Self-Care B3 Session 13: Insect Bites, Stings, and Pediculosis

What are the five myths about head lice?

1. Poor hygiene causes head lice. 2. Pets can cause lice to spread. 3. Lice can jump from person to person. 4. Going swimming will kill head lice. 5. The best way to get rid of lice is to shave your head.

Permethrin rinse has residual effects for up to how many days?

10 days Note: Thus, retreatment in 7 to 10 days is not required unless active lice are detected.

Where should you avoid contact of pediculicide with?

Avoid contact of the pediculicide with eyes and mucous membranes.

What should you avoid using to treat head lice?

Avoid kerosene or gasoline

True/False: Anaphylaxis is very common with insect stings.

False; very rare Note: In anaphylaxis, fall in BP, light-headedness, chest tightness, dyspnea, loss of consciousness can occur.

When do you repeat treatment for head lice with pyrethrin or permethrin?

For pyrethrin products, repeat entire process in 7-10 days; permethrin products can be used again in 7-10 days if lice or nits are detected. Note: Because of treatment resistance, proper use of these products is required and overuse must be avoided.

If an allergy to topical anesthetics is present, use

OTC product containing counterirritant, topical AH, skin protectant, or hydrocortisone. Counsel on product use and preventative measures.

If an allergy to topical anesthetics is NOT present, use

OTC product containing topical anesthetics or skin protectants. Counsel on product use and preventive measures.

What are other insect repellents?

Others: citronella, lemon eucalyptus oil, soybean oil, cedar oil, lavender oil, tea tree oil, garlic, thiamin, scented moisturizers in mineral oil

Lice observe on scalp

Pediculicide containing permethrin or pyrethrins. Counsel on product use and preventive measures.

Lice observed in pubic area

Pediculicide containing pyrethrins. Counsel on product use and preventive measures.

Non-drug measures for insect stings.

☻ For honeybee stings, remove the honeybee stinger immediately. Do not squeeze or rub the stinger ☻ Apply an ice pack or a cold compress promptly to the sting site to help slow absorption of the venom ☻ Avoid scratching the affected area ☻ Avoid wearing perfume, scented lotions, and brightly colored clothes; control odors in picnic and garbage areas; change children's clothing if it becomes contaminated with summer foods such as fruits; wear shoes when outdoors; and destroy nests of stinging insects near homes.

Nonprescription medications for insect stings.

☻ For nonallergic stings, apply a topical nonprescription external analgesic such as a local anesthetic, topical antihistamine, counterirritant, or hydrocortisone to the affected site to relieve pain and itching. ☻ A skin protectant can also be recommended to prevent irritation and inflammation as well as prevent secondary bacterial infection. ☻ These products can be applied 3-4 times daily for up to 7 days.

Exclusions for self-treatment of insect stings.

☻ Hives, excessive swelling, dizziness, weakness, nausea, vomiting, difficulty breathing ☻ Significant allergic response away from site of sting ☻ Previous sting by honeybee, wasp, or hornet (need to evaluate possible development of hypersensitivity) ☻ Previous severe reaction to insect bites ☻ Personal or family history of significant allergic response (ex. hay fever) ☻ <2 years of age

Exclusions for self-treatment of head lice.

☻ Hypersensitivity to chrysanthemums, ragweed, or pediculicide ingredients ☻ Presence of secondary skin infection to lice-infested area ☻ <2 years of age for pyrethrins ☻ <2 months of age for permethrins ☻ Lice infestation of eyelids or eyebrows ☻ Pregnancy or breast-feeding (strong caution for self-treatment; benefits must outweigh risks) ☻ Presence of active tumors

Exclusions for self-treatment of insect bite.

☻ Hypersensitivity to insect bites, resulting in systemic symptoms or symptoms away from bite area ☻ history of tick bite and systemic effects indicating possible infection ☻ suspected spider bit requiring medical attention ☻ signs of secondary infection of bite area

When to seek medical attention for insect stings.

☻ If you have experienced previous severe reactions to insect stings, seek emergency medical care immediately. If a primary care provider has prescribed epinephrine or an oral antihistamine and you have it on your person, administer it according to the primary care provider's instructions. ☻ If develop symptoms of an allergic reaction, such as hives, excessive swelling, dizziness, vomiting, or difficulty breathing. ☻ If pain and itching worsen during treatment or if they do not improve after 7 days of topical treatment.

What are complementary therapies for treating head lice?

☻ Lice enzyme shampoos - 10% tea tree oil & 1% lavender oil applied weekly x 3 weeks - MORE effective than pyrethrin/piperonyl butoxide

To minimize itch, what 4 things can be used?

☻ Local anesthetics ☻ topical antihistamines ☻ hydrocortisone ☻ some counterirritants

LouseBuster

☻ Machine applying heat to scalp ☻ Dehydrates and kills nits and louse; kills 90% of nits ☻ Expensive and requires technician to operate machine

What are the EMERGING therapies for treating head lice?

☻ Nuvo method ☻ Dimethicone 4% ☻ LouseBuster

Skin protectants

☻ Reduce skin inflammation or irritation ☻ Apply up to 4 x/d ☻ Can be applied to skin of children LESS than 2 years

Nonprescription medications for head lice. Application steps for a permethrin cream rinse

☻ Shampoo with regular shampoo, rinse, and towel dry hair. ☻ Apply sufficient cream rinse to wet hair and scalp. ☻ Allow the treatment to remain for 10 minutes; then rinse and towel dry. ☻ Use a nit comb as described previously.

Higher concentrations of insect repellant can increase adverse effects. What are the AE?

☻ Skin irritation ☻ CNS: seizures, ataxia, hypotension, encephalopathy, angioedema

How is pubic lice (aka crabs) transmitted and what may they infest?

☻ Transmitted through high-risk sexual contact, toilet seats, shared undergarmets, or bedding ☻ May infest armpits, eyelashes, eyebrows, mustaches, beards

Topical anesthetics

☻ Use external anesthetic to relieve itching and pain ☻ Apply products 3-4 x/d for no more than 7 days ☻ Preferred local anesthetics: pramoxine and benzyl alcohol ☻ Do not use dibucaine in large quantities; can cause myocardial depression, convulsions, or death ☻ Do not cover with bandages ☻ Do not use hydrocortisone on scabies or infections ☻ Do not allow children to ingest camphor

What ingredient does insect repellent should contain that releases vapors that tend to discourage the approach of insects?

N, N-Diethyl-M-Toluamide or DEET Note: Does NOT kill insects

For information about treatment of lice infestations, who can you contact?

National Pediculosis Association at www.headlice.org or 1-781-449-6487

True/False: Biting insect a mosquito, chigger, bedbug or flea and reaction confine to site of bite may use OTC products.

True

True/False: Treatment of other family members should be determined on the basis of presence of lice or nits and the family members' level of contact with the infested individual; unnecessary treatment should be avoided.

True

Body lice (aka) cooties are commonly found in whom?

Those with poor hygiene.

Dimethicone 4%

☻ Coats lice and irreversibly immobilizes them in 5 minutes ☻ Causes less irritation than traditional treatments

What is the concentration of DEET used for adults?

☻ Concentrations 10-40% are usually acceptable ☻ If long periods of time outside or in high heat or humidity use higher concentrations

Symptoms for insect bite treatment must be resolved after how many days before advising medical referral?

7 days

Which of the following methods should never be recommended for removal of head lice? A) Use of mayonnaise B) Use of permethrins C) Use of the Nuvo method D) None of these

A) Use of mayonnaise

How often is insect repellant applied?

Apply usually no more than every 4 to 8 hours

A 1 year old boy was bitten by a wasp. His mom is looking for a product to minimize the itching. What do you recommend? A) Topical lidocaine B) Topical hydrocortisone C) Topical diphenhydramine D) Topical calamine

B) Topical hydrocortisone

With which of the following allergies should patients not use permethrin? A) Sulfa B) Daisy C) Chrysanthemum D) Latex

C) Chrysanthemum

Insect stings can come from which kinds of insects?

Honeybees, Wasps, Hornets, Yellow Jackets, Fire Ants

Where does head lice infest and live on?

Infect the head and live on the scalp

What do most people usually complain of after an insect sting?

Most people complain of pain, itching, irritation at site

What is not effective to treat head lice?

Petroleum jelly and mayonnaise not effective

What is pediculosis commonly known as?

head lice

After an insect sting, those who are allergic will experience what?

hives, itching, swelling, burning sensation

Exclusions for self-treatment of insect bite: AGE

less than 2 years of age

What concentration of DEET are preferable in children?

less than 30%

If you use large quantities of dibucaine for treating insect bites, what can occur?

myocardial depression, convulsions, or death

When is head lice most common in the year?

peak August to November

What blocks pyrethrin breakdown?

piperonyl butoxide

Name the two preferred local anesthetics for insect bite.

pramoxine and benzyl alcohol

What should not be used in those with chrysanthemum allergy when treating for head lice?

pyrethrin and permethrin

Insect repellants are available as?

sprays, solutions, creams, and wipes

Side effects of pediculicide.

temporary irritation, erythema, itching, swelling, and numbness of the scalp; itching should be relieved in a few days

Preventive measures for insect bites.

☻ Cover skin as much as possible ☻ Avoid swamps, dense woods or brush ☻ Keep pets free of pests ☻ Remove standing water from around house ☻ Limit amount of time spent outside at dawn and dusk ☻ Use barriers like netting and screens ☻ Apply insect repellent

Topical antihistamines

☻ Diphenhydramine 0.5-2% 3-4 x/d no more than 7 days ☻ Produces local anesthetic effect ☻ Can have systemic absorption in young children

Nuvo method

☻ "Shrink wraps" lice to suffocate them ☻ May be more effective than pyrethrin/piperonyl butoxide

Hydrocortisone

☻ 1% 3-4 x/d no more than 7 days

Treating head lice with permethrin.

☻ 1% cream rinse for treating head lice ☻ Disrupts sodium channel to cause paralysis and death ☻ Leave on hair for 10 minutes before rinsing ☻ After use lice comb to remove nits ☻ Retreatment in 7-10 days needed if lice seen again ☻ Adverse effects: pruritus, burning, stinging, irritation ☻ Contraindicated in patients with allergy to pyrethrins or chrysanthemums ☻ Do not use in infants younger than 2 months

The progression of head lice.

☻ A nit is 1 mm and is usually found near the scalp, typically on the hair shaft ☻ Once hatched, louse begins feeding, matures in 8-9 days ☻ Repeats every 3 weeks

Non-drug measures for treating insect bites.

☻ Apply ice pack promptly to reduce swelling, itching, pain ☻ Avoid scratching affected areas ☻ Remove ticks with tweezers ☻ Do not wear rough, irritating clothes over affected area

Nonprescription medications for head lice. Application steps for a pyrethrin shampoo:

☻ Apply sufficient quantity to wet the dry hair and scalp. (Foams should also be applied to dry hair.) ☻ Allow the treatment to remain for 10 minutes. ☻ Work the shampoo into a lather and then rinse thoroughly. (Remove foams with shampoo or soap and water.) ☻ Use a nit comb to remove dead lice and eggs as described previously.

Treating head lice with synergized pyrethrins

☻ Approved for treating head and pubic lice ☻ Pyrethrins block nerve impulse transmission; piperonyl butoxide inhibits pyrethrin breakdown ☻ Applied topically as shampoos, foams, solutions, gels ☻ Applied to affected area for 10 minutes ☻ Use lice comb after use ☻ May be repeated in 7-10 days if lice spotted again ☻ Adverse effects: irritation, erythema, itching, swelling ☻ Should not be used in those with crysanthemum allergy

Local anesthetics

☻ Benzocaine, pramoxine, benzyl alcohol, lidocaine, dibucaine, phenol ☻ Produces loss of sensation ☻ Apply to area 3-4 x/d for no longer than 7 days ☻ Do not use phenol in pregnant patients or children

Counterirritants

☻ Camphor 0.1-3%, depresses cutaneous receptors, do NOT ingest ☻ Menthol <1% depresses cutaneous receptors

Non-drug measures for head lice.

☻ Wash hairbrushes, combs, and toys of infested patients in water at a temperature of 130°F (39.4°C) or higher for 10 minutes. ☻ Use water at a temperature of 130°F (39.4°C) or higher to wash the clothes, bedding, and towels of infested patients. Dry the items on the hottest dryer setting that the fabric permits. ☻ Objects or clothing that cannot be washed should be sealed in plastic bags for the length of the louse's life cycle (2 weeks) so that it is unable to feed on a host. ☻ Avoid close physical contact with an infested patient; do not share articles such as combs, brushes, towels, caps, and hats. ☻ Vacuum living areas thoroughly and regularly during treatment period. ☻ Visually inspect the hair and scalp before, during, and after treatment for evidence of lice or nits: - Use a nit comb diligently to remove nits. - Comb the hair in segments. (Individual hairs can be trimmed if nit removal proves difficult.)

Skin protectants agents

☻ Zinc oxide, calamine, titanium dioxide