It is important to remind parents that care must be taken to accurately identify live lice and that treatments should only be used when this is definitely the case.

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