In Ontario, pesticide treatment (lice shampoos, creme rinses) for head lice are recommended as “first line” treatments, or the first option that doctors try to treat head lice. Large-scale evidence-based studies, combined with our years of public health experience disagree with this recommendation as the first option. Instead, we recommend wet combing as a screening method, and as a first line treatment for head lice infestation.

 

Although the Canadian Pediatric Society (2022) states that “wet combing is not an effective method of head lice treatment”, this sentiment has been disproven several times in reputable international studies. Wet combing has been proven, in large scale studies, to be at least as effective as pesticide shampoo treatment for head lice when done correctly on schedule. Pesticide shampoo treatments are only between 4-51% effective, they're expensive, and the active ingredients do not rinse away after treatment.

Outside of Ontario, including most other Canadian provinces, wet combing is the first line recommended treatment for head lice for a few reasons: it’s cost effective, there are no pesticides in the products, and it requires combing every few days which will remove any remaining lice. The reality of head lice is that there is no treatment product that can kill lice eggs (aka “nits”), they need to be combed out by hand when they hatch, about every 4 days. Wet combing follows the life cycle of head lice, and allows you to remove as many lice as possible before they can lay more eggs. It is more time intensive, but in our experience, it is the most effective method when the schedule is followed.

 

In Ontario, patients who seek out advice for head lice management are sent to the pharmacy.

Pharmacists usually consult briefly with patients about treating head lice, and then sell them a treatment option. Individual pharmacists likely have limited experience with case management and the required hand-on clinical skills to treat head lice infestation. Many pharmacies carry expensive, unregulated “lice treatments” and “lice removal” gadgets that do not work, which in our professional opinion, is predatory towards those who are seeking advice from a health care professional in a time of fear and panic. This is not true for every single pharmacist/pharmacy, but in our experience it is common enough that we feel the need to address the issue via our position statement.

 

In contrast, Registered Nurses are required to follow strict guidelines about recommending and selling products to our clients. Although we are a private health care option ourselves, we do not sell treatment products. 

 

All supplies are included with our advertised costs regardless of the course of treatment. Although we strongly recommend wet combing for head lice treatment, we do medicated shampoos to treat head lice when clinically indicated, or when the client requests this treatment option.

 

Registered nurses are autonomous practitioners, and we are not bound to treatment recommendations made by medical organizations or pharmaceutical companies, especially when there is an overwhelming amount of reputable evidence for a more accessible, lower-cost (and lower profit) option. We are required to provide evidence-based treatment options to our clients so that they can make the best decision for their care. We use our years of nursing experience and clinical expertise to work with you to determine the most effective course of treatment. We incorporate our experience with your preferences in order to ensure a comfortable and collaborative treatment experience. 

 

This is one of many reasons why we decided to establish Expert RN Lice Management. We want to empower our clients with knowledge of their treatment options, and to help people with head lice save their money by not buying products that don’t work.