Head Lice Prevention

Got Lice? Come On In.

My kids’ school lets students with head lice stay in class. What a great policy!

If you’re a parent, you’ve probably gotten the dreaded call from the school nurse, letting you know that your child has lice. It happened to our older daughter in kindergarten, and then again two years later when our youngest was in the same grade. Each head lice infestation was a mini nightmare: a work and school day lost to early pickup, chemical shampoos, vacuuming, and endless combing for nits (eggs). The days after, spent worrying that a stray louse might mean another call from the nurse and another day out of school. And that call always came: Your daughter has lice again. She’ll be waiting for you in the office. Last year we spent a couple hundred dollars on a proffesional lice remover, just because we could no longer face the hours every night we needed to spend nit-picking.

At many schools, any discovery of live lice in a child’s hair warrants a phone call and the immediate removal of the child from school. At some schools, the child may return the next day if the parents have treated the child’s hair—that is, shampooed it to kill live lice. But in schools with “no-nit” policies, a child can’t return unless every last tiny louse egg has been combed from her hair—and schools may check returning students and send them home if any nits are found.

But then, this fall, everything changed. The schools here in Arlington, Va., have adopted what you might call a live-and-let-lice policy. No child will be sent home for lice or for nits. If a child has lice in her hair, the nurse will contact parents but send the child back to the classroom for the rest of the day. Parents are expected to treat the lice, but no one is checking in to enforce this expectation. No classes or groups will be screened for bugs. “No healthy child,” the policy reads, “should be excluded from or miss school because of head lice.”

When I told friends in other school districts about the shift in our school’s lice plan, their jaws dropped. That’s amazing, they said. Finally, they said. And, How can I persuade my school to do the same thing? But my friends are gross, so you may, understandably, have a different reaction to this news. Like, Ew, a school is letting a bunch of bug-covered, itchy kids rub heads in the classroom?

Sorry, your response is wrong. Arlington’s new stance on lice is being adopted by schools all over the country, encouraged by the American Academy of Pediatrics and then National Association of school Nurses. And its the right one. Lice are not particularly contagious, they hurt basically no one, and they’re not a public health risk. Lice don’t actually matter. It’s high time that squeamish parents and school administrators stop acting like they do.

Let’s start with many schools’ long-standing no-nits policies—policies that say kids can’t return to school unless every last tiny louse egg has been combed from their hair. “No-nit policies don’t make any medical or scientific sense,” said Dr. Barbara Frankowski, professor of pediatrics at the University of Vermont. Frankowski, the lead author of the American Academy of Pediatrics’ study recommending changes in school lice policies, told me that, as any parent who has tried to remove nits knows, the eggs are firmly cemented to a child’s individual strands of hair. “They’re not going anywhere,” she said, “and pose no risk to other children.”

But even parents who understand the logic of not checking endlessly for nits get nervous about sending a child upon whom the nurse has just discovered live lice back to the classroom for the rest of the day. Shouldn’t those children go home so they won’t spread the lice to other kids? “If you find live lice during the school day, it’s likely that child has had lice for weeks,” said Carolyn Duff, the president of the National Association of School Nurses and the nurse at an elementary school in Columbia, S.C. “Allowing that child to remain in the classroom for a few more hours is not putting children at risk.”

After all, despite what you may think, “It’s not that easy to get lice!” Duff exclaimed. “They don’t fly. They don’t jump. They can barely crawl through your scalp. They can only spread through head to head contact, and children in schools don’t usually have head-to-head contact.” Even transmission through hats or hairbrushes is difficult—it can happen in families where such sharing is commonplace, but much less frequently in schools. (According to the experts I talked to, children are much more likely to spread lice during sleepovers or playdates, or at sleepaway camp.)

And even if they were highly contagious: The point that both the AAP and the NASN want to make is that it’s far more important to keep kids in school than it is to send them home in the hope of stopping the spread of lice. Because, again, lice don’t hurt anyone. “We’ve heard stories of kids missing weeks of school because of lice, even being held back a grade,” said Frankowski. “It’s unfair to kids. It’s unfair to parents who work or who have other difficulties that don’t allow them to go through hours of delousing.”

If your school still sends kids home for lice or (God forbid) for nits, what can you do? Find out who makes the decisions on those policies. Sometimes it’s a school-by-school choice, which means you can collect all the relevant scientific information and talk to your principal. (Consider enlisting your school nurse, who almost certainly agrees with you, to help argue the case.)

Sometimes these policy decisions go through the school board. “I don’t want to disparage school boards,” said Frankowski. “But they don’t always make policy connected to what’s scientific—sometimes it’s just what’s easiest, or what they think parents want.” So you need to convince your school board that what parents want is a policy based on science, on expert recommendations, and on making life saner for busy parents.

Who would possibly disagree? Well, there are definitely parents who do. They can find support from Deborah Altschuler, the president and co-founder of the National Pediculosis Association, a nonprofit with a website touting the benefits of no-nit policies. In a phone interview, Altschuler told me that the school policy question was “a minefield” and said there is “a small club of people who follow the idea that there is some kind of scientific basis for allowing children with lice back in school.” She disagrees: “It’s a communicable disease that is easily transmitted among kids. We want to send kids to school lice- and nit-free, rather than lowering our standards to accommodate those who can’t do it for whatever reason.”

When I asked Altschuler about the AAP and NASN’s rejection of no-nit policies, she accused the organizations of being overly influenced by lice-chemical manufacturers. (For what it’s worth, Altschuler funds the anti-chemical National Pediculosis Association  through sales of the LiceMeister nit comb.)

Altschuler’s claim that lice transmit disease—that they are, themselves, a disease—is not supported by most scientists. In general, experts say, parents stress out way too much about head lice. “Head lice are a fact of life. It happens. It’s not a health issue, really,” said Marian Harmon, the school health bureau chief for Arlington County’s public health division who signed off on our schools’ new policy. “It’s not a sign of poor hygiene. It’s not an infection. It’s not a communicable disease. We treat it for the comfort of the child and the family. It shouldn’t be escalated to such a high priority.”

What I wondered after talking with all these experts is whether lice even need to be treated at all. Treatment’s expensive, it can expose your kids to pesticides, it takes forever, and all it does is rid your child of a basically harmless pest—and then only until the inevitable next time it shows up. I certainly didn’t get any of the experts I spoke with to come right out and say that you can pretty much ignore lice. They all note that parents want their children to be lice-free, regardless of whether the lice pose any actual threat. “It’s an emotional issue!” allowed the NASN’s Duff. “It’s a live bug crawling on the head of your child.” But I wonder if emotions aren’t getting in the way of common sense. After all, as Frankowski wryly noted, “No one’s ever died from a head louse infestation.”

That’s what I often found myself muttering in years past, as my wife and I spent work days and weeknights washing and combing and washing and combing the heads of perfectly healthy children. In an educational environment in which intervention is the default, a message from a school district announcing that its new policy is for everyone to just relax is extremely welcome. My kids need to be in school to learn, and to play with their friends, and to build their bright futures, and to stay out of my hair. I don’t need them sent home because of the harmless things crawling in theirs.

Smartphones blamed for the dramatic rise in head lice as schoolchildren gather together to view the screens

Smartphones have been blamed for a dramatic rise in head lice among schoolchildren because they encourage youngsters to gather round in groups, allowing the bugs to jump between heads.

A study of more than 200 youngsters found those owning a smartphone - or tablet - were more than twice as likely to be infested with lice.

Out of the 98 who did not have or use either type of device 29 (29.5 per cent) experienced head lice - compared to 65 of the 104 (62.5 per cent) who did.

Almost half of the participants had lice at some point in the previous five years, up to 22 times more than the figure of two to eight percent that has been calculated in the past.

However taking regular selfies was not a major factor in the rise contrary to previous suggestions.

In 2015, Wisconsin GP Sharon Rink coined the phrase 'social media lice', claiming the upsurge in head lice was caused by group selfies, which caused friends to bump heads. 

Dr Tess McPherson, of Oxford University Hospitals NHS Foundation Trust, said: "Compared to previous estimates of head lice incidence our figures were much higher, showing that almost half of children have had them in the last five years, which may not come as a surprise to parents.

"We also noted that children with smartphones or tablets were more likely to get head lice, which is interesting but we can only guess that this is due to the way that young people gather around them, though there could be other reasons.

"Selfie culture gets its fair share of negative press so it's worth noting that despite previous speculation it seems that selfies can't specifically be blamed for helping the spread of head lice at this stage."

The study presented at the British Association of Dermatologists annual conference in Liverpool said previous estimates of the prevalence of head lice in British children "may be conservative."

It found 91 (45 per cent) of the children had had head lice in the last five years, a longer period than covered by earlier research.

Girls with siblings aged six to nine were most commonly affected.

Matthew Gass, of the British Association of Dermatologists, said: "Head lice are a pain to deal with, both for children and their parents.

"Speaking from experience, they are intractable misery bugs that take far more time and effort to remove than is reasonable.

"Not to mention the obligatory quarantine period that they necessitate. That's why a better understanding of how these pests are transmitted is useful.

"Prevention is always better than a cure, particularly if the cure means wrenching your poor daughter's hair with a fine-toothed nit comb, or relying on over-the- counter remedies that head lice are increasingly resistant to.

"We're not saying that smartphones are causing children to get head lice, but that there is a link, so if there's an outbreak at home or at school, consider how electronic devices might cause children to congregate, allowing head lice to spread."

In the study questionnaires were given to parents or guardians attending the paediatric outpatient department at the John Radcliffe Hospital in Oxford, over a one-month period.

The survey collected information on sex, hair length, socioeconomic status and smartphone or tablet ownership.

Head lice live in hair and are particularly common in four to eleven year-olds - causing an itchy scalp and general discomfort.

They range in size from the size of a pinhead to that of a sesame seed and are a whitish or grey-brown colour.

A variety of treatments to get rid of head lice are available to buy from pharmacies, supermarkets, as well as online and you don't usually need to visit your GP to tackle the problem.

You catch them via direct head to head contact, where they climb from one person's hair to another's - they cannot jump, swim or fly.

They are very unlikely to be spread by items such as combs, hats or pillows and are specific to people - you can't catch them from animals.

Contrary to the old wives' tale, head lice have no preference for dirty or clean hair - nor short or long. They usually die within 12-24 hours of being removed from hair.

The Things Head Lice Carry: Stigma and hassle, but no harm

Add lice to the list of four-letter words that make people cringe. The wingless parasites are itchy and bothersome, and an infestation is often embarrassing to admit and challenging to conquer. But at least head lice have something going for them that a lot of other bugs don’t: They’re harmless.

“Ticks can transmit Lyme disease; mosquitoes transmit West Nile virus and malaria, among other things,” said Navy Capt. Kevin O’Meara, a physician and chief of pediatrics at Fort Belvoir Community Hospital in Virginia.

“But head lice – those guys are pretty benign,” O’Meara said. “They’re not dangerous. They’re just annoying.”

Three types of lice afflict humans. Pediculus humanus capitis, or the head louse, is common in childhood. Up to 25 percent of all school-age children will have head lice at some point, according to the Centers for Disease Control and Prevention, with anywhere from 6 million to 12 million cases reported each year in the United States in children ages 3 to 11.

As O’Meara explains, head lice don’t jump or fly. Instead, they crawl from one person’s head to another person’s. Less commonly, lice also can be transmitted through sharing personal items, such as towels at swim meets and pool parties, and pillows and other bedding at sleepaway camps.

Head lice live on the human scalp, where they eat meals of human blood and attach their eggs, or nits, tightly to the hair shaft. It takes seven to 10 days for the nits to hatch into baby lice, scientifically known as nymphs. The nymphs mature into adult lice anywhere from nine to 12 days after hatching, the CDC says. The sesame-seed-sized critters can live up to about a month on a person’s head.

“It may not be readily apparent that you have head lice,” O’Meara said. “Once you become sensitized to their saliva, you’ll start feeling very itchy. But that may be weeks after that first louse has crawled onto your scalp.”

O’Meara said it’s fine to see a health care provider for help getting rid of lice, but effective over-the-counter medications are also available. 

“Basically, you massage the medication into your hair, let it sit for at least 10 minutes, and then wash it out,” O’Meara said. “Generally, you don’t need to be treated again, but a lot of people do so after seven days because of fear of reinfestation.”

Head Lice Are Becoming More and More Resistant to Lice Shampoos and other Insecticides

Interesting article in SciAm about the difficulty in treating head lice infestations. “Overexposure to insecticides has bred resistance in the parasites, making it harder than ever to treat infestation." The situation is different in Europe, where they've stopped using insecticides to kill lice and nits and use synthetic oils:

Further confounding matters, the co-pay for visiting a doctor, plus the cost of prescriptions, which may or may not be covered by insurance, can impede patient access to these newer medications. And despite their diminishing efficacy, over-the-counter lice shampoos remain the first response recommended by most doctors, health plans and even the American Academy of Pediatrics.

The situation is totally different in Europe, where treatment moved on from pyrethroids and virtually all insecticides about a decade ago, says Ian Burgess, president of Internationals Society of Phthirapterists (people who study lice). Instead most Europeans now rely on silicone and other synthetic oils to eliminate head lice.

The oils envelop the lice, preventing them from excreting water. As liquid builds up inside the louse, its internal organs start to shut down from the exhaustion of trying to pump out the water. Either it dies of this exhaustion", Burgess says, “or its guts rupture from the liquid.”

The Latest on Head Lice

Like many other parents, I’ve paid my dues when it comes to head lice. It was a while ago, back in day care, and there was a dress-up box with hats and crowns and helmets that was probably the smoking gun. We all had to do the whole routine, applying insecticide rinses to our children’s heads and washing sheets and pillow cases in hot water, and becoming somewhat fanatical about not sharing hats.

Meanwhile, my parents, who had grown up in New York tenements, were vaguely horrified that their affluent privileged grandchild was acknowledged to have what they thought of as a mark of disgrace, an infestation that went with poverty and dirt.

And yes, eventually I became convinced that my own head was itching, and bought my own bottle of rinse, though I suspect I was by that point treating phantom lice. Since then, I have checked many heads in the exam room, and I have seen kids with lice, kids with nits, and kids with nothing much going on in the lice department — and I have learned to suppress the phantom lice response; I wear gloves and I wash my hands.

One aspect of the confusion around head lice is that we may think of them as “infectious” because they are spread from person to person — but they do not actually carry infections. They’re just bugs, and technically, we call head lice an infestation rather than an infection, but that doesn’t necessarily make anyone feel any better. (Body lice are different — they can indeed spread infections, most famously typhus).

So when it comes to head lice, the pediatric role in recent years has largely been to reassure, to beg for calm, and to try to get kids back to school as quickly as possible.

The American Academy of Pediatrics put out its latest clinical report on head lice in 2015, a joint project of the group that focuses on school health and the committee on infectious diseases. The report reiterated longtime pediatric positions, emphasizing the importance of careful diagnosis, by trained observers, and arguing first and foremost that children should not miss school because of head lice or nits.

“Misdiagnosis is really common, even with medical personnel,” said Dr. Mary Anne Jackson, the director of infectious disease and professor of pediatrics at Children’s Mercy Hospital in Kansas City, Mo., who works with the A.A.P. committee on infectious diseases.

She said administrators at one school she worked with worried that its football field might be a source of lice, and were concerned with fumigating or otherwise disinfecting it. But unless the players are sharing helmets they are unlikely to transmit head lice.

There are many misunderstandings about head lice, Dr. Jackson said, including the persistent idea that a child with head lice is evidence of an unclean home. (Head lice are, in fact, one of the great equalizers; just look at all the high end “salons” offering to pick to child’s nits for a hefty fee.)

It’s not necessary to treat all the children in a classroom, or all the people who live in the house, though anyone who shares a bed should get treated. We no longer use some of the more toxic insecticidal drugs that used to be employed, like lindane, which was a potential neurotoxin. The over-the-counter preparations that are available now are much safer, but there are concerns about resistance, so many people resort to prescription drugs. One that is commonly prescribed is topical ivermectin, a drug with what Dr. Jackson called “a strong safety portfolio,” but it can be expensive.

And there are many treatments out there that have no evidence to back them up. For example, Dr. Jackson said, there are clinics using heat on children’s hair, which may work under certain conditions, but there is no regulation of how it is being used “to quote unquote inactivate the lice,” she said. “I am skeptical.”

And then there are the “suffocation treatments,” from olive oil to mayonnaise, applied to the hair in hopes of killing off the insects without resorting to chemicals and insecticides. Some of these probably work some of the time but “all will work no matter how you place them if you don’t have lice,” Dr. Jackson said.

So diagnosis is key — someone experienced should look at the child’s head, looking for lice and not just for nits, since all kinds of debris in the hair can be mistaken for nits; everything from dandruff to dirt to drops of hair care products. And someone who knows the resistance patterns in your area should advise you about whether to use the over the counter preparations or the prescription medications.

The head louse life cycle takes about three weeks; the adult female, about the size and color of a sesame seed, lays about 10 eggs a day, and glues each one to a hair near the scalp. Eggs hatch in about nine days, warmed by body heat emanating from the scalp, and the larvae then leave the egg case (which remains glued to the hair, though it’s now empty) and go through several different developmental stages over the next nine to 12 days, before reaching adulthood and starting to lay their own eggs.

That’s why it can be helpful to treat more than once, usually after about nine days, if you are using a product that does not kill the eggs, or if you see live lice after a first treatment. And there are indeed some lice that are resistant to some insecticides, so it’s important to know what is common in your community.

Removing nits with a fine-toothed comb can be done after treating the child’s head, and usually is most effective when the hair is wet, though still not a short or simple process.

From an infectious diseases point of view, Dr. Jackson compared head lice with pinworms, another parasitic infestation parents regard with fear and sometimes with shame, and which may be treated repeatedly without a firm diagnosis that establishes beyond question the presence of these unwanted passengers on the child’s head — or the child’s tail. People worry, kids get treated, sometimes repeatedly, and the treatments cost money and take time. We spend a billion dollars a year on treatments for head lice, according to the American Academy of Pediatrics.

The A.A.P. has fought hard against “no nit” policies in schools, in the interest of reducing the school absence associated with head lice; the C.D.C agrees, and schools are increasingly unlikely to exclude children for nits, but still, in some schools, the policies persist.

“There should never be a case for a child with head lice spending days out of school,” Dr. Jackson said. “Families should be notified, they should be able to access topical medication and they should be able to re-enter the next day.”

I Spent Years Dreading the Day My Daughter Would Get Lice — and Then It Happened

I had just escaped from my kids, handing them off to my husband to take a few minutes to myself before the chaos of bath and bedtime began. The calm didn't last long. Five minutes later, he entered our bedroom and announced that our daughter had lice. "Are you sure?" I responded, hoping, of course, that the answer was no. "Look for yourself," he replied instead. I did, and yep, that definitely wasn't a case of dandruff. Those were bugs crawling around on my daughter's head.

Her lice took me by surprise (though is anyone really expecting it?). Months before, when I got notes home from school about the cases reported in her classroom, or when her best friend's mom called to let me know her daughter and son, who had been in my carpool just that afternoon, were both lice-infected, I had braced myself for an impending doom that never came. I heard horror stories from my neighbor, mom to one of my daughter's classmates, about her whole family battling lice. At one point, she said, she was seriously considering shaving her own head just to ensure she'd gotten them all. 

My own scalp immediately began itching, though my husband couldn't spot a single nit (weeks later, that phantom itching still happens every time I even think about the word "lice"), and I began picturing the long, complicated, and annoying process that ridding our family and home of lice would entail. I'm glad to say that although it was pretty annoying (never have my washer and dryer worked harder), we were able to defeat the lice — it ended up only affecting my daughter, who luckily had a mild case — within 24 hours. Here are six things I learned about lice and getting rid of it that I never knew. If your house comes down with a case, don't despair. You can vanquish those annoying bugs quickly and thoroughly. 

Related:

My Toddler's Eardrum Ruptured and I Didn't Even Know It

  • Lice are only passed through head-to-head contact. Head lice don't crawl, jump, or fly. The main way they spread is from close, prolonged head-to-head contact, and to a lesser degree, they spread through items that come into contact with an infected head, like brushes, hats, and (at our school found out last year) the helmets used in gym class. 

  • You'll almost certainly know them when you or your child gets them. When friends and classmates of my daughter's got lice, I checked her head obsessively, wondering if I was missing something. I wasn't. She was clear. When she actually did have lice, she complained about her head itching, and when we checked, it was pretty easy to spot a few bugs (they're called a louse, are around two millimeters long, and are pale gray in color) crawling around on that head of hers. Because she's blond, the nits (tiny white or yellow eggs that attach to the hair with a sticky substance that holds them firmly in place) were harder to spot, but because of the bugs, we knew they were there.

  • Lice don't live long off a head. Head lice only live with the aid of a scalp to feed on (gross, I know). Once they leave a head, they're usually dead in a day, two tops, so don't feel like you have to fumigate your whole house. Instead, focus on the things that have come in contact with your child's head over the past 48 hours (beds, brushes, hats and hair bands, towels, and clothing are the big ones).

  • A laundry cycle will kill lice. Wash all bedding and clothing that's come in contact with the a louse-infested person in very hot water, then put it in the hot cycle of the dryer for at least 20 minutes, and you're golden. I continued to wash my daughter's pillowcases every morning for a few more days just to be safe.

  • Isolate or clean items that can't be washed. You can put items like stuffed animals in a bag or simply isolate them from your child and you can be assured that they'll be lice free in a few days. Simply vacuum rugs, carpets, upholstered furniture, and your car. Hair items like brushes, hair ties, and headbands, you can either wash in hot water, soak in rubbing alcohol for an hour, or simply toss. 

  • Don't be afraid to call in the professionals. When I texted my neighbor who was threatening to go bald the previous year because of lice, she directed me to a nearby "salon" that focuses solely on removing lice. While the service wasn't cheap (because of my daughter's mild case, we opted for the shorter comb out, which was still around $150). However, they were able to remove almost the 55 nits that were still inhabiting my daughter's head after we used special lice shampoo and spent three hours combing out her hair the night before. We also bought a far superior comb than the one that came with the drugstore lice shampoo we'd used. After that one service, the lice were gone, so in my mind, it was definitely money well spent. We followed their comb-out advice and kept checking for the next few weeks, but thankfully, not a nit was found.

De-lousing the house

Parents frequently ask us at Larger Than Lice how to remove head lice within the home. If I can only count how many times I, or one of our Lice Specialists have arrived to a home only to find ten, twenty, thirty garbage bags full of “household things”. One family even went as far as removing their curtains, just in case. On top of all that, countless numbers of laundry loads have already been done. No wonder head lice becomes such a stressful event for many parents. I almost feel bad telling the families that all this cleaning is just excessive and not necessary at all. That’s right. Excessive cleaning is not at all required when you, or your child has a case of lice.

The reason? Head lice live on the head. They do not live on inanimate objects. They have no interest in leaving one’s head to go wander around on the living room couch, or kitchen floor, or roam the car. A human host is the only place they want to be, the only place that they can potentially survive a whole month while they feed off of the blood of an individual. Typically, a louse that has fallen off the head is not healthy and is in the process of dying. Once they are away from their feeding source, a louse can only survive up to 24 hours. And let's pretend as though a healthy louse has fallen off and has found its way onto the couch- it will not burrow or sit around and wait for another human to sweep it off its feet and place it back into a new head. The chances of getting a displaced louse back into one’s hair are as small as finding a needle in a haystack, nearly impossible.

  • Remember that lice are not living in your environment, they are living with you!

Don’t get me wrong, there are some things that need to be cleaned and laundered, but the list is very minimal. Laundering the bedding, any recently used towels and bathrobes is important. Same goes for all recently used hairbrushes and hair accessories. Bagging, laundering or drying on high heat should be considered for any stuffed toys that reside in your child’s bed. That is it. Use the rest of your energy on properly eliminating head lice and nit picking. Being meticulous is essential if you want to rid head lice for good. Removing every single nit is crucial to being lice free so make sure that no nits are left behind, which is exactly what Larger Than Lice are experts in.

When Larger Than Lice dispatches a Lice Specialist for an in-home lice removal treatment, you can rest assured that every single live louse and viable nit will be removed – in just one visit. After one lice treatment, and minimal laundering, you can rest at ease and be confident that your home will be lice-free.  

What Are Crabs (Pubic Lice)?

"Crabs" is the common term for lice found in the pubic hair of humans. Crabs is a parasite infection medically known as Pediculosis pubis or pubic lice. Barely the size of a pinhead, lice are organisms that live only with the help of another organism, called a host. There are thousands of types of lice, some of which have developed an attraction to humans. The official name for the organism responsible for pubic lice is Pthirus pubis. Other lice that often infect humans are Pediculus humanus capitis (head lice) and Pediculus humanus corporis (body lice). The term "crabs" seems to come from the microscopic appearance of the pubic louse. The pubic lice organisms are visible to the naked eye in affected areas. The lice are typically seen attached to hair in pubic areas, but may sometimes appear in other areas of the body where coarse hair is present (such as beard, chest, armpits, etc.).

The pubic louse is distinct morphologically (somewhat rounded with three pairs of legs on either side of the body from which it takes its descriptive name) from the head and body louse. The female lifespan is slightly shorter (three weeks), and she produces fewer eggs per day (three) than her counterparts. The eggs attach to the base of the pubic hair shaft for approximately six to eight days before hatching.

A new case study in The New England Journal of Medicine tells a torrid tale of an unnamed 65-year-old man who showed up at a dermatology clinic complaining of an itchy crotch. On examination, the man didn’t appear to have a rash or any lesions, so the doctors investigated his pubic area with a hand-held dermoscope.

The first bit of evidence they uncovered was a nit firmly implanted on a pubic hair. And then came the culprit itself—a freakishly agile, crab-shaped parasite moving from hair to hair like it was nobody’s business.

For the dermatologists, it was a classic case of pubic pediculosis—also known as “crabs.” This happens when the pubic louse, Pthirus pubis, infests a person’s hairy nether regions.

“Pubic pediculosis is usually sexually transmitted but can occur after contact with fomites [materials that are likely to carry infection] such as clothing, bedding, and towels used by an infected person,” write the researchers, who work out of Mexico City’s General Hospital. “The condition most commonly affects teenagers and young adults. This patient reported that he had had no recent sexual contact, and no other sexually transmitted infections were identified on screening.”

The doctors prescribed the oral drug ivermectin, and after two weeks the itching was gone. Which is all fine and well—but what about the psychological scars?