All About Head Lice

Kathy Wheeler — Wed, 14 Jan 2009 18:00:00 GMT

What are head lice?

Lice are tiny, wingless parasites that live on the moist, warm, clean hair of the scalp of those that are infested. Outbreaks of head lice affect 10 to 12 million Americans annually. These outbreaks are generally seen between August and November after the beginning of school each year.

What do head lice look like?

Adult lice range in size from 1 to 4 millimeters—about the size of a sesame seed. Head lice lay 4-6 eggs on the hair shaft each day. These eggs, called nits, will hatch in approximately 5 to 10 days. The newly hatched lice are called nymphs and will mature in 7 to 10 days. Adult lice can live on the scalp for about a month.

This is a picture of a louse that is attached to a hair shaft. They are difficult to see due to their small size. Head lice can also crawl 6 to 30 centimeters per minute making them even more difficult to find when checking your child’s scalp. The nits are difficult to see as well. Generally the nits are found very close to the scalp. The picture to the right shows nits attached to hair shafts. Their size is compared to the head of a pin. Good places to find nits are behind the ears and the nape of the neck. Dandruff, scabs, and dirt may sometimes be mistaken for nits. However, nits are firmly attached to the hair shaft and are more difficult to remove than dandruff, scabs and dirt.

How do I know if my child has head lice?

The most common complaint your child will have is scalp itching. You may notice your child scratching their heads more than usual. In natural, bright light check your child’s scalp by parting the hair and examining the scalp. The most reliable sign of head lice infestation is, of course, actually seeing a louse on the hair shaft or scalp of your child. Look for nits attached to the hair shaft very close to the scalp. When checking your child’s scalp, you may notice a rash that is produced by the infestation. Excessive scratching can increase the chances your child may develop a secondary skin infection on the scalp.

How did my child get head lice?

Lice can crawl quickly; however, they generally do not like to leave the warmth of the scalp. They do not hop or jump. They can cling to clothing such as collars and hats, especially if there are a large number of adult lice present. Head-to-head contact is one way lice can be transferred to another person. Lice may be found in brushes, combs, scarves, hats, headphones and helmets and can be transferred through the sharing of these things.

How do I treat my child?

Getting rid of head lice involves not only killing the lice but also removing the nits from the hair shafts. You may shave the heads of boys to remove active lice and nits. If so, place all hair in a trash bag, close it tightly and dispose of the bag immediately.

There are medications in the form of shampoos and crème rinses that you can buy from your local pharmacy to treat head lice. In some cases prescription medications may be needed.

Pyrethrins and Permethrin are the two agents that are sold over-the-counter to treat head lice. Both of these products are made from chrysanthemums. Anyone with an allergy to chrysanthemums should not use these agents.

q Pyrethrins

o As much as 75% effective against lice.

o Anyone with ragweed allergy may experience an allergic reaction with this product.

o Apply medication to scalp for 10 minutes and then shampoo or rinse as directed by the product.

o Combing with a lice comb should be done following treatment. Parents must be diligent and patient in order to adequately remove the nits from the hair shaft. This may take a significant amount of time, but is an important part of treatment.

o Application must be repeated in 7 to 10 days to kill any remaining nits that have hatched.

o Rash, itching and burning may be experienced after applying the product.

o Avoid contact of medication with the eyes.

o Over-the-counter products such as A-200â Gel and shampoo concentrate, RIDâ, Prontoâ, R&Câ shampoo, and Licetrolâ are just a few that are available.

q Permethrin

o As much as 99% effective for lice after one application.

o Allow product to remain on hair and scalp for 10 minutes before rinsing.

o Comb hair with lice comb to remove nits. Parents must be diligent and patient in order to adequately remove the nits from the hair shaft. This may take a significant amount of time, but is an important part of treatment.

o May require re-application in one week if active lice are seen on your child’s scalp after the first application.

o Irritation with burning, stinging, and itching may be experienced.

o Avoid contact with your eyes.

o This product should not be used in children less than 2 years of age.

o Over-the-counter products such as Nixâ Cream Rinse, A200®, Acticin®, Rid®, and Elimite® are available.

To assist with the removal of nits you may use a 1:1 solution of vinegar and water applied to wet hair avoiding contact with eyes. Wrap the hair in a towel for 1 hour and then comb the hair with a lice comb. Do NOT cover the child’s face during this process. Supervise your child throughout the entire process.

Contact your doctor if your child is allergic to chrysanthemums, has ragweed allergies or if you have noticed a scalp infection. If your child is less than 2 years of age call your doctor before using any over-the-counter products. If your child has lice or nits in the eyebrows or eyelids, call your doctor prior to treating.

Prescription medications may be needed if over-the-counter products do not work. Available prescription products are Malathion and Lindane.

q Malathion

o As much as 95% effective.

o There are no lice that have shown resistance to this agent.

o Apply to clean, dry hair and leave on for 8 to 12 hours before washing the hair.

o Made in a flammable alcohol base so do not use a hair dryer or smoke while product is in the hair.

o Repeat application usually not necessary.

o Do not use in infants less than one month of age.

o Priodermâ and Ovideâ are malathion products available with a prescription only

q Lindane

o Apply to cool, dry hair only and let hair air-dry. Do not use a hair dryer following application. The heat of blow-drying may increase absorption through the skin and lead to side effects.

o Absorption through the skin may cause nausea, vomiting, and even seizures.

o Lindane is approved for a single use and a 4-minute application time only.

o This agent should not be used in infants less than one month or those with seizure disorders or skin diseases.

Are there any “natural” remedies that work?

There are several alternative remedies that you may have heard can cure head lice. These remedies have not been scientifically proven to kill head lice.

Vaseline treatment or mayonnaise treatment.

· Apply Vaseline or mayonnaise liberally to the head.

· Cover your head with a shower cap for 8 hours. Be very careful NOT to cover the face. Make sure that your child is supervised throughout this process.

· Shampoo the Vaseline or mayonnaise out of the hair.

· Brush out any remaining lice.

Shampoo + oils treatment

· Mix together: Small amount of an inexpensive shampoo

3 tablespoons of olive oil

1-teaspoon tea tree oil

1-teaspoon eucalyptus oil

· Work into hair.

· Cover your head with a shower cap for about an hour. Be very careful NOT to cover the face and supervise your child throughout the process.

· Wash hair to remove oils.

· May repeat as needed.

How do I rid my house of these lice?

All members of the household should be checked for possible head lice. All areas in your home and car that have come in contact with your child’s head should be cleaned.

All clothing, bed linens, and towels should be washed in hot water and dried on the hot setting in your drier. Dry cleaning and ironing with a hot iron will kill lice and nits as well. If you cannot safely wash the bed coverings in hot water then you can double bag them in black plastic bags and put away for three days. At the end of the three days, wash the bedding according to the normal washing instructions. NOTE: Be careful to supervise your child at all times.

Combs and brushes should be soaked in hot water with 1% Lysol or bleach for 10 minutes.

Vacuum all carpeted areas—even under the beds. Vacuum all upholstered furniture. Do not use chemical sprays in the home.

What can I do to prevent this from happening again?

Talk with your child and reassure them that head lice are not due to poor hygiene habits. Talk with your child about the signs of head lice. Ask your child to tell you if they develop any excessive itching on their scalp. Tell your child to only use her own comb/brush on her hair and not to share them with her classmates. Ask your child to not share sports equipment, hats, or scarves with her classmates. Understand that even with the most diligent of efforts, head lice infestation can still occur and should be promptly treated.

For more information on head lice, contact the National Pediculosis Association at www.headlice.org.

References:

Buff W. Insect Bites and Stings and Pediculosis. In: Berardi RR, McDermott JH, Newton GD, et al, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 14^th ed. Washington, DC: AphA;2004:902-911.
Frankowski BL. American Academy of Pediatrics guidelines for the prevention and treatment of head lice infestation. Am J Manag Care.2004;10:S269-72.
Greene A. Treating head lice. Available at: http://www.drgreene.com/21_640.html. Last accessed on August 9, 2008.
Hensel P. The challenge of choosing a pediculide. Public Health Nursing. 2000;17:300-4.
Lebwohl M, Clark L, Levitt J. Therapy for head lice based on life cycle, resistance, and safety considerations. Pediatrics. 2007;119:965-74.

Pictures were downloaded from various Internet web sites to include:

Head Louse picture: http://www.borealforest.org/insects/insects7.htm
Pin and nit picture: http://ohioline.osu.edu/b893/b893_24.html
Child’s head picture: http://pediatrics.about.com/od/headlice/ig/Head-Lice-Pictures/Live-Louse-on-Hair.htm
Child and Mom: http://www.remedies-for-natural-health.com/home-remedy-for-head-louse.html
Pictures of products: http://www.ridlice.com/products.html; http://www.walgreens.com/popups/s_image.jsp?id=prod389053&skuid=sku389054; http://www.liceandscabies.com/liceusagerc.shtml; www.anbcanada.com;

http://www.abconlinepharmacy.com/ns/customer/product1792-c-p1; http://www.irxmedicine.com/products/pdt.asp?p_unitid=29009

14-Jan-09 12:00 PM

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