Clinical recommendation	Evidence rating	References	Comment
A “no-nit” policy is not recommended for schools and day cares because nits alone do not indicate an active infestation. Children should not be kept out of school during treatment, even with active infestation, because the likelihood of transmission is low, and this can result in significant absences.	C	1, 8	U.S. and Canadian consensus guidelines based on basic knowledge of the lice life cycle
Permethrin 1% lotion or shampoo (Nix) is first-line treatment for pediculosis. Alternative treatments should not be used unless permethrin fails after two treatments.	C	1, 8	U.S. consensus guidelines balancing effectiveness and toxicity
Nonovicidal therapies for pediculosis should be applied twice, seven to 10 days apart, to fully eradicate lice. Some authors postulate that three treatments with permethrin or pyrethrins might be most effective.	C	1, 8, 19, 20	U.S. and Canadian consensus guidelines based on basic knowledge of the lice life cycle Inappropriate retreatment may result in resistance and lack of treatment effectiveness
Scabies should be considered in patients with a pruritic, papular rash in the typical distribution and pruritus in close contacts. The classic burrows in webs and creases may not be present.	C	27, 29–31	U.S. and European consensus guidelines based on epidemiologic data and case studies
Oral ivermectin (Stromectol) should be reserved for patients with scabies who do not improve with permethrin 5% cream (Elimite).	C	10, 31	Guidelines using consensus agreement in area of little clinical research