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.

The low-down on head lice

Around 10 years ago, my family got head lice—and I thought we might have them forever.

I will never forget it. My head had been itchy for a while; I tried dandruff shampoo but it didn’t help. One day, desperate with itching, I asked a colleague at work if she’d check my scalp for me. “Claire,” she said, “you’ve got head lice.” I called home, and told my husband to check himself and the kids. They were infested too.

By the time I got home, my husband had bought permethrin cream rinse and treated everyone. I immediately globbed the stuff on my scalp for the allotted time and used the little plastic comb in the box, combing out some of the nits (and lots of creepy-crawly black bugs). We washed all the bedding and clothes, scrubbed all the brushes and combs, tossed the stuffed animals in the dryer. We were relieved—but within a day or two, it was clear that we were still infested. A week later, according to the instructions (and what I’d learned in medical school), we did it again—to no avail. Those bugs were undaunted; they had no intention of leaving our heads.

Our experience is becoming remarkably common. Head lice have been around for thousands of years (they’ve been found on Egyptian mummies); they are strong, resourceful little buggers, and develop resistance to chemicals used to get rid of them. Which doesn’t mean you shouldn’t try pyrethrin or permethrin, the treatments you can pick up at the drug store; it just means that you shouldn’t be surprised if they don’t work.

We get head lice from other people with head lice—head-to-head contact does it best, but they can also be spread by shared combs, brushes, hats, or other head accessories. They can hang out on bedding or upholstered furniture for a short time, so it’s easy for them to spread within a household. While they don’t fly or jump, kids at school (especially preschool or elementary school) often get close enough and share things enough that outbreaks are common. And until they are gone from everyone, they can keep spreading. Each female louse lays around 100 eggs, that hatch eight days later; once those lice start laying and hatching, well, you can imagine the math (I’m getting itchy again writing this!).

So it’s not surprising that people would go looking for stronger and better cures for head lice, and this month there was a study published about two of them: malathion, an insecticide, and ivermectin, an antiparasitic drug. The researchers used them on people who still had head lice two to six weeks after using permethrin or pyrethrin (my family would have qualified!), and found that 85 percent of the malathion group got rid of their lice, and 92.5 percent of the ivermectin group got rid of theirs.

Sounds great, right? Well, there are two problems to consider. First, as we’ve said, head lice are resourceful creatures. If we start using these treatments frequently, it’s likely that the lice will begin to be resistant to them (the researchers were careful to point out that these treatments should be reserved for cases where nothing else has worked). Second, and more importantly, both malathion and ivermectin can be toxic—usually just if used incorrectly, but even correct use could cause side effects in some people.

So what do you do if your child (or your family) has lice? There are lots of remedies out there, most of which don’t work or are dangerous (and some of which, like petroleum jelly, can be very messy). The Harvard School of Public Health has lots of great information on remedies (and on head lice in general), but what I recommend, and what ultimately did the trick for us, is the simplest treatment of all: combing. It’s not a quick fix, but it works. Here’s what you need to do:

• Buy a good lice comb, one with long, metal tines that are very close together (drug stores and pet stores sell them).

• Get out any tangles before you get started, or the lice comb will just get stuck. Detangling spray can help; if you do the whole thing in the tub, putting conditioner on the hair helps the comb go through (and you can rinse out the conditioner afterward).

• Separate the hair into sections. Start at the scalp where the bugs and live eggs are, and comb through to the end. Rinse or wipe the comb after each pass (check to see what you got first).

• Comb every day until you haven’t seen any eggs or live bugs for at least eight to 10 days (since that’s how long it takes an egg to hatch).

Not only is this approach completely non-toxic, if you go at it with the right attitude (i.e. a fun and patient one), it can be quality family time! Try telling stories (you can take turns adding to them) or making up songs—or just use it as a time to catch up and find out what’s going on in your child’s life. That’s what we did, and after two weeks of bonding—I mean combing—we were finally lice-free.

When fighting lice, focus on kids’ heads, not hats or toys

I recently attempted a technically demanding “around the world” braid on my kindergartner. On my sloppy and meandering approach to the South Pole, I discovered a loathsome sight that scuttled my circumnavigation — a smattering of small, brownish casings stuck onto hairs.

I tried to convince myself that I was looking at sand. She’s always covered in sand! But I’ve spent enough time around insects to know that I was looking at something biological. Bad braid abandoned, I began combing through, looking for more specks. And I sure found them: Lice eggs, or nits, that were glued onto the hair next to the scalp, and precisely one live bug.

Today, I am delighted to report that our outbreak is over. (Although with three young children, our situation will probably swing between “having lice” and “waiting to have lice again.”) Our first brush with the little buggers sent me into full research mode, and I’m now armed with a deeper understanding of lice habits and preferences. In the interest of streamlining your next lice experience, I offer below some little-known and helpful facets of lice life.

The best way to spot lice and their tiny nits is with wet combing.

Compared with spot-checking the scalp, pulling a fine-toothed metal comb through hair that’s slick with conditioner turns out more critters. 

Pepper-sized nits can range from white to brown in color and are glued to single hairs. These suckers are on tight: You might need a fingernail to pop them off. Live nits need to be close to the warm scalp to survive; casings that are farther than a centimeter away from the scalp are probably empty or contain dead eggs.

Once hatched, a live human head louse, or Pediculus humanus capitis, grows no larger than the diameter of a pencil eraser. It’s grayish white. And its favorite — and only — food is blood from a human scalp, which it slurps several times a day.

Super lice laugh at pesticides.

More and more lice can withstand permethrin or pyrethrins, the pesticides inside most of the boxes you’ll find in your panicked drugstore run. And there’s not much evidence for other treatments, including mayonnaise and tea tree or lavender oil. And please don’t even think about gasoline.

Lice burrowed onto heads are surprisingly hardy, even underwater.

In one series of experiments, researchers watched lice cling to cut hair in regular water, seawater, salt solutions and even chlorinated water. The pests didn’t respond to a poke, either, researchers found.

Another study looked at lice pulled off the heads of people in France. After six hours underwater, all the lice in the experiment (188 of them) were happily alive. About half of the lice were still alive after 24 hours underwater. Hardy, I say.

But: Lice are wusses when not on a head.

Off their favorite spot, adult lice quickly dry out and starve, particularly in dry environments. Most are dead within 40 hours after their last meal. And it is unlikely that eggs removed from a head can yield healthy adults.

Lice aren’t all that contagious.

They can’t jump, fly or swim. Their dire need for a human head means that direct head-to-head contact, such as the type you see with little girls coloring together, is what allows lice to crawl to a new home. 

“The control of head lice should focus on the head, not on the environment,” researchers wrote in 2010 in The Open Dermatology Journal. That paper mentions a study of over 1,000 hats, worn by students who, combined, had over 5,500 lice on their heads. The heads had lice, but the hats didn’t. The risks of transmission from hairbrushes, hats, helmets and toys are really, really low. The same goes for flooring: When researchers combed the floors of 118 classrooms at a school with a known lice outbreak, they turned up no lice.

All this to say that you don’t need to wage war on your house and bag up your kid’s clothes, bedding and stuffed animals for three days. “This recommendation has no basis in science,” a 2016 review stated.

Lice aren’t dangerous.

They are gross, to be sure, but they’re not a menace to public health. Kids don’t usually get sick from lice, beyond a little bit itchy. That’s why the American Academy of Pediatrics objects to “no nit” school policies that prevent kids with lice from attending. The Centers for Disease Control and Prevention agrees, as does the National Association of School Nurses.

Lice can be a valuable commodity, in exactly one scenario:

Shrek (the real ogre in the delicious book, not the sanitized movie version) trades several of his rare lice to a witch in exchange for his fortune. It’s a great deal.

So there you have it. I’d certainly prefer to live a lice-free life, but now that I know more about these relatively harmless insects, I feel a little bit better about our prospects.

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.

Mutant lice are infesting kids all over the US

Mutant lice sound like the star of a low-budget horror film, but they're a real problem being found around the nation.

These insects' mutations seem to make them resistant to some over-the-counter treatments typically used to get rid of lice, sold under brand names including Elimite and Nix.

While some treatments are no longer effective in some cases, methods that do work are still available, so you just might need to ask your child's doctor.

Lice are a parasitic insect that live in human hair on our scalps, eyebrows and eyelashes, and feed off our blood.

Lice can't jump; they can only crawl, so they spread through head-to-head contact. They have adapted so well to living on us that their feet are especially evolved to cling to human hair, even during washing.

An infestation can feel like a tickling, itchy sensation on the head, and can be diagnosed by looking for adult or nymph lice on the scalp or hair, according to the U.S. Centers for Disease Control and Prevention. It's tough to know how many people get head lice, but among kids aged three to 11, it's anywhere from 6 million to 12 million infestations in the United States every year, according to the American Association of Pediatrics.

Every parent dreads the moment their child comes home from school scratching her head, and the thought that these lice may not not be killed off with over-the-counter treatments is even more unsettling.

A growing problem

To figure out how lice are evolving resistance, biologist Kyong Yoon from Southern Illinois University, Edwardsville and his team tested the genes of head lice collected from 30 states. In samples from 25 of those states, they found that the lice had a gene that protects them against a lice treatment called permethrin.

In four other states — New York, New Jersey, New Mexico, and Oregon — the lice showed some level of resistance, but it hadn't reached a point that would render these treatments useless.

Yoon reported his results at a meeting of the American Chemical Society on August 18, and he has been tracking the spread of resistance in the U.S. since 2000. These latest results, though, haven't been published in a peer-reviewed journal.

With each round of research, Yoon and his team noted that lice are getting more and more resistant to permethrin. In their latest study, published last year in the Journal of Medical Entomology, they noted that until reports from 1995 indicated that permethrin was at least 96% effective, but a 2001 report described it as only working 80% of the time.

That rate seems to have dropped to as low as 28% effectiveness in some places, they wrote.

Dr. Jason Yaun, an assistant professor of pediatrics at the University of Tennessee Health Science Center in Memphis who wasn't involved in the research, told MedPage Today that permethrins are still the most safe and effective treatment. And they're still what the CDC recommends as a first resort.

The Mayo clinic also suggests that multiple treatments may be needed, since permethrin won't kill off freshly laid lice eggs, so parents need to make sure that the treatment is being used correctly.

But even if some cases in certain areas do still react well enough to lice lotions now, there's no reason to think that will last. The spread of mutations to permethrins over time could become a much bigger problem, Yoon argues.

"If you use a chemical over and over, these little creatures will eventually develop resistance," he said in the press release announcing the results. "So we have to think before we use a treatment."

Other Treatments

Luckily for parents everywhere, it is possible to get rid of lice without these insecticide lotions.

An insecticide in pill or lotion form, the anti-parasite drugivermectin, sold under the brand name Stromectol or Sklice, is relatively new (the FDA approved it in 2012) and requires a prescription. Several lotions with stronger insecticides are also only available with a prescription, but are more expensive than the ones with permethrin and some have dangerous side effects that make them not suitable for use on children.

That being said, using more chemicals on a pest normally makes it evolve even more resistance, so these treatments are best used as a last resort.

Some parents use home remedies, like the application of mayonnaise or Vaseline to the head in order to suffocate the lice. But, according to the Mayo Clinic, there is little to no clinical evidence to show that they work.

In the end, many families may need to go back to the tried-and-true standby: Nit combing. A recent study in the journal Parasitology Research, suggests that in about half of cases, combing can be an effective treatment for head lice.

"Combing works," Claire McCarthy, a pediatrician Boston Children's Hospital, said in a Harvard Health Blog about lice treatment with ivermectin in 2012. "It takes patience and perseverance, but not only does it get rid of both live lice and eggs, it's completely nontoxic and without side effects. That can't be said of any other treatment for head lice, ivermectin included."

"Combing works," Claire McCarthy, a pediatrician Boston Children's Hospital, said in a Harvard Health Blog about lice treatment with ivermectin in 2012. "It takes patience and perseverance, but not only does it get rid of both live lice and eggs, it's completely nontoxic and without side effects. That can't be said of any other treatment for head lice, ivermectin included."

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?

Head Lice Treatment: Comb Them Out Instead Of Using Nix, Rid, Or Other Chemicals

Many parents, desperate to get rid of a case of lice crawling around in their child's hair, will dash out to the pharmacy to buy Nix or Rid, the most widely sold lice-control products in an estimated $130 million over-the-counter market.

There’s a reason those chemical products are so popular. The American Academy of Pediatrics and the Centers for Disease Control and Prevention on their websites recommend using those pesticides, as well as even stronger prescription-only products, to get rid of the nasty insects. Says you should physically remove them instead.

“There’s no reason for parents to douse their children’s heads in chemicals,” says Urvashi Rangan, Ph.D., director of consumer safety and sustainability for Consumer Reports. “Physically removing lice, while it seems daunting, is safest for your child’s head.”

The over-the-counter products are losing their fight against lice because studies suggest that most of the bugs in the U.S. have evolved to become genetically resistant to the insecticides found in those products. That includes pyrethrum in shampoos such as Rid and the permethrin in creme rinses such as Nix. Pyrethrum is a naturally occurring pyrethroid extract from the chrysanthemum flower, and permethrin is a synthetic form of that drug. Products with those ingredients have been available to consumers for decades.

A study published in the March 2014 issue of the Journal of Medical Entomology found that 99 percent of the head lice collected by school nurses and professional lice combers in 12 states and three Canadian provinces were genetically resistant to permethrin. “It’s not surprising that we are seeing a resistance to these products,” Rangan says. “That’s what happens with insecticides and pests over time.”

And despite the label claims, pyrethrum and pyrethroid-based products have only a marginal ability to kill the eggs that remain attached to the hair shaft after treatment. “They can’t be relied on to kill all lice eggs,” says Michael Hansen, Ph.D., a senior scientist at Consumer Reports. When the makers of Nix were asked for the evidence to support the claim that Nix “kills lice and their eggs,” a lawyer for the company said its labeling is scrutinized by the Food and Drug Administration, but the content behind it is considered “proprietary and confidential.”

Lice are sesame-seed-size wingless insects that feed on human blood. They don’t transmit disease, but their bites cause intense itching, which can lead to sores and possible secondary infections. Lice can crawl from one head to another in seconds when children touch their heads together during play or when they share combs or hats. The affliction is now second only to the common cold when it comes to conditions that affect elementary-school students in North America. The U.S. has 6 million to 12 million cases a year among children 3 to 11 years old.

So what is a parent to do? First, don’t panic, and don’t be mortified. “Anyone can get lice,” Rangan says, including the parents of the children who bring them home. In the U.S., African-Americans are less likely to get head lice because North American lice can’t get a good grip on the tightly curled oval hair shafts common in African-American hair.

If you get a warning letter that lice have been discovered at your child’s camp or school, inspect your child right away. A female louse (singular for lice) can lay five to six tiny pearl-colored eggs, or nits, a day near the base of a hair shaft, especially behind the ears or at the back of the neck, and before you know it a few generations could be living on your child’s head if you ignore the problem.

But a child with a first case of head lice may not notice anything for four to six weeks. That’s generally how long it takes for the immune system to develop sensitivity to louse saliva. There’s a chance that the itching could be caused by eczema, dandruff, or an allergy. But if it is a case of lice, it will not clear up on its own.

Here’s what Consumer Reports’ experts recommend.

1. Look for live bugs:

Use a metal nit comb—not plastic—that is thin-toothed and finely spaced. Combing your child’s hair with conditioner or another lubricant, such as olive oil (wet-combing), is much better than just looking for the bugs on your child’s head, according to a study in the March 2009 Archives of Dermatology.

German researchers compared the two methods on 304 students, ages 6 to 12. They found that wet- combing identified infestations in 91 percent of the cases, compared with about 29 percent for visual inspections on dry hair. “Wet combing is the only useful method if active infestation has to be ruled out,” researchers wrote.

Make sure you work in bright light; during the summer you can do this outside on a sunny day. Otherwise, use a bright lamp. To wet comb, first coat your child’s hair and scalp with conditioner or another lubricant. Use a wide-tooth comb to separate hair into very small sections. Follow with a metal nit comb—not plastic—that is thin-toothed and finely spaced (you can also use a flea comb, available at most drug stores), concentrating on very small sections closest to the scalp.

After each comb-through, move the section over, wipe the comb on a paper towel, and inspect for lice. Seal the paper towels in a resealable plastic bag and dispose. Remember to clean combs in very hot, soapy water.

2. If you find any lice, comb and comb and comb

Consumer Reports’ experts say the safest method of getting rid of lice is to physically remove the insects and their eggs by combing with a lubricant such as a hair conditioner. “The chemicals on the market don’t kill 100 percent of the eggs, most pose some level of risk, like itchy eyes or chemical burns or seizures, and they are unnecessary in most cases compared with physical removal,” Hansen says. The key, he says, is to continue to comb out your child’s hair every day until no live lice are seen and then every few days for about a month.

A study of two “bug busting” campaigns in the United Kingdom showed that persistence pays off: All lice were eradicated when combing-out treatments were extended from 14 days to 24 days.

3. Skip the chemical products

Over-the-counter chemical treatments have become less effective over the years. As a general rule, younger children have thinner skin, making them more susceptible to chemical absorption, and they are more vulnerable to the side effects of pesticides.

As noted above, over-the-counter chemical treatments such as Rid and Nix ($20 each) have become less and less effective over the years as the bugs have evolved to become more resistant to them. And they are marginal at best when it comes to killing lice eggs. Possible side effects of using them include red, itchy, and inflamed skin or difficulty breathing, which may be problematic for people with asthma. The products shouldn’t be used near cats because felines are especially sensitive to this class of drug.

Prescription treatments come with a range of risks or side effects, and the drugs can be expensive. In 2011 the Food and Drug Administration approved a new drug called spinosad (Natroba), a topical treatment for use in children ages 4 and up, that was found to be more effective in killing lice than permethrin, according to two manufacturer-sponsored studies. And it claims to kill lice eggs. Possible side effects were minimal, including skin and eye redness or irritation. But its long-term safety is still under study, and it costs $280 for 4 ounces.

Other prescriptions include:

Benzyl alcohol (Ulesfia): (About $140 for 7.7 ounces) A topical lotion for children 6 months old and older (the safety for people over 60 is not established). It claims to kill live lice but not their eggs. Possible side effects include skin or eye itching, redness, and irritation.

Citronellyl acetate (Lycelle): (About $190 for 3.4 ounces) A topical gel for children 2 and up and people under age 60. It claims to kill live lice and some eggs, but not all. Possible side effects include skin or eye itching, redness, stinging, irritation, and burning.

Ivermectin (Sklice): (About $300 for 4 ounces) A topical lotion for children 6 months and older and people under age 65. It claims to kill live lice but not their eggs. Possible side effects include conjunctivitis, eye irritation, dandruff, dry skin, and a burning sensation on the skin.

Lindane: (About $120 for 2 ounces) This topical lotion is banned in California, and Consumers Union petitioned the Food and Drug Administration to outlaw this neurotoxic, possibly carcinogenic pesticide as a lice treatment in the early 1980s. But it’s still on the market as a prescription drug for lice despite reports of seizures and even deaths from improper use. And it’s the only lice treatment that carries a black-box warning (the worst kind).

Malathion: ($210, generic, and $255, Ovide, for 2 ounces) A topical lotion for children 6 and older. This drug is flammable, so any source of heat, such as a hair dryer, could cause your child’s hair to go up in flames. Possible side effects include second-degree chemical burns. Accidental contact with eyes can result in a mild form of conjunctivitis.

5. Prevent it from spreading

If your child has head lice, all household members and close contacts should be checked and treated if necessary. Also tell your child’s teacher, who can then advise other parents to check their children’s hair and treat them if necessary.

6. Don’t waste your money on shielding shampoos

Katie’s note: I don’t agree with the header “Don’t waste your money on shielding shampoos”. While Lice Shield and other products may have falsely advertised, other products such as the ones we recommend, have been clinically proven to help prevent head lice. Products just need to be properly tested before making claims.

Parents eager to prevent their children from bringing home lice may be tempted to buy a shampoo or spray called Lice Shield, which claims it can prevent or reduce the risk of getting head lice. But the Federal Trade Commission charged its maker, Lornamead, with false advertising in May.

The products and ads for it claimed that citronella and other essential oils used in the Lice Shield line would “dramatically reduce” the risk of head lice infestations, the FTC said. The company claimed that its products, sold at CVS, Rite Aid, Walgreens, WallMart, and other stores, were “scientifically shown to repel head lice.” But it doesn’t have a well-controlled human clinical study to support that claim.

As a result, Lornamead must shell out $500,000 as part of the settlement and is banned from making any similar claims in the future. “As any parent knows, an outbreak of lice can wreak havoc,” said Jessica Rich, director of the FTC’s Bureau of Consumer Protection. “When marketers say their products can be used to avoid these pests, they’d better make sure they can back up their claims.”