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Doc Dispels Common Myths About Head Lice

Parents should be reassured that personal hygiene has nothing to do with the problem

Although lice do not cause serious physical harm, they can result in a lot of emotional distress because many people still mistakenly believe they are a sign of poor hygiene, an expert explains.

Head lice bite into the scalp to feed on blood, but these bites are usually not painful. Still, a lice infestation can strike fear in families for a number of reasons, including the stigma of being deemed "dirty."

A lice infestation, however, is not a reflection of a person's cleanliness, according to Dr. Andrew Bonwit, a pediatric infectious disease expert at Loyola University Health System in Illinois.

"Personal hygiene and socioeconomic status have nothing to do with having or transmitting head lice. The head louse is an equal-opportunity pest," explained Bonwit in a university news release. "The infestation is usually a nuisance and almost never a serious problem in itself."

There are other common misconceptions about lice, Bonwit pointed out. In order to ease parents' fears, he dispelled the following myths:

  • Myth: Pets spread lice. "Animals are not known to carry head lice nor to transmit them to people," Bonwit said.

  • Myth: Sharing personal items spreads lice. "Although it's probably best not to share such items as combs, hairbrushes and hats, these do not seem to transmit the pest," Bonwit added. "Transmission of lice seems to occur only by direct head-to-head contact from one person to another."

  • Myth: Kids with lice should be sent home from school immediately."The American Academy of Pediatrics does not endorse 'no-nit' policies that exclude children from school because nits are present," Bonwit noted. "In fact, even the presence of mature head lice is not considered a valid reason to exclude children, only a cause for prompt referral to the physician for treatment."

  • Myth: Lice carry disease. "Head lice do not transmit serious infectious disease," Bonwit explained.

Although lice often cause a big stir, they are tiny and often hard to spot. "Lice are very small, about the length of George Washington's nose on a quarter," said Bonwit, who is also an assistant professor of pediatric infectious disease at Loyola University Chicago Stritch School of Medicine. "The lice produce eggs, called nits, which become strongly cemented to the host's hair shafts."

Nits look like small, dark spots on the side of the hair shaft. Although the infestation isn't painful, it can be itchy, Bonwit cautioned. "Sometimes the patient has been so itchy that he or she scratches the scalp to the point of minor skin infections and even causing some enlarged lymph nodes on the back of the neck or behind the ears," he said. "While these changes may alarm parents, they aren't directly harmful."

The U.S. Centers for Disease Control and Prevention reports that up to 12 million lice infestations occur each year in the United States among children aged 3 to 11 years.

"Parents and school staff may become understandably upset by outbreaks of head lice, but it is important to remember that if the problem occurs, it is treatable, although repeat applications of medicine are usually needed," Bonwit said.

The most common lice treatment is over-the-counter or prescription shampoos or lotions that must be applied to the scalp, left on for a specified time, then rinsed off. Often a fine-toothed comb is also needed to remove nits to prevent further infestation.

"The life cycle is about seven days from the laying of the eggs to the hatching, so a second insecticide treatment is recommended, after the first application," Bonwit advised. "If the treatments are used as directed, problems other than scalp irritation are unlikely to occur."

5 Ways to Lower Your Odds of Getting Lice

You’ve never had lice and want to make sure it stays that way. Head lice is very common among kids between ages 3 and 11. If you’re a parent, teacher, or caregiver of a child this age, lice are more likely to find their way into your home.

You can have lice and not yet know it. Lice eggs (nits) are very hard to see and may not cause itching at first. It’s not always possible to keep these mites away, but you can take a few simple steps to reduce your risk. Here are five things to know about preventing lice.

1. Watch Your Head

Lice crawl onto the body. They can’t fly or jump. They most often spread with head-to-head contact. That means you usually must be close to someone with lice to catch it. Avoid activities that involve hair-to-hair contact as much as possible.

2. It's Nice to Share, But Not Always

That hat on the store rack might look tempting and make for a great selfie, but think twice before you try it on. You can get lice if you share hats, hoodies, towels, beds, and pillows with someone who has or recently had it. Sometimes, lice spread on combs and brushes. Such “shared contact” is uncommon, but can happen. Lice can live for about a day or two after falling off the body. To prevent lice, never share things that touch the head.


3. Don’t Lend an Ear

Lice don’t often live on hard surfaces like plastic, but they can sometimes hang out on ear buds for a short time. To lower your risk of catching them, don’t share headphones at home or at the gym.

4. Avoid the Comfy Couch

It might be nice to sit on the plush sofa at the doctor’s office or library, but ask yourself this: Who sat there before you? Lice or lice eggs (nits) can live for about 48 hours on upholstered furniture and rugs. A safer bet is a wooden or plastic chair. Stuffed animals are a hideaway for lice, too.

5. Do Your Laundry

Worried you may have been around someone with lice? Lice die when exposed to temperatures greater than 128.3°F for 5 or more minutes. Prevent a lice outbreak by tossing your clothing, hat, jacket, scarf, gloves, and any other items into the washer. Use hot water (130° F or higher), and then dry on high heat. Soak your combs and brushes in the wash, too. Can’t wash an item? Place it in a plastic bag and put it in the freezer for 2 weeks.

Parents, Schools Overreact to Head Lice, Expert Says

Aug. 24, 2000 -- The start of the school year can mean more than just back-to-school shopping trips and first-day-of-class jitters; for many children, it also means creepy, crawly head lice. Even hearing the words makes most people wrinkle their noses in disgust. But are the strict measures taken against head lice -- such as the so-called "No Nits" policy that bars children with even one louse egg from attending school -- warranted, or are they overkill?

For one scientist from the Harvard School of Public Health, society has definitely gone overboard, over-diagnosing, over-treating, and over-worrying about a minor nuisance that doesn't even qualify as a public health issue.

"We are dealing with head lice: They don't cause disease, they don't transmit anything, and we think they are much less contagious than people believe," says Richard Pollack, PhD, an instructor of immunology and infectious diseases.

Pollack and his team of researchers recently published a study in the Pediatric Infectious Disease Journal that showed that in about 40% of cases, head lice are incorrectly diagnosed, leading to unnecessary treatments and unnecessary absences from school.

Pollack invited people who visited a web site that provides information on head lice to submit specimens of items that they considered to be lice or nits. The researchers examined the samples under a microscope within two days of receiving them. Each sample was identified by the species of louse and its life stage (egg, nymph, or adult). A person was considered infected if their sample included at least one adult or nymph louse, or a louse egg capable of hatching.

The researchers received more than 600 samples, each containing from one to 100 or more objects. Lice or their eggs were found in 60% of the samples; other critters, such as beetles, mites, and bedbugs, were found in 5%. The rest contained other debris, including dandruff, scabs, fibers, dirt, and knotted hair.

Slightly more than half of the samples that actually did contain lice or nits had a living louse or egg capable of hatching (indicating an active infestation); the other half were either hatched eggs or dead eggs.

Don’t pull your hair out over head lice

So-called “super-lice” are big news now, just in time for children to go back to school. While that news may be somewhat overblown, as any parent who has been through one will tell you, a lice infestation can be a time-consuming and worrisome health issue. One of the bigger concerns for parents is that if their child is diagnosed with lice, they will have to stay home from school or daycare, something that recent guidelines have stated is NOT the case.

Here are six important facts about lice to keep in mind:

  1. Anyone can get lice.

    Lice are not related to cleanliness. Anyone can get lice if they are in prolonged, close contact with someone else with lice. Lice only infect people—not pets—and cannot hop or fly. They spread by crawling from one scalp to another scalp. It is very uncommon to get lice from hats or brushes or combs since they cannot survive off the scalp for more than 24 hours.

  2. If your child has lice, he/she’s actually had them for a while.

    The characteristic itch on the scalp, back of the neck or behind the ears is an allergic reaction to lice saliva. It often takes three to four weeks for that reaction to start.

  3. Regular scalp checks are the best way to help keep lice away.

    According to the American Academy of Pediatrics, here’s how to check your child for lice:

    • Check your child in a brightly lit room.

    • Part the hair and check your child’s scalp.

    • You are trying to find either crawling lice or eggs (called nits) on the hair. Live lice are small insects (OK, that’s a little gross, we admit), about the size of a sesame seed (2 to 3 mm). They are hard to see because they move fast and avoid light. Nits are quite small (less than a millimeter) and appear pearly/white, almost like a grain of uncooked rice. They will be firmly attached to the hair shaft very near the scalp.

    • You can also wet the hair, and comb it out with a fine-toothed comb. After combing you can wipe the comb on a wet paper towel, and check the comb and the paper towel for nits.

    Nits can be confused with dandruff or dirt, so if you are unsure check with your pediatrician.

  4. Your best bets for treating lice are lotions and combs.

    If your child has lice the American Academy of Pediatrics recommends treatment with one of several topical lotions that will kill the lice and possibly even kill the eggs.

    The first choice is an over the counter (OTC) lotion containing 1 percent permethrin. This choice is generally very effective, but if it doesn’t work there are prescription lotions that have each been tested and are safe to use on children. Depending on your pharmacy and insurance plan, some of these lotions can each be expensive.

    Sometimes parents decide to avoid any chemical treatments, and although there are other options, none has been proven to work. One approach is to pick out all of the eggs by combing damp hair with a fine-toothed comb. This can be challenging because of the time it takes to remove eggs from each hair shaft over many days, especially if a child has fine, long hair.

    Other methods include suffocation, meaning the application of either petroleum jelly or other thick preparations such as mayonnaise or olive oil. This method is rarely effective, and the ointments can be hard to remove from the child’s hair. Never use kerosene or gasoline or products meant for animals on your child.

    All household members should be checked for lice and nits and treated accordingly. Given that most household members are in close contact with one another, it is prudent to have a low threshold for treating all household members, even parents.

    You might have seen recent news stories suggesting that a) treatment-resistant lice are more common than ever, and b) parents shouldn’t use the usual first-line, over-the-counter  treatments anymore. To those stories I offer one caveat: The study behind them was funded by the maker of a prescription lice treatment. Let the reader beware.

  5. Lice are not very hearty.

    Lice can’t survive off the scalp for more than a day, so they can’t live for very long on any objects. Also, since they can’t hop or fly from person to person, they are only contagious by scalp-to-scalp contact. This is good news.

    To rid your home of lice, you don’t need to do multiple deep cleans or throw away items. And you don’t need to spray with any pesticide. You just need to clean objects that have been near a child’s head for the past three days (e.g., hats, towels, pillow cases, stuffed animals, hair care items). Lice can’t survive in heat, so any item should be washed in hot water and dried in a hot drier. Any item that can’t be washed can be dry cleaned, vacuumed (in the case of furniture) or sealed in a plastic bag for two weeks.

  6. Children with lice CAN go to school.

    According to the American Academy of Pediatrics and the National Association of School Nurses, lice and nits are no reason to exclude a child from school, daycare or any activity. These organizations have taken this position for two reasons:

    • As I mentioned above, by the time your child gets diagnosed she likely has had lice for three to four weeks, and likely got them from school or daycare. Thus, excluding a child from school or childcare does very little to prevent the spread of lice.

    • Head lice are not a dangerous medical illness that would warrant any kind of quarantine.

Kids shouldn’t be sent home for lice, but schools can’t ignore the issue either

Last night, my 3-year-old daughter made soft, singing noises while she dipped a plastic boat in and out of the bubbles of her bath, oblivious to my actions of raking a fine-toothed metal comb through her mop of curls that reach her shoulders when they are wet.

Just a few months ago, the sight of a hairbrush in my hand caused her to shriek. Bath time was a battle. I was certain her first memories would be the pain from my tugging tangles out of her hair. Then, that fateful day came when the sun shone on her little forehead, still from sleep in her car seat. I bent over to carefully unbuckle her and saw the telltale bug crawling through her blond curls. Head lice.

I was no stranger to this terror. My oldest daughter seems to attract them. Maybe it is her mass of light-brown hair, so thick I can barely get a comb through it. Maybe it is her many invitations to sleepovers with several friends where they try on five different outfits. When I first discovered my oldest had them, my youngest was a newborn. I was on my own, barely making ends meet, scrambling to find work I could do at home to pay rent. Dropping $20 on a tiny bottle of shampoo that claimed to kill the bugs that had invaded our house was an expense I could not afford. Plus, I had to wash and dry everything I could — including stuffed animals — on high heat, vacuum, and repeat a week later. I bagged most of it instead.

My oldest had been in kindergarten that year, and I faintly remembered a line in the classroom newsletter telling me they had a report of lice. There was not any mention of ways to check for it, or how to prevent it. This was several years ago, when the school nurse came around with her flashlight to check every head. I knew if she found any, she would send those kids home because of the district’s “No Nits” policy. So, I didn’t worry. Lice happened to other people. Not my daughter, who stayed in the bath so long, her fingers wrinkled before I convinced her to get out of the tub.

When I found lice last spring, I sent an email to my daughter’s teacher. I half expected her to tell me that, even though I had used the shampoo and spent an hour combing her hair, my daughter would have to stay at home until the nits were gone. The school nurse called me instead.

“We don’t send students home anymore,” she cheerfully said, explaining that only 10 percent of lice are transferred at school. Because of this, they no longer checked students, did not call parents to pick up their children and did not notify the parents there had been a report. My daughter’s teacher did not send out a note, email or even include the infestation in the newsletter that week.

I applauded the idea of not sending children home. Low-income families don’t need the added hardship of missing work on top of the expense of ridding themselves of lice and nits, along with the stigma their kid would experience of being the one with cooties. The expense of lost wages, in addition to the added expense of laundry and buying shampoos and kits, could mean less rent money, not just an inconvenient afternoon. But shouldn’t there be a system in place to notify parents in the chance their child is part of that 10 percent?

As kids are back in school, connecting with friends, and putting their heads together, either by taking selfies or studying, lice transferring from one head to the next seems inevitable. But there was no mention of that possibility in the student handbook my daughter’s school sent home.

In deciding to allow students who have lice to come to school, the flip side should be educating parents on what to look for, how to prevent them and how to get rid of them without spending $50 on chemical-laden shampoos, salon treatments and loads of laundry. Keeping lice out of schools should be a herd immunity type of attitude. Schools should send home brochures with a plastic comb attached in an envelope. If every parent knew that the best way to prevent lice from spreading is by looking for them, cases decrease dramatically.

Nobody wants to admit their kid is the one with lice. Not only because of the work involved in getting rid of them, but because lice are still associated with dirt, grime, neglect and often poverty. Yet, when stomach bugs run rampant, we all accept that it will run its course and we will be spending a day doing laundry along with everyone else. If parents admitted they are part of the 6 million to 12 million cases of lice reported a year, maybe it’ll be on par with stomach bugs, and not shrouded in secrecy.

More than that, I want a way for parents to notify the school their child has lice, anonymously if needed. I want to get a text message every time this happens so I know to check more than once a week for a while. If parents know how many times others are finding lice on their kids’ heads, maybe other parents will not hide their own discoveries in shame.

How to combat a case of psychosomatic lice after receiving the dreaded letter from school

One would think the worst part of lice would be actually having (gag) lice. Not true for me. Since my oldest started elementary school, the biggest little injustice in my life has been opening an email that reads, “There has been one reported case of lice in first grade” — and feeling my scalp begin to crawl. Then I spend the following two weeks obsessing when the wind blows through my hair or my toddler tries on a fire helmet at the children’s museum. The terror descends around 10 times a year, between elementary school, after-school programs, preschool and camps.

I squirm because I know my kids will sit alongside peers wearing crowns of unborn lice now that most school districts exclude only children with live bugs. The American Academy of Pediatrics guidelines recommending abandonment of “no-nit” policies make sense. Eggs firmly affix to shafts of hair and even if one were to hatch during recess and wind up on another child, lice present no health hazard.

Still, my children’s proximity to nits rubs me the wrong way. And rubs again. Now over there. And here. And back there again. Even if no one in our family shows signs of pediculosis, I itch.

Known by psychologists as a “hysterical condition,” psychosomatic itching is nonetheless a “genuine physical affliction caused by emotional anxiety,” says San Francisco-based psychologist Juli Fraga. That means the problem is real-ish.

Luckily, there are ways to vanquish phantom parasitic insects — and they’re much more pleasant than the protocol for live ones.

Prevent dry scalp

My fear doesn’t need much help making my head itch, since it’s already dry, thanks to the hormonal fluctuations of pregnancy and nursing. Dandruff also makes it more difficult for my husband to rule out lice on a visual inspection.

Maritza Buelvas of The Every girl recommends combating dry scalp with pre-wash treatments such as scalp massage and DIY hair masks. She also suggests trying a natural shampoo, topical spot treatments and general hydration. If dryness rises to the level of scalp psoriasis, doctors can inject steroids into problem areas, prescribe medication or recommend phototherapy involving lasers or natural sunlight. Tea tree oil offers a win-win, reportedly both hydrating the head and some say actually repelling lice.

Restore perspective

 A removal company in Atlanta, says: “If your head did not itch the minute before hearing the word lice, . . . the itching you are experiencing is in your head, not on your head.” For another good reality check, I ask myself whether my sleep loss comes from trouble falling asleep or if I’m actually being awoken. The latter should only happen with live critters.

Though some folks with lice remain asymptomatic, when they do itch, it’s usually specific to small bumps that stay put, such as mosquito bites. Genuine crawling sensations also tend to be localized, feeling like tiny, slow ants moving through one’s hair. Generalized itchiness, I constantly remind myself, is more likely to be psychosomatic.

Drink alcohol

If sober self-assessment doesn’t work, I drink a glass of wine. Maybe three. I try to relax and otherwise engage my consciousness. If I manage to focus on a conversation about my recently divorced friend’s new paramour or lose myself in George Clooney’s suave mischievousness for a few hours only to have the itching restart as soon as the call ends or the credits roll, I have my answer.

Blow-dry hair

Here’s the thing that keeps me scratching my head. They could be in there. Lurking. Feasting.

There is another way. Just as only abstinence can prevent 100 percent of unwanted pregnancies, only painstaking removal of bugs and eggs can ensure complete eradication of head lice. That doesn’t mean other methods are worthless.

Now, whenever I itch, I blow-dry my hair and congratulate myself on having desiccated potential eggs and maybe some lice. If my head still crawls the next day, I do it again knowing the odds only improve each time.

Applying heat to my hair may not adequately treat an infestation, but it has been 100 percent effective at putting my mind at ease — which, of course, is what stops psychosomatic itching.

Itchy and scratchy – why the battle against head lice just got serious

Nits and lice don’t just infest children and getting rid of them can be hard work – especially with their growing resistance to pesticides. Now a whole new industry is growing up to offer hi-tech solutions to this itchy problem.

This article will make you itch. I’m sorry. There’s no way round it. I’m pretty itchy myself, but that’s head lice for you. They warm themselves on Planet Scalp, sifting wisps with their antennae and, as the experts creepily put it, “taking a blood meal”. I have learned to recognize many types of itch since discovering two of the beasts in my hair. Some are a slow, creeping thaw on the head. Others, a fleeting tweak.

Between 8 and 10% of children in the UK are thought to have head lice at any one time and there are an estimated 6-12m cases a year in the US. But lice can also move from adult to adult. You might have hugged a colleague who has caught them from her children. They can ping from the static of a comb. Or maybe you tried on a hat in your lunch break, and a louse moved into its new home. Contrary to popular belief, there is no data to prove that men are less attractive to lice than women. Can you feel that tickle behind your ear yet?

Head lice have been around as long as humans. They have been picked, preserved, from Peruvian mummies, and pried from the teeth of a Roman soldier’s comb. Yet, despite our long acquaintance, humans know little about lice and what makes them tick. (On the bright side, they do know some lousy puns.) “I’ve combed my head obsessively, I’ve applied treatments, and still found only two lice and some unhatched eggs. How am I meant to know if I have caught them all?” As I speak, the colleagues either side of me stop typing. A few minutes later, they start scratching their heads.

If you don’t have lice, you can still catch delusional parasitosis – the mistaken belief that you are infested. One nit-removal professional told me that for weeks after she started her job she dreamed she was being chased by giant lice. They even infest your telecommunications: every time I text the word “love”, my phone autocorrects it to “lice”. Why, after centuries of medical advancement, have humans not found a way to eradicate them? Why are they so good at evading treatment? And is the anti-lice industry really doing all it could to help those of us at the ticklish end of the problem?

The future of mutating, treatment-resistant head lice is already here

Head lice aren't particularly dangerous, but they are a nuisance -- one that has become such a common part of life with young children that multiple over-the-counter remedies are available to parents.

That very fact has made the increase in prevalence of lice cases since the 1990s -- despite the corresponding increased access to effective treatments -- so puzzling.

A new study that will be presented at the National Meeting & Exposition of the American Chemical Society on Tuesday suggests one reason for the increase: After decades of treatment with anti-pest remedies sold in drugstores across America, head lice are evolving to resist our efforts to snuff them out.

The study found that of the head lice samples collected across 30 states, all but five showed signs of a very high level of resistance to pyrethroids -- the chemicals contained in some of the most common over-the-counter treatments.

"We are the first group to collect lice samples from a large number of populations across the U.S.," said Southern Illinois University at Edwardsville researcher Kyong Yoon. "What we found was that 104 out of the 109 lice populations we tested had high levels of gene mutations, which have been linked to resistance to pyrethroids."

The trio of mutations -- called kdr, for "knock down resistance" -- affects the insect's nervous system and makes them less sensitive to the insecticide chemicals that are found in lice treatments and also in mosquito repellant or fly spray, for example.

In four states, head lice were found to have one, two or three of the mutations. Only one state -- Michigan -- had head lice samples that didn't show any signs of widespread resistance to treatment; Yoon added that the reason for that is unclear.

 In recent decades, pyrethroids have been increasingly used as a pesticide as part of a broader effort to shift away from harsher chemicals like DDT. Pyrethroids resistance has been found, for example, in house flies.

Anecdotal evidence and previous studies have also suggested that head lice were also increasingly becoming resistant. A 1999 study, for example, found evidence of resistance to pyrethroids in the United States in a small sample of kids who had contracted and had been treated for lice multiple times in the past.

The solution, Yoon says, may be to treat lice with other chemicals that are more likely to be available with a prescription.

"If you use a chemical over and over, these little creatures will eventually develop resistance," Yoon added. "So we have to think before we use a treatment. The good news is head lice don't carry disease. They're more a nuisance than anything else."