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Head Lice, Ick

December 8, 2007

If your child has comes home from school with lice, the treatment can be extremely time-consuming for the entire family. Your child’s doctor may suggest insecticide lotions, extensive home cleaning measures, and repeated combing to remove the nits from your child’s hair. There are several treatment regimens, but they all require patience and a sense of humor.

Head lice infestations are a common problem in infants and children, and do not reflect poor hygiene and infrequent hair washing. Lice are spread by direct contact with someone who is already infected or by sharing of contaminated items such as hats, brushes or combs. Unfortunately, reinfection is common, and persistent infection is possible.

Nits are eggs from the adult lice and are whitish and are firmly attached to hairs. The eggs hatch in 6-10 days and it then takes another two to three weeks for the lice to mature and be able to reproduce. Adult lice are reddish-brown and 1/16 of an inch long. They move very fast and are most commonly seen at the back of the neck and behind the ears. Adult Lice can only survive for two to three days off of the human body.

The most common symptom of children infected with head lice is itching, although some children do not complain if they have a light infestation. However, if you suspect lice or the school nurse informs you of a lice case in the classroom, do a thorough check of your child’s hair and scalp to look for live lice. If you do not see adult lice, but find nits, then you may be able to just try and remove the nits on a regular basis and continue to look for live lice. Since most of the anti-lice medications are not ovicidal, meaning they don’t kill the eggs, treating a child with just nits may not be necessary.

If you find lice and nits on your child, use an anti-lice shampoo, such as Nix or Rid, and follow the package directions carefully. Apply the shampoo to washed and dried hair until the hair and scalp is saturated and thoroughly wet. Leave the shampoo on for ten minutes and then rinse it out. Consider using a second shampoo treatment in 7-10 days to kill newly hatched lice.

Another shampoo, Ovide (malathion), is available with a prescription. It is applied to clean, dry hair so that the scalp and hair are thoroughly wet, left on overnight under a shower cap, and then washed out in 8 to 12 hours. However, this shampoo is flammable and toxic. It should not be used in newborns or infants.

Lindane is a medication approved by the U.S. Food and Drug Administration (FDA) that’s used to treat lice and scabies. It is found in prescription-only shampoos and lotions that can be applied to the scalp or skin to treat these parasitic infections. But according to researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, lindane poses a risk of poisoning for many people every year when it’s accidentally ingested.lindane ingestion did cause symptoms such as vomiting, nausea, mouth irritation, abdominal cramps, coughing, and seizures. The average age of the person ingesting lindane was 13 years of age. One of the problems with lindane is that it is packaged in containers that look like those used for liquid oral medications such as cough syrup.

Lindane is no longer recommended as the first line of treatment against lice or scabies because there are safer medications that are generally more effective and less costly. It also is not recommended for people under 110 pounds (50 kilograms). However, lindane is still used when previous treatments are ineffective or not tolerated.

To assure total lice treatment it is necessary to remove all of the nits using a fine toothed metal comb. Separate your child’s hair into sections. Use a lice comb to go through each section of hair from the scalp to the end of the hair, removing all of the lice and their nits (lice eggs). After finishing each section, search again for any lice and remove them.

It is important to check your child’s hair every night until all of the lice and nits have been removed. Sit your child in the bathtub and comb their hair out with a regular comb. Check the scalp thoroughly and remove all lice (alive or dead). Use your lice comb again and go through each section of hair until all nits have been removed. For lice in eyelashes, apply Vaseline to the eyelashes twice a day for a week to kill them.

Some health experts question the effectiveness of these measures and the safety of some of the insecticides used.

Newer therapies for treating resistant lice include the application of full fat mayonnaise, olive oil, Dippity-Do brand styling gel, or Hair Clear 1-2-3 to the hair overnight. This is supposed to suffocate or smother the lice.Some physicians are using oral therapies to deal with resistant lice, including the drug ivermetim (a one time dose) and the antibiotic Bactrim (3 day course).

Lice can live for up to three days off of the human body, so, in order to prevent reinfestation, it is important to wash all bedding and recently worn clothing in hot water (>120º) and dry in a hot dryer.

It is also important to soak combs and brushes in hot water for 10 minutes. Vacuum the house to remove all lice and hairs with attached nits from furniture, rugs, stuffed animals and car seats. Place items that can not be washed or vacuumed into plastic bags for three weeks and change the sheets and pillowcases every night for a week and wash in hot water.

While there is much evidence that lice are becoming resistant to the effects of antilice shampoos, the most common reasons for treatment to not work is failure to remove all of the nits or your child is continuing to be exposed to someone with lice. Be patient, be thorough, and encourage you child never to share hair brushes or hats with their classmates.

Posted by NatalieGeary, MD | Filed Under Dr Geary 

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