Head Lice Don’t Take Summer Off

Head lice are equal-opportunity parasites and don't mean you or your home are dirty.

Cases spike when school begins or after school breaks, but can spread at summer camp.

Treatment can mean hard work; professional services are available.

If any of my neighbors had seen me ironing my daughter’s mattress while wearing a blue shower cap, they undoubtedly would have thought I was nuts.

But after we found nits lice eggs in my 9-year-old daughter’s hair, I panicked.

I washed her hair in olive oil and vinegar. I put her dirty clothes and linens in large plastic bags and washed them in hot water. I crammed pillows and stuffed animals into the dryer and set it on high heat. And yes, I even ironed her mattress because a friend told me heat kills lice.

I’m embarrassed to say I wore that shower cap too often during the first few days after lice became part of our lives. I didn’t just wear it for ironing; I also used it when I tried to comb the nits out of Emma’s hair after using an over-the-counter lice treatment creme rinse.

None of this was surprising to Dr. Shirley Gordon, a nurse and professor at Christine E. Lynn College of Nursing at Florida Atlantic University. Gordon, director of the Head lice Treatment and Prevention Project, has studied lice since 1996 and is fascinated by the social ramifications.

Lice: what to look for, how to treat it

“On a scale of 1 to 10, you’re a 11.2,” said Gordon, whose research focuses on persistent cases. Some parents, she said, have used kerosene and gasoline to rid their children of lice.

Lice is an equal-opportunity parasite, yet so many myths continue to surround head lice, including the idea that people who get lice are dirty or live in dirty homes, she said.

“I think one of the causes of the transferability of head lice is silence,” Gordon said. “People don’t want to tell other people their family has head lice because of the social stigma and the long-term ramifications. You become known as a lice family. When you clear up the infestation, that stigma doesn’t go away.”

It’s hard to say how many people get lice in the United States. According to the Centers for Disease Control and Prevention, between 6 million and 12 million infestations occur each year among children ages 3 to 11.

But that number is likely low. Lice is not a reportable condition, which means there isn’t good data on how many cases there are, Gordon said. Cases spike, however, during the first few months of school and after winter and spring breaks.

“We see increased cases after children have spent extended periods of time in the community,” she said. Summer camp is also one form of community, she said. Many camps screen for head lice when children arrive; others send letters to parents telling them to check their children for lice before camp starts.

Lice is controversial at every turn, Gordon said, from how children with lice should be treated in school the American Academy of Pediatrics says no healthy child should miss school because of head lice and that schools should abandon no-nit policies to treatment with over-the-counter products, which are pesticides. I was confused and misinformed when my daughter got lice. I was also loath to tell people, but knew I had to. I e-mailed her teacher and told her I believed Emma got lice from a wig she had worn a day earlier for play rehearsal (that’s possible, but unlikely, Gordon said). “The most frequent reaction is anger and disgust, and there is a sense of wanting to know the source of the head lice infestation,” Gordon said.

A few other things to know about lice, she said:

• Lice don’t jump or fly; they crawl from one person to another.

• Head lice are treatable (it might take some work) and rarely cause serious health problems.

• Head lice are usually spread from head-to-head contact, not from sharing brushes, hats or bedding (although that is also possible).

• Head lice may be on your head, your child’s head or your spouse’s head, but it won’t affect your pets and can’t infect furniture, bedding or pillows.

For days after using the over-the-counter lice treatment, my husband and I diligently combed through my daughter’s hair with a comb designed to remove nits.

This wasn’t easy. The nits attach themselves to the hair with a glue-like substance. I thought I was doing a good job and naively thought we had the infestation under control.

But a week after the treatment, I found a louse. I panicked again, this time because my daughter had spent all day and night with a group of close friends. I immediately sent texts to my friends, apologizing profusely. Then I sought out a professional service, in California – one of many such services nationwide.

Emma watched a movie on a DVD player while our lice technician, separated her hair into sections, methodically combing it and removing nits, sometimes with a pair of tweezers.

The technician, who has been removing lice for five years, admits you need a lot of patience.

“What we have learned in this industry is that there are no shortcuts to removing lice,” said Michelle Aloisio, “the only way to remove it is the long, hard, manual way.”

Gordon recommends using the Shepherd Method to remove lice and nits. The Technician did: after combing Emma’s hair, she divided it into four equal sections. She examined each quadrant in paper-thin sections, one strand of hair at a time. Then she did another check for missed bugs or nits before inspecting my hair. (I said a silent prayer of thanks when she told me I didn’t have lice.)

“Removing all the nits is the toughest part of lice removal,” Aloisio said. “If you don’t get every single nit, they are going to hatch and the whole cycle is going to start all over again.”

Products kill adult lice, but not eggs or babies. Most of Aloisio’s clients go to her after about a month of trying to get rid of lice themselves.

As far as prevention, Aloisio suggests girls wear their hair pulled back in braids or in a bun. “Swinging hair offers a bridge to infestation,” she said.

The technician used a stainless steel comb and showed me the correct technique for pulling it through my daughter’s hair. I’ve been doing that every night since.

She also used a nontoxic lice infestation removal mousse and a mint spray Aloisio says deters lice. While preliminary evidence shows lice are repelled by mint in laboratory settings, Gordon said there are no strong field studies supporting mint as an effective repellent.

Two and a half hours and $210 later, we left the salon with the comb, the mousse, the spray and the hope that we had won the battle.

If your child has lice, Gordon advises screening friends, relatives, neighbors and people your child spends time with. She also recommends checking for lice once a week.

Her final advice to parents? “Take a deep breath. It’s just lice.”

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."

Scour That Scalp: Some Lice Eggs Linger Before Hatching

Here’s some lousy news for parents of itchy-headed kids: Lice eggs can take 2 weeks to hatch in human hair, making standard 7-day delousing treatments ineffective in some cases. New research shows that if conditions are right, the eggs, called nits, can sit dormant during treatment, only to pop later and reinfest the scalp. A third application may be necessary after 14 days to eliminate any slow-hatching nits, they say.

Lice don’t lay their eggs directly on skin—instead, they deposit nits at the base of hair shafts. The timing of louse hatching on a human head is difficult to track because adult lice lay eggs continuously, obscuring earlier hatches, and the effectiveness of traditional insecticides on eggs is variable. Previous estimates of how long nits remain viable did range up to 14 days, but much of that work dated to the 1920s and 1930s, when researchers reared body lice inside boxes strapped to a person’s arm or ankle. More recent work relies on head lice raised in lab incubators, which are more stable than the wide range of temperatures and cleanliness found on a human scalp.

For a more reliable estimate, medical entomologist Ian Burgess of Insect Research & Development Ltd. in Cambridgeshire, U.K., analyzed data from 20 previous studies of treatments that kill lice through physical means, such as lotions that suffocate the insects, but do not kill eggs. They didn’t include insecticide treatments because lice across the United Kingdom have developed resistance to standard drugs, Burgess says, leading more doctors to try a brute-force approach that does not rely on insecticides.

The data from 1895 patients revealed cases in which technicians found newly hatched louse nymphs on the 14th day after treatment began, even though the second scalp application had occurred 7 days before. “Some [nymphs] had emerged only an hour or two before checking,” Burgess says. To rule out cases where re-infestation from another child had occurred, or where a few adult lice had escaped treatment, he excluded cases with lice that appeared older than the number of days since the last treatment. Nearly two dozen cases remained—enough to verify that a handful of nits can outlast standard treatment protocols, Burgess reports in an upcoming issue of Medical and Veterinary Entomology.

Although the treatments themselves may play a role, a person's scalp temperature is likely to be the most important factor in how long it takes eggs to hatch, Burgess says. Location and hairstyle matters, too: Lice develop faster at warmer temperatures, so they will hatch more quickly when laid on the warm, thick hair at the nape of the neck than on the thinner hair on top and in front of the scalp.

The analysis is the most rigorous yet to quantify louse hatching times, says Rich Pollack, a public health entomologist at Harvard University. “It should be considered by those who are trying to make a management treatment decision,” Pollack says, observing that just a small number of patients are likely to need a third dose.

New oral insecticides may render the question of hatching times moot, Pollack notes. Those drugs, now available by prescription in the United States, are up to 85% effective at killing lice and eggs with one dose, sparing parents from dousing a squirming child's scalp multiple times.

Tale of Human Origins, Told by Lice

Researchers itching to understand how modern humans evolved are turning to lice for answers. A genetic analysis of head lice suggests that two species of early humans had close physical contact after millennia of isolation, information that may help anthropologists narrow the possibilities for the origin of humans.

According to one theory, Homo sapiens migrated out of Africa and quickly replaced other human species, such as H. erectus in Asia, without interbreeding. The competing theory of "multiregional evolution" contends that modern humans appeared when Homo sapiens from various geographical regions mated with each other as well as with archaic Homo populations, blurring regional and species boundaries. A middle-ground proposal suggests that as modern humans from Africa spread across the globe, they interbred with other archaic humans, but that only African genes persisted. After analyzing the genes of lice, Dale Clayton, an evolutionary biologist at the University of Utah, Salt Lake City, says that the history of these pests best fits the third hypothesis.

Clayton and postdoc David Reed, now an evolutionary biologist at the University of Florida, Gainesville, compared mitochondrial DNA from lice, primarily Pediculus humanus, to published data on human evolution. The data reveal that two genetically distinct lineages of P. humanus appeared about 1.18 million years ago, Reed, Clayton, and their colleagues report online 5 October in the Public Library of Science, Biology.

Clayton argues that the two subgroups must have diverged when two human lines--perhaps Asian H. erectus and the African ancestors of H. sapiens--went their separate ways, which anthropologist believe happened at about the same time. The fact that the lice evolved into subgroups suggests that they had little or no contact with each other, which implies that their human hosts were also isolated--contrary to the multi-regional hypothesis.

But the data do suggest that there must have been some contact among different kinds of early humans. Today, there is only one species of human--but two subgroups of lice. So the lice thought to have been living on H. erectus must have jumped to H. sapiens at some point before H. erectuswent extinct, perhaps as late as 30,000 years ago, possibly through fighting or sex, and that conclusion weakens the African replacement idea.

Milford Wolpoff of the University of Michigan, Ann Arbor, author of the multi-regional hypothesis, doesn't agree with Reed and Clayton's interpretation, calling the new study a "fringe explanation." But paleontologist Chris Stringer of the Natural History Museum in London is quite pleased with the work as it provides "an indirect but informative new window on ... modern human origins."

Gorillas Gave Us the Itch

Among primates, humans have the dubious distinction of having not one, but two types of sucking lice--one that nests on the head and the other that calls pubic hair home. Where did these buggers come from? A new study suggests that while we've been sharing head lice with chimps since before we were even separate species, pubic lice came from gorillas--and not very long ago.

Each year, 3 million people in the United States catch a case of pubic lice, otherwise known as "crabs." It's an important public health problem, but evolutionary biologist David Reed of the Florida Museum of Natural History in Gainesville prefers to look at it as an evolutionary conundrum. Typically, lice share the same evolutionary history as their hosts. For example, if a population of hosts splits into two and each of the isolated populations begins to evolve into separate species, then the parasites evolve too. Human head lice, for example, share a common ancestor with a chimp-based louse, and the two lice are closely related--just as chimps and humans are. But the closest relative to human pubic lice is not found in chimps, but rather gorillas, which are more distant kin from humans. Reed wanted to know why.

He and his colleagues compared the DNA sequences from two genes in various lice and calculated when the different species appeared. As expected, human and chimp Pediculus (head lice) began to diverge about the same time as hominids and chimps started down independent evolutionary paths, about 6 million years ago. The gorilla and pubic lice (both Pthirus species) split just 3.5 million years ago, however, about 4 million years after gorillas and the line that led to chimps and hominids diverged. Thus rather than co-evolving with our ancestors from the very beginning, these lice were acquired at a later point in time, Reed and his colleagues report today in BMC Biology.

Because lice rarely survive more than a few hours off their hosts, this jump required close contact between the two species. "They must have been in the same place at the same time," Reed points out. Vincent Smith, a cybertaxonomist at the Natural History Museum in London, says the study "raises some interesting questions about what gorillas and our hominid ancestors were doing in such close proximity to share each other's lice.

Here is how you beat indestructible head lice

Head lice don’t pose a particularly serious threat to our health but they do cause great anxiety among parents and carers. This anxiety, and associated stress, is made even worse given the perceived social stigma of a family infested with parasites, and the seemingly endless battle to exterminate these pests.

What are head lice?

Head lice are small insects that are highly adapted to one type of environment: hair on a human’s head (especially the hair and head of primary school-aged children).

Infestation with head lice is affectionately known as “pediculosis”, but while the lice will scuttle up and down the strands of hair, feeding on blood at the scalp, they don’t seem to cause anything other than very mild irritation. They’re not involved in the spread of any nasty diseases either.

But head lice are highly contagious. If you or someone in your family has them, you’ll probably want to get rid of them.

Are head lice becoming ‘indestructible’?

For many years we’ve known that commonly used insecticides (particularly pyrethrins and pyrethroids) aren’t working as well as they once did against head lice. Similar types of insecticides are currently being employed to battle outbreaks of mosquito-borne Zika virus in South America.

In much the same way that mosquitoes, bed bugs and many agricultural insect pests are becoming resistant to commonly used insecticides, so are head lice.

A recent study published in the Journal of Medical Entomology provides some insight into just how prevalent insecticide resistance in head lice may be.

Thanks to school nurses and “professional lice combers”, scientists from the University of Massachusetts were able to analyze more than 14,000 head lice from almost 140 locations across 48 US states. They were looking for the genetic markers that indicate potential resistance to insecticides such as pyrethrins or pyrethroids.

The researchers found a very high prevalence of “knockdown resistance”, a mutation in the insect that make it less susceptible to insecticides. The results suggest that more than 98% of head lice analyzed may not be susceptible to many head lice treatment products currently available.

The result isn’t surprising. With so much use of insecticides against head lice, the development of resistance should almost be expected.

Before everyone panics, it is important to note that while the mutations that confer insecticide resistance were found to be widespread, that doesn’t necessarily mean that all head lice will be resistant to commonly used insecticides. They may be, but we just don’t know to what extent.

There are also likely to be differences between head louse populations across the world.

We can even ditch the insecticides

Here is the really good news. We don’t have to rely on insecticides to control head lice.

The “conditioner and comb” method works well enough. By applying conditioner to the hair, any adult lice present will be “paralyzed” and can then be removed with specially designed “lice combs”. (Interestingly, the earliest known “lice combs” date back to 1500 BC).

Repeat the process a week later to catch any lice that hatch from eggs remaining in the hair and you should be done – at least until next time.

The biggest barrier to success is getting the children to sit still long enough to methodically work through their hair. Wrangling the kids is probably more difficult than wrangling the lice!

Head Lice Prevention: Everything Parents Should Know

Is there a head lice infestation in your child’s school? Learn how to prevent lice with these easy, natural methods.

Head lice have become an increasingly prevalent problem in our nation's schools and child-care centers, according to the American Head LiceInformation Center. Some 12 million people are infected with lice each year, most of them between the ages of 3 and 12. And although head lice isn’t a serious medical problem, it proves annoying for parents, teachers, and students alike. Here are some head lice prevention techniques to stave off a pesky infestation.

Head Lice Prevention: How to Prevent Lice

If you’ve discovered a lice infestation in your child’s daycare or classroom, here are some head lice prevention methods to implement into your daily life.

1. Don’t Touch Heads: Lice are spread most easily by direct person-to-person contact. This is often the case when children touch their heads together during play. Talk to your kid about the risk of lice, and warn him not to come into contact with another child’s head.

2. Keep Belongings To Yourself: Lice also can be spread indirectly when kids share combs or brushes, pillows, or head gear such as hats or helmets. Tell your kid not to borrow these items from others, and separate personal belongings as much as possible in the classroom.

3. Sanitize Your Possessions: Head lice can't survive away from a human scalp for more than 48 hours or at temperatures above 120 degrees. You can use these weaknesses against them when cleaning your house and possessions. For instance, soak all hairbrushes, combs, and hair ornaments that might’ve been exposed to lice in hot (not boiling) water. Wash all stuffed animals, bed linens, towels, and recently worn clothing in hot water, and place them in the dryer on a high-heat setting. Items that can't be washed or dried in this manner can be dry-cleaned or stored in sealed plastic bags for several days.

4. Wash Your Hair with Anti-Lice Shampoo: Anti-lice shampoos claim to fend away infestations, since lice are repelled by their scent. Many of these shampoos contain essential oils; popular options are lavender oil, tea tree oil, and coconut. You can find these anti-lice shampoos at many natural stores; alternatively, consider making your own by mixing small amount of essential oils into your existing shampoo.

5. Do Your Research: Spotting a lice infestation early can save your family from the annoying bugs. Perform routine head checks on your children to search for the tiny mites, which are found most often in the hair above the ears and at the back of the head, just above the neck. More visible though, are the tiny white nits that are found on the hair shaft, just above the scalp. They look like dandruff, but aren't flaky and are difficult to remove. If you are uncertain of what you're searching for, ask your child's school nurse or your pediatrician to show you what a nit looks like.

6. Watch Out for Yourself, Too! Because parents aren't likely to share hats, combs, clothing, and other items – or to come into direct head-to-head contact –  they're unlikely to become infected with lice. "We don't see parents with lice very often, and only occasionally will we even see siblings with it," says Dr. Herbert. Still, if your child does become infected with lice, it's a good idea to have another adult inspect your head just to make sure they haven't taken up residence.

Let's Talk About...LICE

The best part of my day was (and always is) picking JD up from school. But not today. Today, his teacher handed me a paper that read: “Unfortunately we have confirmed cases of head lice within the school. You child’s classroom has been affected. Head lice is highly contagious and we need your help to diligently check your child’s head everyday for the next few weeks.”

My face went white. I felt that woozy panic feeling (I have panic disorder and sometimes I have panic attacks – it sucks!) I didn’t have a panic attack right there, but I did start drilling JD’s teacher. She told me 2 kids were sent home with lice and are not permitted back until they are re-inspected by the school. She told me she checked JD’s hair and scalp and didn’t see anything, but lice are small, like tiny small and clear and JD has white blond hair—awesome. 

My face went white. I felt that woozy panic feeling (I have panic disorder and sometimes I have panic attacks – it sucks!) I didn’t have a panic attack right there, but I did start drilling JD’s teacher. She told me 2 kids were sent home with lice and are not permitted back until they are re-inspected by the school. She told me she checked JD’s hair and scalp and didn’t see anything, but lice are small, like tiny small and clear and JD has white blond hair—awesome. Then she recommended I buy lice shampoo and use it this evening, because if there is lice in his head, it’s good to attack it now before it gets out of control. Now I felt panicky. JD was tugging on my shirt and asking for juice and my head was itching. No time to panic.

I warmed up leftover cavatelli and peas and made chicken nuggets (all white meat - no preservatives!). JD ate and I scanned his head over and over and saw nothing—even with my glasses on. After a successful week of showers, JD was thrilled to take a bubble bath, because the shampoo needed to sit for 10 minutes on his hair. He played happily. "Don't touch your head," I said. "Why?" he asked. "Don't, dude." I Facebook messaged my mom friend, *Valentina who has a daughter in JD’s class. “I did a spot check -- all clear, bathed her and changed the sheets!” she wrote. Sh*t, the sheets! After JD’s bath, I stripped our beds and threw them in the wash with extra soap and hot water. I combed JD’s wet hair strand, by strand and saw nothing, nada. And then I called his Pediatrician and left a message with the answering service because I am THAT MOM. I prefaced my message for the doc to the answering service lady: "Please don't think I'm crazy, but..."

The Dr. was so kind and understanding—and reassuring. She told me if I didn’t see live lice there was no need to use the shampoo. She also said lice don’t leave bite marks, so I shouldn’t freak if I see anything suspect, like a scratch or red spot. She said JD is allowed to itch his head without having lice. She also said The American Academy of Pediatrics recently released a study that said kids with lice shouldn’t have to leave school if they have lice. Lice are not dangerous. They don't carry disease. Our society associates lice with filth and that is false. JD gets one or sometimes 2 baths/showers a day. His school is clean and bright—one of the best in our area—and lice happens. But I HOPE it doesn’t happen to us. I’ll be checking 24/7. I’ll be checking my thick, super-long hair too. Great.