BUG WEEK: Day 6- How to treat head lice

Robinson D, Leo N, Prociv P, Barker SC.Potential role of head lice, Pediculus humanus capitis, as vectors of Rickettsia prowazekii. Parasitol Res. 2003 Jun;90(3):209-11.

Head lice are the same species as body lice and can transmit disease! However, there have been no cases that I could find of an isolated head lice infestation that caused the transmittal of infection. The article above makes the excellent point that when one has a body lice infection, one will also have a head lice infection, so it is difficult to tell which ones are transmitting disease. I suspect that head lice treatment guidelines will continue to be lax as long as there are no elementary school kids who come down with typhus.

Head lice don't live on pets or clothes, and they require human blood to survive. You can see the nits (the eggs that are near the hair root) much easier than you can see the actual louse. So when people do lice checks, they're not actually looking for little bugs running around on your scalp, but they are trying to see little clearish oval eggs attached to your hair.

I've never had lice, but it seems pretty popular with the under-12 crowd. All that hat-sharing, head-to-head contact, and shared nap space makes for the perfect environment for a lice infestation. Judging from a quick Google search, there's big money in the lice-removal market. Combs, medicinal shampoos, and non-chemical treatments are all over the place. But what do the doctors recommend????

Here are the basics of lice removal:
1. treat with an agent that will kill the lice and help loosen the nits
a. pyrethroids- over the counter, permethrin and pyrethin are most common, documented increasing resistance, relatively few side effects
b. lindane- over the counter, documented increasing resistance, associated with some CNS side effects (seizures)
c. malathion- prescription, 98% ovicidal (should only require 1 or 2 treatments), no known serious side effects, flammable (so monitor children after treatment), no known resistance
2. manually remove the nits and lice
3. wash clothes, sheets, and other heads that the infected head may have come in contact with

The American Academy of Pediatricians recommends the use of over the counter pediculicides first (permethrin 1%) and malathion for resistant cases. Also, once treated, patients are safe to return to school, even if they still have nits in their hair. Interestingly enough, the main societal cost associated with lice is the lost school time by the kids and the lost work time by the parents who have to stay home with them. The AAP believes that the "no nit" policy is obsolete and that the treatments are effective enough to prevent outbreak. Also, they think that lice screening and the "no nit" policy are out of proportion to the medical significance of a head lice infestation. The children should, however, be discouraged from head-to-head contact with others.

The National Pediculosis Association disagrees. They are not proponents of pesticidal treatments as they can be dangerous depending on the medical condition of the patient, are often overused, and are not 100% effective. They have chosen to endorse the Licemeister comb. Really all you need is a comb with teeth that are as close together as possible (this is to physically drag the nits off your hair), but having one with a cool name couldn't hurt.

Although I would tend to agree with the AAP over the NPA, I must admit that the NPA website is full of wonderful treasures. There's a page with a bunch of educational videos, you can even observe an effective comb out! And my personal favorite is the lice e-card. I believe I have some e-cards to send now...