boy scratching head
The mention of the word lice commonly invokes a reaction of horror, disgust and a spontaneous case of the heebie-jeebies. You know the feeling: your head starts to tickle, a crawling sensation even, as you casually run your fingers through your hair in an effort to mask a scratching motion. And that’s just from the word.
Now imagine you get that dreaded call from the school nurse, and chances are at some point you will. Even if you don’t, you most likely have gotten the memo from school about outbreaks of lice threatening a classroom near you. Suddenly, girls are wearing pony tails shellacked back with gel and hairspray and boys are sporting military-style crew cuts. What can you really do to prevent this parasite from taking over your home?
First, educate yourself about this tiny nuisance. Review your options. Then approach the enemy with a take-no-prisoners attitude.
Becoming the Lice Slayer
Evidence shows that 50% of lice cases are resistant to the current treatments available on drug store shelves, but these treatments still are a good first-line defense. According to Jill Hefti, a family nurse practioner, following the product directions in conjunction with daily combing with a lice comb carries little risk and is relatively cost effective. When patients present with lice to the practice where she works with family practice physician Jesse Haven, M.D., they provide patient education on how to rid the home and hair of the parasite.
In resistant cases, Hefti says, they have seen good results with prescribing Sklice (ivermectin) lotion, a topical scabies and roundworm treatment that was approved for head lice in 2012 and claims to destroy live lice and eggs without nit-picking. Studies show that Sklice is 95% effective after two days according to the New England Journal of Medicine and 74% of those treated were lice free at 15 days. “We have to consider the financial situation of the family,” Hefti says, as the treatment can cost $300 per application when not covered by insurance. Over the counter treatments such as Nix or Rid usually run $15 to $25 per person, depending on volume of hair product needed. Retreatment always is necessary after 7-10 days to kill newly hatched lice from eggs left behind before they grow up to lay more.
In addition to Sklice, two other prescription products have been approved recently. Spinosad topical suspension 9% (brand name Natroba) and benzyl alcohol 5% lotion (brand name Ulesfia). Natroba is a combination of an organic pesticide often seen in flea medication for pets combined with benzyl alcohol that boasts 85% success 14 days after a single treatment. The downside? Its safety has not been approved in children under age 4. Ulesfia relies on the benzyl alcohol to suffocate the live lice, which is not considered a pesticide and is safe for children age six months and older. The major warning here is that these two products are flammable, so staying away from a spark is mandatory.
Natural remedies are available for parents who want to avoid applying pesticides to their children, whose children are too young for the treatment (minimum age varies by product) or who have kids with allergies or asthma. These involve using various herbal oils, olive oil, mayonnaise or non-pesticides such as Vaseline or dimethicone in combination with diligent nit picking with a lice comb. The obvious downside is the oily mess and the difficulty removing these products from the hair. These unproven products usually are low risk but the key to results most likely is due to the daily combing. The heavy nature of these products slows down these fast crawlers making combing them out easier and nits more visible. In its Guidelines for Controlling Head Lice, the Spokane Regional Health District states that “combing the hair with an effective, metal lice removal comb is the most important step in treating head lice. Combing alone can be an effective option, so long as it is done daily for up to two weeks or seven days after the last nit or louse has been found.”
The guidelines also recommend combing out hair in bright or day light, discarding any lice or hair in comb after each pass in alcohol or wipe comb with a tissue and place in a plastic bag. The smaller the section of hair combed, the better chance you have of catching all the lice and nits.
Your best defense
The key to preventing reinfestation is treat all family members who show evidence of lice and to inform any friends or household in which you have had close contact. Not only is it the friendly thing to do, it prevents that child from reinfesting you! Here is a check list of other measures and precautions:
1. Place brushes, hair ties and combs in alcohol for two hours, in the freezer in a zip lock overnight, in the dishwasher on hot cycle or don’t use for 24-48 hours.
2. Clean bed linens and recently worn clothes in washer and dryer on hot cycles.
3. Pillows, bedspreads and stuffed animals can be placed in a dryer on hot for 30 minutes,. They also can be isolated in another room for 24-48 hours.
4. Perform daily head checks and comb-throughs with a metal lice comb until you have been lice free for two weeks.
5. Keep girls’ hair pulled back anytime they are playing with others.
6. Lice are averse to mint, so using a peppermint shampoo and/or leave spritz may send them elsewhere for a host.
7. Watch for itching and scratching of the scalp which may persist after lice have been destroyed.
And now for the good news
Armed with a little knowledge and an arsenal of combs, your family can prevent lice or face it without fear. With the approval of the new topical treatments in recent years, families can stop wasting their money, time and tears on ineffective techniques and products, and not miss valuable time in school.
The Lice Cycle According to the Federal Centers for Disease Control and Prevention, the life cycle of the louse has three stages:
1. Nit: The egg, which is oval and yellowish white and is different than dandruff because it is “glued” to the hair shaft. Nits take seven to nine days to hatch.
2. Nymph: These babies are about the size of a pin head and become sexually mature after about seven days.
3. Adult: About the size of a sesame seed with six legs and tan or gray color, adult females can lay up to eight nits per day and can live 30 days on a human head or two days without a host.
The Facts of Lice
1. Head lice love human hair only. Clean or dirty, long or short, chemically processed or natural. They need human blood to survive; likewise, the nits or eggs need the warmth and moisture of the scalp to mature.
2. Lice cannot survive more than two days without a human. They cannot fly or jump. So a louse or nit in a hairbrush or on the carpet will not survive unless it makes contact with a human within 48 hours of its last meal. A hairbrush cannot successfully transmit lice unless both sexes go on the journey and reproduce at the destination.
3. Pets cannot carry lice.
4. Nits carry almost no risk of transmission. Nymphs are of little risk as they are sexually immature. Mature lice are the troublemakers, spread by head-to-head contact.
5. Head lice do not carry disease.
6. Nits attached more than a 1/4 inch from the base of the hair shaft indicate that the eggs are already hatched and dead. If no live lice are seen then the infestation is no longer active and does not require treatment.
7. While lice can hold their breath for several hours they are not likely to be transmitted in a swimming pool.
8. Lice are unlikely to be spread by sharing sports helmets and headphones because their feet are adapted to grasp human hair and they have difficulty adhering to slippery surfaces such as plastic or metal.