Head Lice

So what exactly are lice?

Lice are parasites which can be found anywhere on the head, although favorite places include around the ears and near the neckline in the back. They enjoy and need to feed on human blood throughout the day to survive. There are three forms of lice: the egg (aka the nit), the nymph, and the adult. The eggs are laid by the adult near the base of the hair shaft where they then firmly attach. While these eggs may be difficult to see and often look like dandruff, they then hatch about 8-9 days later. Nymphs are the immature lice and after feeding on human blood for about 10 days or so, become adults. Adults have six legs and are often grayish-white to tan in color and also require human blood to survive, as they will die within 1-2 days after falling off a child's head.

Who gets lice?

Really, just about any child can, but the numbers obviously increase in those who attend preschool/elementary school and obviously household members of infected children. And just so you know your child is not alone; some estimates have 12 million cases occurring annually in the U.S in the 3-11 year age range. Because they cannot fly, head lice spread by direct contact with the hair of an infested child — head-to-head contact. While it is not impossible for lice to spread via contact with clothing or hair-care items (combs and brushes), it is considered to be rather unlikely.

What to expect if your child has lice?

Typically, a child infested with lice will be somewhat uncomfortable secondary to the itching. Furthermore, because lice are more active at night, getting a good night sleep may be tough. Lesions, which can become infected, are often noted on the head secondary to the intense scratching.

How do you diagnose lice?

Find one live nymph or adult louse (but remember adult lice move quickly) and you've made your diagnosis. The use of a magnifying glass with a fine-tooth comb in a well-lit room may aid in making your diagnosis. With nits, it becomes a bit tricky as if you find them attached within ¼ inch of the base of a hair shaft, an infestation probably exists. But if nits are greater than ¼ inch from the scalp and no live nymphs or adult lice are seen, it usually indicates an old infestation and treatment is not warranted. Best advice, if you're not sure, then come in and see one of us.

And what about the treatment for lice?

Well, consider it to be a three-step process, which involves killing the lice, ridding the hair of nits, and preventing their spread.

So what products are best for killing lice?

Well, a variety of treatment types exist: gel, shampoo, cream rinse and mousse. Nearly always, a second course of treatment is required. Two of the over-the-counter (OTC) medications include:

  1. Pyrethrins (brand-names include Rid and Pronto among others): As they only kill live lice and not the nits (aka the eggs), a second treatment occurs 7-10 later. As they are usually in shampoo form, application time is usually for just 10 minutes before rinsing out. Unfortunately, resistance is more common these days. Also, if your child is sensitive to ragweed, treatment with pyrethrins is not recommended secondary to the concern of an allergic reaction — although there is some debate surrounding this.
  2. Permethrin 1% (brand-name Nix): Approved for children above 2 years of age, this cream rinse is applied after shampooing with a non-conditioning shampoo. It is left on for about 10 minutes and because it, too, kills only the live lice and not the nits, reapplication occurs 7-10 days later as well. But bear in mind, the residue from this cream is designed to kill the newly hatched lice (unlike the pyrethrins). But following the theme of pyrethrins, resistance is now being reported.

As far as some of the prescription medications, I offer you three of the more commonly used ones:

  1. Permethrin 5% (brand-name Elimite): Now some of you may recognize this is as the cream used for scabies treatment. Although there is some debate on whether it is more effective then permethrin 1%, there has been definite anecdotal reported success. With this cream, it is left on overnight and then washed off in the morning.
  2. Malathion 5% (brand-name Ovide): This lotion had been off the U.S. market for a period of time then reintroduced earlier this decade. It, too, is left on overnight and then washed off in the morning. Repeat use in 7-10 days is typically recommended. The concerns surrounding this product are that it has a high alcohol content, making it quite flammable and there is risk of respiratory compromise if it is ingested.
  3. Lindane 1% (brand-name Kwell): It is important to begin by saying that Lindane has central nervous system side effects if used improperly and seizures have been reported with its use. Application time is only 10 minutes with reuse 7-10 days later. Because resistance has been reported for quite some time and the above-mentioned health concerns, we certainly try to avoid its use.

But remember with whatever medication that is used, please follow the directions as outlined on the box or on the prescription label. And just a couple of words on the home remedies many of you are probably already aware of — mayonnaise, olive oil, petroleum jelly, and herbal oils. Although it is certainly okay to try these, they have yet to be scientifically proven to work. But for those hoping for a natural treatment resolution, go ahead and give it a go. Just lather it in and leave it on the hair overnight with a shower cap on top.

Now as far as combing out the nits, there are a few important points to keep in mind: Go ahead and use the special comb as it can make it more effective in removing the lice. Be patient — both you and your child. This process can take quite some time. Spend the same amount of time daily for about two weeks before feeling comfortable you have a resolution. And it is certainly okay to call upon one of the local agencies to come to your house and assist with the lice picking, but remember a fee is involved.

Lastly, here are some basic tips to prevent lice from spreading:

  • Check everyone else in the house for lice. Don't overlook anyone.
  • Wash all clothes, towels, hats and bed sheets in hot water and dry on high heat.
  • Vacuum things that cannot be washed, such as furniture, carpets and fabrics; anything your child may have been in contact with 1-2 days before starting treatment
  • Items that cannot be washed, such as toys and stuffed animals, should be put in a plastic bag for two weeks (more than enough time to kill off the lice).
  • Soak combs/brushes in boiling water for at least five minutes.
  • Avoid head-to-head contact, as this is the most common way for lice to spread.
  • And even though it is much less common for lice to spread in this fashion, we still recommend avoiding the sharing of combs, brushes, hats, coats and scarves.

And please remember no matter how annoying and embarrassing lice may be for your child, there are no significant health consequences from acquiring it and it doesn't incriminate one's personal hygiene or home cleanliness. The goals are simply to treat it in a timely manner and prevent its spread.