This time of year can bring lots of lice checks. Head lice is a very common issue in school aged children.

The phrase nit picking comes from the practice of humans picking lice nits (egg sacks) from hair.  Head lice are not known to transmit any disease and therefore are not considered a health hazard.  Personal hygiene or cleanliness in the home or school has nothing to do with getting head lice.  Lice do not jump, fly, or use pets as vectors

NOTE: The Center for Disease Control (CDC) notes that “Children diagnosed with live head lice do not need to be sent home early from school; they can go home at the end of the day, be treated, and return to class after appropriate treatment has begun.”

Symptoms:

Infestations may have no symptoms – especially at first when there are few lice

An itchy scalp may occur related to an allergic reaction to lice saliva

Sores on the head from scratching

Tickling sensation/feeling of something moving in the hair

Examining for lice:

May be done with conditioner on wet or dry hair.  Brush /comb hair to remove tangles.  Use fine-toothed comb starting right at the scalp and slowly and firmly examine hair during entire stroke.  Entire head should be combed thoroughly at least twice.

Look at your child’s head especially behind the ears and on the nape of the neck for lice and nits

White nits attach to the hair within ¼ of inch of scalp – and are firmly cemented to the hair shaft

If lice or nits are found on one member of the family, examine all household members

Non-medication treatment:

Wet or dry combing as described above can be used, but is time consuming and effectiveness can vary depending on how it is done.

Topical medications:

Follow package instructions.

Hair conditioners should not be used prior to application; these products may reduce effectiveness of medication

Rinse over a sink with warm (not hot water) to reduce skin exposure and absorption of medication

Over-the-counter Medications

Pyrethrioids(piperonyl butoxide/pyrethrin- brand name A–200, Pronto, R&C, Rid, Triple X and Permethrin lotion brand name – Nix). Kills only live lice, not unhatched eggs (nits). Apply to dry hair and leave on for for 10 minutes before rinsing off with water. A second treatment is recommended 9 to 10 days after the first treatment to kill any newly hatched lice before they can produce new eggs. Pyrethrin is approved for use on children 2 years of age and older. Permethrin is approved for use on children 2 months of age and older. (do not use if ragweed or chrysanthemum allergic).

Prescription medications

• Spinosad (Brand name product: Natroba) is derived from soil bacteria. It kills live lice as well as unhatched eggs and re-treatment is usually not needed. Nit combing is not required.  It is approved for the treatment of children 6 months of age and older.
• Benzyl alcohol lotion (Brand name product: Ulesfia lotion) A second treatment is needed 7 days after the first treatment to kill any newly hatched lice before they can produce new eggs. Benzyl alcohol lotion is intended for use on persons who are 6 months of age and older. It can be irritating to the skin.
• Ivermectin lotion (brand name product: Sklice). It is effective in most patients when given as a single application on dry hair without nit combing.  Approved in persons 6 months of age and older.  Although not FDA-approved for the treatment of lice, ivermectin tablets given in a single oral dose of 200 micrograms/kg or 400 micrograms/kg repeated in 9-10 days has been shown effective against head lice. It should not be used in children weighing less than 15 kg or on pregnant women.

Follow-up

• After treatment check hair and/or nit comb ever few days for 2-3 weeks
• If crawling lice are still seen after a full course of treatment, contact your health care provider. Nits may persist after treatment, but successful treatment should kill crawling lice.
• Machine wash all clothing, bedding, towels with hot water and dry with high heat. Put any items that cannot be laundered in a sealed bag for 2 weeks.
• Head lice do not survive long after they fall off a person and cannot feed.

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