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HEAD LICE |
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THE LOUSE |
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2 to 4 mm in length (a sesame seed)
Pale tan or gray in color
Lifespan: 3-4 weeks
Females lay 10 eggs (nits) per day - Attach to the hair shaft via a glue like substance - Empty casings are easiest to see -white - Eggs incubate thanks to our body heat - Hatch in 7-12 days
Nymphs leave their casings and grow for 9-12 days only to mate again!
Itching is due to small amounts of saliva injected into the scalp when the lice feed every few hours
Lice will not survive for more than a day away from a room temperature scalp
Eggs won’t hatch at a temperature lower than that near the scalp
Do not transmit any known diseases
Transmission is by direct contact –they do not hop or fly!
Spread through contact with personal belongings is less common |
Diagnosing Head Lice |
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Finding a live louse!
Finding nits -especially at the nape of the neck or behind the ears and close (<1 cm) to the scalp
Live lice move quickly and can be hard to capture or even see. A magnifying glass can help.
Look also for nits —If you have trouble removing the suspicious speck, it’s probably a nit.
If it brushes right off, it’s far more likely to be dandruff or something else. |
Treating Head Lice |
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Pediculicides
Permethrin 1% (Nix) Currently recommended first treatment of choice Very low risk of toxicity Applied as a cream rinse Shampoo hair with a non-conditioning shampoo and towel dry Apply Nix to hair and leave on for 10 minutes then rinse off Residue on hair kills 20-30% of the emerging nymphs not killed during the application Repeat in 7 to 9 days and again on day 13-15 Resistance has been reported
Pyrethrins (RID, Pronto) Derived from the chrysanthemum plant Rare allergic reaction in those allergic to ragweed Shampoo hair with a non-conditioning shampoo and towel dry Apply RID to hair and leave on for 10 minutes before rinsing in cold water Repeat in 7 to 9 days and again on day 13-15 Does not kill unhatched nymphs Resistance has been reported
Malathion 0.5% Organophosphate (Cholinesterase inhibitor) Available only by prescription for kids over 2 yrs old Apply lotion to hair and allow to air dry Wash off after 8 to 12 hours Avoid using a hair dryer due to high alcohol content High ovicidal activity…but repeat treatment in 7 to 10 days may be needed Use in resistant cases
Permethrin 5% (Elimite) Prescription cream Usually used for scabies Used for resistant lice Apply and leave on for several hours before rinsing
Conditioning Agents
Lice MD Slick hair conditioner to make nit removal easier
Occlusive Agents
Ulesfia (Benzyl Alcohol) Prescription lotion for ages 6 months and up Apply and leave on for 10 minutes and repeat in 1 week Effective in 75% of cases –Not very effective on nits.
Spinosad (Natroba, ParaPRO) Prescription suspension for 4 years old and up 86% of children were lice free 2 weeks after treatment Does NOT require nit combing Apply and leave on for 10 minutes. Can repeat in one week
Other Products (Not formally proven) Petroleum jelly mayonnaise olive oil Clean 1-2-3 eucalyptus-clove oil Cetaphil helmet (Nuvo lotion) Apply large amounts to dry hair followed by low heat from a hair dryer. Leave on overnight, then wash off in the morning Apply once a week for three weeks.
Manual Removal Difficult and Tedious but quite effective Use nit comb close to the scalp and repeat daily
Itch Relief Topical Steroids and Oral Antihistamines |
Other Tips For Lice |
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Any item which has come in contact with the person’s head over the previous 24 to 48 hours should be cleaned.
Wash bed linens in hot water (130°) and dry at high heat for 20 minutes to kill any runaway lice.
Put all cloth materials (stuffed animals) that have come in contact with the infected person’s head in the dryer.
All household members should be checked.
Furniture, carpeting, and car seats can be vacuumed.
Items that can’t be washed can be bagged in plastic and put aside for 2 weeks.
School nurses can assist in rechecking heads and in aiding families having difficulty with treatment.
The AAP recommends return to school as soon as possible.
The presence of nits should not prevent a treated child from returning to school. |
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Metropolitan Pediatric Group, Pediatricians, Teaneck & Closter, NJ, Bergen Co 704 Palisade Avenue, Teaneck, NJ 07666 201-836-4301 570 Piermont Road, Closter, NJ 07624 201-768-8811 |
