Treating Head Lice
Preschool and elementary school children ages 3-10 and their families are among those at the greatest risk of exposure to head lice. Girls get head lice more often than boys and women more than men. Most often found on the scalp behind the ears and near the neckline at the back of the neck, head lice hold onto hair with hook-like claws they have at the ends of each of their six legs.
How do you know if your child has head lice? According to the US Centers for Disease Control and Prevention (CDC), any of the following is a good indication:
- Tickling feeling of something moving in the hair
- Visible eggs or “nits” attached to the hair
- Itching caused by an allergic reaction to the bites
- Sores on the head caused by scratching
"My daughter was itching and scratching and it never occurred to me [that] she might have lice," says Maria Botero, a woman whose daughters attend a South Florida elementary school. "I took her to the doctor and even he didn't realize she had lice. He prescribed a dandruff shampoo. She was itching for three more weeks before, finally, the school called."
Where Do the Little Critters Come From?
The most common causes of head lice include:
- Contact with an already infested person during play at school or home (slumber parties, sports activities, camp, playground)
- Wearing infested clothing, such as hats, scarves, coats with high collars, or hair decorations
- Using infested combs, brushes, or towels
- Lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person
Many schools send children home when evidence of lice is found in their hair. But Richard Pollack, PhD, who conducts research on head lice at the Harvard School of Public Health, advises against such extreme measures, which can take children away from studies and often prevent parents from working. He describes the measure as hysterical, adding that his team of researchers has found no evidence of a lice epidemic. He believes the biggest problem is misinformation and misdiagnosis. As you might imagine, Dr. Pollack's opinion is not universally shared, especially by school administrators and the National Pediculosis Association (NPA).
How to Get Rid of the Little Critters
When you find head lice, spring into action as quickly as you can. "The most important thing is to get the nits (lice eggs) out," says Sofia Khan, a South Florida pediatrician. "If you don't get rid of the nits from the hair, you'll never get rid of the lice."
If your doctor recommends a shampoo, follow the directions carefully. Then wash all bedding in hot water. Vacuum floors, beds, chairs, car seats, and headrests—anyplace where lice-infested individuals have been (although lice won't live more than a day or two without a human body as host).
Both Dr. Pollack and the NPA agree that the greatest harm associated with head lice results from the well-intentioned but misguided use of caustic or toxic substances to eliminate the lice. Anecdotal evidence shows that certain strains of head lice may have become resistant to traditional products containing permethrins and pyrethrins.
Examples of products to treat head lice include:
- ]]>Pyrethrin]]> products (RID, Pronto)—These are derived from the chrysanthemum plant. Kids who have allergies to chrysanthemums, ragweed, or kerosene should not use these shampoo-type products.
- ]]>Permethrin]]>-based products (Nix)—Check the status of the head lice on a daily basis. Although the advertising would have you believe that only one dose is necessary, it sometimes takes two.
- ]]>Lindane]]> and ]]>malathione]]>—These two prescription-only insecticides are often prescribed when resistance to pyrethrins and permetrins is widespread in a community. Malathione may be the more effective of the two, but resistance has been reported to both substances. Public health nurses in your community may be able to advise you and your doctor what the current state of resistance is.
Using Caution With Lindane
It’s important to point out that lindane is considered a second line treatment—only prescribed in situations where patients cannot take the other, more preferred medications or those first line treatments have failed. The Food and Drug Administration includes a warning on prescription shampoos and lotions containing lindane because it can rarely cause serious side effects, including seizure and death.
Those especially susceptible are infants, the elderly, children and adults weighing under 110 lbs, and individuals with other skin conditions. Lindane is toxic and should not be overused. Patients are given small amounts (1-2 oz) and instructed to apply a very thin layer and not to reapply. For more information, visit http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm110848.htm .
Use a fine-toothed comb designed to capture and remove the lice and nits. A lice comb is the standard for lice detection and removal. Known as the LiceMeister, it is made by embedding 32 stainless steel teeth in a rigid plastic handle. The teeth are long and tapered and are set so close that combing removes virtually all lice and nits.
"Check the hair section by section," says Hazel Brellis, community health nurse with the Broward County Health Department in Florida. "Start at the top and pin it up and work your way to the bottom, making sure that the hair that's been checked doesn't come in contact with the hair that may have nits in it. You may have to use your fingernails to get the nits off the hair shaft. Then flush the eggs down the toilet or seal them in a plastic bag—anything to get them out of the house." While short hair does not make children less likely to get lice, it may make the checking and combing easier for parents.
Beware Unproven Treatments
According to W. Steven Pray, professor of nonprescription products and devices at Southwestern Oklahoma State University, several companies have begun promoting generally unproven head lice remedies, including tea tree oil and rue. The biggest problem with using these herbs is that if they don't work, the head lice population can increase unchecked, worsening the infestation and associated symptoms.
Some herbal remedies, though, have shown to be effective in clinical trials. An example is a spray that contains coconut oil and anise. If you are unsure of which product to use, talk to your doctor.
Others are experimenting with "suffocating the head lice" by covering the hair with mayonnaise or olive oil and wrapping their heads in plastic wrap overnight. There is no evidence that these methods work either. And the multiple shampooing required to remove the oil from the hair can irritate an already itchy head to say nothing of having your child sleep all night with rancid mayo on her head.
Tips For Preventing Head Lice
Dr. Khan offers a few tips to prevent getting head lice. She advises washing hair regularly and keeping it out of harms way in braids and clips to avoid coming in contact with lice. But don't delay dealing with the little critters if they do strike.
Some people report that despite vigilance and treatment, the lice keep coming back. Be sure to continue checking heads daily. Repeat the medicated shampoo application as directed in 7-10 days. As much as no one wants to reveal that they have head lice, it's important to warn friends who may have been exposed. After spending weeks to eliminate the lice, you don't want your child to pick it up all over again from his pals.
"People get so discouraged," says Brellis. "Parents really should check their children at least once a week, especially when they know that friends and classmates have it." Checking should be done with a fine-tooth louse comb, and children should be treated only if live lice are found.
"It was so hard to get rid of it," agrees Botero. "But now I'm an expert."
Head Lice Infestation
Centers for Disease Control and Prevention (CDC)
National Institute of Allergy and Infectious Diseases
Caring for Kids–Canada
Communicable Disease Control (CDC) Network
Province of Manitoba
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12/14/2009 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Burgess IF, Brunton ER, Burgess NA. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr. 2010;169(1):55-62.
Last reviewed May 2009 by ]]>Igor Puzanov, MD ]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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