November 09, 2017
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1. On vacation recently, Kim and I toured Santa Fe’s “Oldest House,” a 800 year old native American dwelling. Among the displayed artifacts I noted an ancient lice comb made of bone. I found it fascinating to contemplate–from such a distant, different time, yet they still struggled with the same annoying, familiar problem. People are still just people.

Head lice have been with us for eons and probably troubled our pre-human ancestors >1.8 million years ago. They are now “species specific”–just us folks. They spend their entire life cycle on the scalp and, unable to fly or jump, die within 2 days of removal. They primarily infect 3-11 year olds with between 6-11 million cases annually. A few misconceptions

  1. Head lice infestation is not indicative of poor hygiene. They are spread by close contact, mostly in schools or camps. So it no more suggests uncleanliness than picking up a cold or flu–just bad luck
  2. Unlike their skeevy cousin, the body louse, there is no known disease spread by head lice.
  3. Sleeping in a bed previously used by an infested person does not spread disease (unless you are sharing the bed simultaneously)
  4. <2% of spread is caused by use of inanimate objects like hats or brushes; it’s almost always person-person
  5. Most important–nits do not cause spread

Given #5, there is no justification for school “no nit” policies. Nits are egg husks and can no more spread disease than egg shells make egg salad.(Chemically bonded to the hair, one can differentiate nits from dandruff by isolating the hair and gently sliding the little flake off with your fingers. If it slides off its dandruff) The official AAP position is that involved children need not be removed from class as, once treated, contagiousness is very limited. So there is more negative impact of social stigma or lost school time for that child and little gained from dismissal. 

While drug resistance occurs, AAP guidelines still recommend OTC treatments like Rid or Nix as first line. Apply a generous amount to the hair and scalp, leave on for >10 minutes, then vigorously shampoo. Long hair may need 2 bottles. Be sure to re-treat in a week. Then vigorously comb out the dead bugs and the nits with a metal fine tooth comb. The teeth of plastic models will likely break and be ineffective (I suppose if one can scrounge up a bone model, like our long forgotten “Oldest House” friends–that would be ok too!). If you notice a few straggles hanging on after treatment don’t be discouraged–that’s what the second dose is for. Personally I recommend everybody in the house be treated together the first time. Only infected people need the second dose. 

These medications are quite safe. However, repeated application can lead to toxicity, so don’t keep retreating–call me and we can talk about prescriptions. One last word: dehydration with a heat treatment is often effective. Other “non-medical” methods–essential or olive oil, petrolatum, mayonnaise(!) fail often and are not recommended. 

Send questions or comments; thanks for following.