Head Lice

It's getting to be that time of year - head louse season. When the weather gets cold, and kids start piling their coats and jackets in the coat closet at school, those pesky little critters make their annual reappearance.

Head lice are more of a social problem than a medical problem. Actually, only body lice - a different critter - spread any known diseases from human to human. Head lice, while disgusting, are not known to carry any significant diseases. But that doesn't make them any less "icky."

Most people have many misconceptions about head lice - the disease carrying idea being a common one. But the biggest confusion arises about actual diagnosis, treatment and prevention.

Diagnosis of head lice should be simple. The patient has either live lice - tiny black insects about a sixteenth of an inch long - crawling in the hair - or has eggs discovered on the hair shafts. These eggs, or "nits," produce the most confusion.

Five Steps to Killing Head Lice
Use a permethrin or pyrethrim-based pediculocide Apply olive oil to the head at bedtime (Wear a shower cap so the oil does not come off.) Use a nit comb before removing oil Clean the environment of lice Check scalp for nits for up to three weeks.

Nits are difficult to remove from the hair, and remain long after successful treatment. It is simply a medical fact that any nit located on a hair shaft more than about 1/8 inch from the scalp has already hatched and is empty or dead and non-infectious. Thus long after treatment has successfully killed all the lice, the nits remain and are visible in the hair.

The discovery of these dead nits often causes the day care personnel or teachers to mistakenly think the child is still contagious. The child is sent home with a stern note, which leads to consternation on the part of the parents - "He's been treated already!" - and often several more rounds of louse treatment that are totally unnecessary.

Treatment of head lice is straightforward, but getting rid of them totally can be frustrating. Nix® cream rinse (1% permethrin) is thought to be the most effective treatment available - it is non-prescription. It is approved for use once every two weeks during epidemics of head lice to prevent re-infestation or spread of lice among family members. Lindane, an insecticide, is effective but if grossly misused can cause brain damage; many doctors (including me) have stopped using it altogether. If you are having trouble getting rid of the lice totally, remember to treat everybody in the family, to spray for the lice on sofas or in bedding, and try the olive oil method in the box to the right.

Removal of those pesky nits can be accomplished by rinsing the hair with vinegar to dissolve the "glue" that holds the egg to the hair shaft, followed by combing them out with a very fine comb. A commercial product, Clear Lice Egg Remover® (Care Technologies Co.) is also very effective and doesn't smell like vinegar!

Spray the furniture or bedding that can't be washed in hot water with Rid® permethrin spray to kill any live lice there. Boil your combs to eliminate transmission of head lice that way.

Now, to get even more information than you ever thought possible (and even stuff and gadgets like the LiceMeister® comb) hop to the National Pediculosis Association Homepage.

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