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Back-to-school Spike in People Seeking Advice on Head Lice

Head lice might not be able to jump, but the number of people seeking advice on head lice and nits from the NHS website certainly did, as children in England returned to school at the start of September.

Figures released by NHS England showed there were 12,720 weekly visits to the head lice pages in the week 15 to 21 September. That compared with 9524 at the start of the month — 1 to 7 September — and represented an increase of 34%, according to NHS England.

On Monday 18 September, the "back-to-school spike" in online visits peaked at 2196 – the equivalent of "one click every 39 seconds".

Dame Ruth May, chief nursing officer for England, said: "Head lice and nits are a common issue, especially among young children and families in close contact with one another."

Head lice are passed on through head-to-head contact, "not dirty hair", NHS England stressed.

Patients Told: "No Need to Consult a GP"

The National Institute for Health and Care Excellence (NICE) described head lice — Pediculus humanus capitis — as "parasitic insects that infest the hairs of the human head and feed on blood from the scalp". The regulator said that head lice infestation, or pediculosis capitis, varies in severity from a few lice — fewer than 10 — to more than 1000 in severe cases, but that "a typical infestation" might have about 30 lice per head.

In an effort to ease the pressure on increasingly over-burdened GPs, Dame Ruth stressed that once detected, "there is no need to consult a GP". However, she emphasised that treatment should "begin immediately", and all household members should be checked and treated to stop further spread.

NICE pointed out that if left untreated, head lice infestation might persist for long periods. Managing the condition was imperative if any "outbreaks of head lice" were to be kept under control, Dame Ruth urged.

The NHS recommended wet combing as the most effective way of treating and preventing head lice, by washing hair with ordinary shampoo, smothering hair in any type of conditioner, combing the whole head from root to tip with a special fine-toothed detection comb, and repeating the process on days 1, 5, 9 and 13 "to catch any newly-hatched head lice". It was vital to "check again" that everyone in the household was lice-free on day 17, according to NHS England.

NICE agreed that detection combing was the best way to confirm the presence of lice, with the "systematic combing" of wet or dry hair using a head lice detection comb with teeth set 0.2–0.3 mm apart.

Asked to comment for Medscape News UK, Joanna Ibarra, spokesperson for the charity Community Hygiene Concern, said that it was "so much easier to cope with head lice if you start with the specially developed combs", and highlighted these were "proven to work" in clinical trials.

Children Can Still Go to School

A diagnosis of active head lice infestation should "only be made if a live head louse is found", emphasised NICE, which pointed out that an itching scalp was "not sufficient" to diagnose active infestation, and that the presence of louse eggs alone — whether hatched (nits) or unhatched — was "not proof" of active infestation.

"A person should only be treated if a live head louse is found," stressed NICE, and added that all "affected" household members should also be treated on the same day, as this gave treatment the "best chance of success".

Headlice could be treated with a physical insecticide, a traditional insecticide, or with wet-combing – but not with essential oil-based treatments and herbal treatments due to the lack of good-quality evidence on their safety and efficacy. The choice of treatment was dependant on the "preference of the person and/or their parents/carers, their treatment history, the presence of any contraindications, and cost of treatment", explained NICE.

Children being treated for head lice could still attend school, and clothing or bedding did not need to be washed at high temperature, or fumigated.

The NHS underlined that there was "nothing you can do to prevent head lice". However, NICE emphasised: "Children of primary school age should be examined regularly at home (using a detection comb) to identify infestation early."

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