Head Lice

Contrary to popular belief, head lice infestation is not associated with poor hygiene or uncleanliness in children. Head lice is a very common problem with 6-12 million infestations per year in the United States. It most often affects children between the ages of 3 and 12. The most common symptom associated with head lice is itching.

The "bug"

Head lice (Pediculosis capitis) are generally 2-3 mm long and usually pale gray in color. They can live up to 3-4 weeks as long as they are nurtured by the heat of the scalp. Lice cannot live away from the scalp for much more than one day. An adult female louse lays approximately 10 eggs (nits) per day. These eggs are attached to the hair shaft with a glue-like substance produced by the louse. These eggs hatch about two weeks later. It is unlikely for eggs to hatch if they are away from the scalp. After hatching, the lice mature and mate, and the cycle repeats.

Transmission (How it's spread)

Head lice are most commonly spread through direct contact with the head of an infested person. Lice cannot hop or fly; they can only crawl. Children are more often at risk because of the nature of their play. Sharing combs, brushes, hats, and pillows are less likely methods of transmission, but do still occur. It is nearly impossible to contract head lice from across the room.

Treatment

Permethrin (1%) (Over the Counter Medication)

NIX is an example of Permethrin, the currently recommended treatment of choice. This product is a cream rinse that is applied to shampooed hair that has been towel dried. The rinse is left on the hair for 10 minutes then washed off. The medicated residue left on the hair helps decrease the emergence of healthy lice. It is recommended to repeat this treatment 7-10 days later. There has been some resistance to this product.

Pyrethrins Plus Piperonyl Butoxide (Over the Counter Medication)

RID, A-200, R & C, and Pronto are examples of commercially available medicated shampoos. These shampoos are applied to dry hair, left on for 10 minutes and then washed out. These treatments should be repeated 7-10 days later to insure all of the eggs (nits) have been destroyed. There has been some resistance to these products.

Malathion (Rx Medication)

Ovide is the prescription brand of Malathion. It is a liquid that is applied to the hair, left to dry, then washed off after 8-12 hours. This product is often applied at bedtime, left to dry overnight, and rinsed in the morning. Ovide is very good at at killing nits, but reapplication is recommended 7 days later.

Lindane (Rx Medication)

Lindane is a prescription shampoo that is left on the scalp for 10 minutes before rinsing. This medication is not commonly prescribed as a first line treatment because of its associated side effects. There has been some resistance to this product.

After using any of the above treatments, it is highly recommended to use a nit comb to remove any remaining eggs. It is especially important to remove the nits that are within 1 cm of the scalp. Nits that are further away are less likely to hatch. Special nit combs can be found at your local pharmacy. It may be necessary to re-treat in one week for new lice that may have hatched.

School Restrictions

Currently, a "no nit" policy is not recommended by the American Academy of Pediatrics or the State of Ohio. Rather, it is recommended to treat a child with one of the above remedies and send them to school the following day with close surveillance (i.e., re-check by the school nurse).

source: AAP Policy Statement

JDMD 2/4/07