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In this scenario, the community pharmacist counsels a patient who has come in complaining of an itchy scalp. The student must take a history, make a diagnosis, and suggest an appropriate over-the-counter medication.
Please ensure that this scenario and mark scheme aligns with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.
You will need a student pharmacist and an actor for this scenario.
Head Lice
You are a pharmacist working in a community pharmacy. The patient is a 10-year-old child complaining of an itchy scalp. You have been asked to take a history, make an appropriate diagnosis and advise the patient's mother on what is the best over-the-counter medication for this condition.
To do:
Assess the patient's symptoms, develop an appropriate treatment plan, and provide relevant medical or lifestyle advice as needed.
You have 10 minutes.
You have access to the BNF.
You are Seemal Patel (See-mahl, Puh-tel).
Opening statement:“I've noticed that my daughter has been itching her head a lot”
Patient information:
To be given if the student asks.
Name: Meena Patel
Age: 10
Past medical history:
“Eczema only affecting the right elbow crease.”
Medication History:
“0.1% hydrocortisone cream during her eczema flares, otherwise just using emollients regularly for her dry skin”
Allergies:
“None.”
Symptoms:
“She has had an itchy scalp for the last week that has gotten worse over time.”
“She is scratching her head a lot.”
“Seen a bug crawling in her hair - are these fleas”
“Her friend came for a sleepover a week ago and had the same issue as her.”
“It is not dry skin on her scalp.”
“We haven’t tried anything to make it better or worse.”
“It is impossible to get her to sleep because of the itch.”
At this point, the student should inform you that they think that the child might have head lice and that the best way to know if Meena has head lice is to pass a fine-tooth comb through the hair and find live lice. The fine toothcomb can be bought at the pharmacy.
The student should offer you treatment for head lice:
“I will take whatever you recommend.”
The student should also offer you advice on what you should do at home to stop it from spreading or recurring. If they do not, prompt them by asking:
“Are there any other precautions I need to take at home?”
Any criteria marked in red must be met to pass this station.
Red Flags missed: 3
Referral Criteria for Head Lice
Refer to Accident & Emergency (A&E) if:
Severe allergic reaction: Signs such as difficulty breathing, facial swelling, or severe rash after using lice treatment may indicate a serious allergic reaction.
Refer for an Urgent GP Appointment if:
Signs of secondary infection: Redness, warmth, pus, or fever around affected areas could indicate a bacterial infection needing prompt treatment.
Persistent itching or irritation: If severe itching or skin irritation continues despite treatment, this may suggest treatment resistance or misuse.
Severe scalp irritation: Significant redness, swelling, or skin reactions to lice treatments should be evaluated by a GP.
Infestation in vulnerable individuals: Infestations in young children, elderly, or immunocompromised individuals may require closer medical attention.
NHS, 2024.Head lice and nits. [online] Available at:https://www.nhs.uk/conditions/head-lice-and-nits/[Accessed 24 August 2024].
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