Head Lice are most often found in children, but adults can have them too. They cannot jump and can only spread by direct head to head contact. Lice feed off the blood supply to the scalp, and their saliva can cause an allergic response – this is what causes the itch. This response may take two weeks to develop so the absence of itch does not mean that infection is not present. Lice lay their eggs on the head and make sure that they stay on the head by gluing them to the base of the nearest hair shaft. These are what are referred to as nits and they stay firmly stuck to the hair even after the treatment has killed all the lice. The only may to remove these is with a fine toothed comb. People make the mistake of thinking that the treatment has failed when these are still in the head.

Scabies is caused by a little mite, which burrows underneath the skin. It is spread by direct contact. The symptoms of scabies include itching accompanied by a rash. The itch is usually quite severe and is worst at night often leading to lack of sleep. Scratching of the skin may change its appearance. The mite lives under the skin and its coat and waste products set up an allergic reaction hence the itch.From the skin surface the burrows look like small grey threads that are raised wavy and 5-10 mm long. The most common places to see these are in the web of the fingers and toes and on the inside of the wrist. (The patient may also have noted then in the armpits, buttock, nipples or genital area.). The mite rarely affects the face and scalp except in infants. Successful eradication of scabies is dependent on adequate skin coverage and treatment of other people with whom you have been in contact.

Infestation by threadworms is very common in school children and can easily be treated in the pharmacy. While threadworms are by far the most common, other worms may occur occasionally, especially after foreign travel. The first sign of worm infestation is usually itch around the anus, (the child can be seen to scratch their bottom), the irritation is due to the eggs lain around the anus by the female, who emerges at night to lay eggs and stick them to the skin. The itching may hence be worst at night. The worms themselves can be easily seen in the faeces as white or cream-coloured threads, of about 10 mm long, which can be seen moving as they survive for a short time outside the body. Diarrhoea may be present in severe cases. Other family members may be affected, even without itch or worms in the faeces.