AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Explore the causes of head lice, discover effective treatments, and find the ultimate solution on Meri Sehat. Don't rely on medicated lotions or irritating shampoos!

A Guide To Deal With Head Lice In Adolescents and Adults

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Online Consultation

Ismail Munir

A Guide To Deal With Head Lice In School-Going Children

Introduction

Head lice. A name that rings familiar to so many of us. A name that fills us up with dread. Especially when it&rsquo;s the start of a new session at school, knowing you&rsquo;ve just spent the entire vacation trying to get your kid&rsquo;s head free of lice. The dread is also because those tiny bloodsuckers are a nuisance; they will spread from one person to another in a jiffy and before you know it the entire household is scratching their scalps as they are gripped by lice infestation.

There are so many other emotions associated with lice infestation. There&rsquo;s mourning for the loss of blood. Then there are those little moments of celebration when you are able to catch them &ndash; and kill them. But, most of all, there&rsquo;s shame. You hesitate going out. And kids, who are frequently targeted by head lice, also fall prey to bullying at school. Not just by other students, but also by parents of these other children who complain about how their little one is exposed to head lice!

So, if your child is under attack by head lice, here&rsquo;s how you can deal with it effectively and efficiently. 
&nbsp;

Understanding Head Lice Treatment In Children

The parasitic insect known as the head louse, or Pediculus Humanus Capitis, can be found on people&#39;s heads, brows, and eyelashes. It&rsquo;s important to note that the presence of head lice does not indicate inadequate personal hygiene or an unsanitary living situation. These insects mostly move directly from one person&#39;s hair to another&#39;s hair. However, they don&rsquo;t cause any bacterial or viral illnesses<a href="#accordion">[1]</a>.&nbsp;

There are a number of over-the-counter and prescribed drugs that may be used to treat head lice and their eggs. You need to be careful while handling drugs; carefully follow the treatment recommendations to get rid of the parasite. In addition to this, you may employ natural or at-home cures. However, there is minimal to no clinical support for their efficacy. 
&nbsp;

<ul>
	<li>A tingling sensation or movement in the hair.</li>
	<li>Itching as an allergic response to a head louse bite.</li>
	<li>Irritation and trouble falling asleep since head lice are most active at night.</li>
	<li>Headaches due to constant scratching.&nbsp;</li>
	<li>Secondary bacterial infection of the skin due to excessive scratching. 
	&nbsp;</li>
</ul>

<h5>Identifying The Peak Season&nbsp;</h5>

To begin with, you need to know when exactly it is during the entire school year that your child is getting affected by head lice. This will help you and, by extension, your child to be better prepared to deal with it.&nbsp;

Children who are 5-13 years old are frequently targeted and they may be spreading it to their family members unknowingly. In that case, adults need to be on alert from August through October and again in January when lice infestations are at their worst.

According to a study, sales of pediculicides follow a clear seasonal pattern, peaking between weeks 34 and 40 of the calendar year, i.e., from mid-September till the end of October. It was concluded that even though the frequency of pediculosis capitis varies throughout the year in Germany, it peaked during the late summer and early fall<a href="#accordion">[2]</a>. 
&nbsp;

<h5>The Comb-Out Method&nbsp;</h5>

The comb-out method is utilized to clear the remaining head lice and nits following head lice medication. It may also be used to monitor the presence of nits and lice. However, the comb-out procedure rarely successfully eliminates head lice on its own.

The comb-out approach is as follows:

<ul>
	<li>Step 1: Wet your child&rsquo;s hair.</li>
	<li>Step 2: Divide your child&#39;s hair into tiny portions and brush each portion using a fine-tooth comb (also known as a louse or nit comb).</li>
	<li>Step 3: Wipe the used comb on a moist paper towel after every comb-through. Pay close attention to all surfaces of the paper towel, comb, and scalp. If there&rsquo;s any lice or nit present, it will be there on the comb after you pull it through the hair.</li>
	<li>Step 4: Keep going through your child&#39;s hair by repeating steps 2 and 3 until you&#39;ve finished, i.e., the comb comes out clean. 
	&nbsp;</li>
</ul>

<h5>1.&nbsp;Permethrin Lotion (1%)</h5>

<ul>
	<li>It doesn&#39;t require a prescription.</li>
	<li>Shampoo your child&rsquo;s hair, towel dry it, and then apply the lotion. Leave it for 10 minutes and then rinse.&nbsp;</li>
	<li>Avoid shampooing for the next 24-48 hours.</li>
	<li>It will only kill lice and not their eggs.</li>
	<li>Repeating treatment is advised if live lice are discovered between days 9 and 10.</li>
	<li>It is appropriate to use in kids who are 2 months and older.</li>
</ul>

&nbsp;

<h5>2. Pyrethrin-Based Product (Shampoo Or Hair Mousse)</h5>

<ul>
	<li>It doesn&#39;t require a prescription.</li>
	<li>You can apply it to dry hair and then rinse 10 minutes later.&nbsp;</li>
	<li>Avoid shampooing for 24-48 hours after a wash</li>
	<li>It kills lice but not their eggs.</li>
	<li>Repeating treatment is advised between days 9 and 10.</li>
	<li>It is suitable for usage in kids who are 2 years of age and older.</li>
</ul>

&nbsp;

<h5>3. Ivermectin Lotion (0.5%)</h5>

<ul>
	<li>It doesn&#39;t require a prescription.</li>
	<li>You can apply it directly to dry hair and then rinse 10 minutes later.&nbsp;</li>
	<li>Avoid shampooing for 24-48 hours following it.</li>
	<li>It kills lice but not their eggs.&nbsp;</li>
	<li>One application is sufficient.</li>
	<li>Ivermectin in veterinary preparations should not be used for this purpose.</li>
	<li>Children and infants aged 6 months and older are permitted to use it.</li>
</ul>

&nbsp;

<h5>4. Malathion Lotion (0.5%)</h5>

<ul>
	<li>It needs a prescription.</li>
	<li>Apply it to dry hair and leave it for 8-12 hours. After that, rinse off the application and avoid shampooing for 24-48 hours.</li>
	<li>It eliminates both lice and their eggs.</li>
	<li>Repeating treatment&nbsp;is advised if live lice are discovered after 7-9 days.</li>
	<li>It is suitable for kids aged 6 years and older.</li>
	<li>It has a strong smell and should be handled with care since it is flammable.</li>
</ul>

&nbsp;

<h5>5. Spinosad Topical Suspension (0.9%)</h5>

<ul>
	<li>It requires a prescription.</li>
	<li>You can apply it to dry hair and then rinse 10 minutes later.&nbsp;</li>
	<li>Avoid shampooing for 24-48 hours following it.</li>
	<li>It eliminates lice as well as their eggs.</li>
	<li>Repeating treatment is advised whenever live lice are discovered after 7 days.</li>
	<li>It is authorized for use in kids 6 months as well as older.</li>
</ul>

&nbsp;

<h5>6. Ivermectin 3-mg Tablet</h5>

<ul>
	<li>It requires a prescription.</li>
	<li>It is recommended for use in treating head lice in adults and other illnesses in kids. However, it should only be used if all other options have failed.</li>
	<li>Repeating treatment&nbsp;is advised whenever live lice are discovered after 9&ndash;10 days.</li>
	<li>It is suitable for usage at any age, provided that the user weighs at least 33 pounds.</li>
	<li>Ivermectin in veterinary preparations should not be used for this purpose. 
	&nbsp;</li>
</ul>

<ul>
	<li>Pay close attention to the written instructions on the packaging.</li>
	<li>Never allow kids to administer medication themselves. An adult should administer medication. Keep the medications locked and out of reach of children.</li>
	<li>Always rinse the medication off over a basin rather than in the shower or bathtub. This should be done to prevent the medication from running off the head and onto other regions of skin.</li>
	<li>Always use warm water to remove the medication (not hot water).</li>
	<li>Never cover a child&#39;s head.</li>
	<li>When a youngster has medication in their hair, never leave them unattended.</li>
	<li>Keep medications out of children&#39;s eyes.</li>
	<li>Always consult the child&rsquo;s doctor before starting a second or third medication &ndash; or even a repeated treatment&nbsp; of the same medication. Perhaps, the doctor will change it.</li>
	<li>Always voice concerns that need to be addressed by the doctor. For e.g., if the lice persist despite using medications. 
	&nbsp;</li>
</ul>

<ul>
	<li>You cannot stop head lice from invading the head. However, you can stop them from spreading.</li>
	<li>Frequent wet or dry combing can help in early detection.&nbsp;Avoid using medicated lotions and sprays to minimize head lice as they may cause scalp irritation.</li>
	<li>Also, it may be challenging to stop the spread of head lice amongst children due to the close contact at schools and childcare institutions. However, that is no reason for your kid(s) to skip school or for you to wash their laundry on a hot cycle.</li>
</ul>

&nbsp;

There is very little probability of indirect dissemination from personal items. However, the following tips may help stop the spread of head lice:

<ul>
	<li>Place your clothes on a hanger that is separate from the children&#39;s clothes.</li>
	<li>Do not exchange hats, brushes, combs, or scarves.</li>
	<li>Avoid resting on any furniture, including pillows or mattresses, that has recently been used by a head-lice carrier. 
	&nbsp;</li>
</ul>

Conclusion

It's okay to feel upset when you discover lice while combing your child’s beautiful locks. But, there’s no need to panic. It’s not your fault and it’s definitely not your child’s fault. Head lice can be found everywhere in the world, including in households, schools, the countryside, and urban areas. Your child is not in danger of any significant health issues as a result of head lice. Don’t delay the treatment, but make sure you do your research before opting for any method to stop the lice from spreading. Only use medications that are recommended by a pediatrician and termed safe to use for this purpose.&nbsp;

Key Points

<ul><li>Head lice are insects that reside in human hair.</li><li>An itching head is a major sign of head lice. If you look closely near the scalp, you might also spot white or dark-brown eggs.</li><li>You can cure head lice at home by utilizing moist combs or anti-lice treatments.</li><li>Children frequently get head lice and they can spread quickly.</li><li>As a caregiver, it’s your responsibility to check your entire family for head lice and notify your child's daycare or school if you suspect your youngster has them. </li></ul>

[1] Veracx A, Raoult D. Biology and genetics of human head and body lice. Trends Parasitol. 2012;28(12):563–71.

[2] Bauer E, Jahnke C, Feldmeier H. Seasonal fluctuations of head lice infestation in Germany. Parasitol Res. 2009;104(3):677–81.

[3] CDC - lice - head lice - treatment. Centers for Disease Control and Prevention.

Neelam Asad

Can you believe that a small, six-legged insect attaches itself to your hairline or to the nape of your neck and feeds on your blood?&nbsp;

You probably can. At some point or another in life, everyone&rsquo;s been affected by what&rsquo;s known as head lice. In fact, approximately 6-12 million individuals in the United States alone are affected by head lice (pediculosis capitis) annually<a href="#accordion">[1]</a>.

Since they are so small &mdash; roughly the size of a sesame seed &mdash; it&rsquo;s easy to overlook or ignore them at first. You see one and think it&rsquo;s just a minor inconvenience. And, in the blink of an eye, they would prove you wrong. They multiply so rapidly and, somehow, they still manage to be challenging to find, making it harder to put an end to the infestation once it begins.&nbsp;

It is also very hard to pick these eggs because they appear in a variety of colors ranging from white to tan to brown, which makes it difficult to distinguish them from hair debris.

But the major reason is still the numbers. Every day, a female adult louse lays up to 6 eggs right onto the hair shaft, attaching it to your hair with its secretions, while ensuring that those eggs are less than 6 mm away from the scalp so that they have the best chance of hatching.&nbsp;

Within a week, the eggs hatch, and the nymphs come out. It takes the nymph only 3 spurts of rapid growth to become adult lice. Once the nymphs develop into lice, they will feed on your blood 4-5 times every day. Their bites release a substance that prevents clotting. 
&nbsp;

Understanding Head Lice Treatment In Adults

Head lice can survive for around 28 days<a href="#accordion">[4]</a>. They grow in 3 stages: egg, nymph, and adult.

&nbsp;

<h5>1. Egg Or Nit</h5>

Eggs are normally located within 4-6 mm of the scalp and die if they are located farther away.

&nbsp;

<h5>2. Nymph</h5>

Nymphs are somewhat similar to an adult head louse; however, they are considerably smaller (about 1.5 mm). Nymphs mature into adults 9-12 days after hatching.

&nbsp;

<h5>3. Adult Louse</h5>

It just takes 12-14 days for newly born eggs to mature.

&nbsp;

Note: If head lice are not treated, this cycle reoccurs every 3 weeks. 
&nbsp;

When considering head lice treatment, it&rsquo;s important to look for a technique that will help you avoid hair damage while effectively killing all the lice.

&nbsp;

<h5>1. Use An Effective Treatment&nbsp;</h5>

To prevent re-infestation from others, all affected people (especially those living together) must be treated at the same time. In most situations, nits need to be treated again in 7-10 days because, unfortunately, there is no particular treatment that is very effective in removing head lice and nits in one go.

&nbsp;

<h5>2. Soak Hair Care Items&nbsp;</h5>

Hair accessories, including combs, brushes, and clips should be soaked in hot or warm water for nearly 15 minutes to get rid of lice and their eggs.

&nbsp;

<h5>3. Reduce Head-To-Head Contact&nbsp;</h5>

Maintain a safe distance from family members, caretakers, and friends if you have lice or vice versa.

&nbsp;

<h5>4. Check Hair And Scalp Daily&nbsp;</h5>

Check your hair scalp and hairs and remove all nits till the infestation is gone. Do weekly inspections to detect re-infestation. 
&nbsp;

This technique yields greater results if you comb damp hair using a specifically designed nit comb. Lice combs are easily available at drug stores.

A metal nit comb, for instance, is the most effective one. Plastic combs, on the other hand, may not work effectively. The National Pediculosis Association recommends the LiceMeister, a specifically made nit comb<a href="#accordion">[5]</a>. A thick hair conditioner can also be used to help with nit-combing. Dimethicone products work wonderfully, even on curly or thick hair that is difficult to manage.&nbsp;

&nbsp;

You&rsquo;ll need the following items for hair combing:

<ul>
	<li>A tissue box with a plastic bag</li>
	<li>A fine-toothed comb&nbsp;</li>
	<li>A light that can be focused on the head</li>
	<li>Hair clips to secure the sections of hair that have been combed</li>
</ul>

If you&#39;re using dimethicone products instead of insecticidal shampoo, you can comb your hair while the product is still on. Dimethicone is extremely slippery and it will make combing considerably easier.

&nbsp;

Nit-picking is not the same as brushing your hair. Follow these steps to end the infestation effectively:

1. Starting from the scalp or crown of your head, detangle your hair carefully. Insert the louse comb at the root of the hair section as close to the scalp as feasible and draw the comb slowly through the hair.&nbsp;

2. Make sure the comb is tilted so that the curved side of the teeth is facing the head. If the comb snags in knotted hair, it is unlikely to remove nits properly.

3. Comb the section of hair until it seems to be nit-free, then pin it out of the way with a hair clip and move on to the next section.

4. If the hair dries during the combing process, moisten it again with water to prevent pulling and loss of your hair.&nbsp;

5. After you&#39;ve combed all of your hair, properly rinse with water and dry. When completely dry, check the entire head for stray nits and remove them one by one. 
&nbsp;

<h5>IMPORTANT!</h5>

There are 2 aspects of hair combing that you should keep in mind while choosing this option:

1. Cleaning the hair comb is essential. Boil the metal comb for 15 minutes to clean it. An old toothbrush, as well as dental floss, can be used to remove debris from the comb&#39;s teeth.&nbsp; 
Combs and hair clips can also be cleaned with warm soapy water. Once clean, put them in a sealable plastic storage bag, and store in a kitchen freezer overnight. After usage, discard them properly.

2. Cutting hair is an option, not mandatory. If the infestation persists despite multiple treatments or has to be immediately controlled due to health issues, you can cut your hair. However, it is rarely practical.&nbsp;

The combing procedure takes time, but combing means control is more likely to be effective. It should be done every day as long as nits and lice are still present on the head, otherwise, the infestation will last forever. 
&nbsp;

It is necessary that the procedures used to control head lice do not create more health issues than the lice themselves. There are numerous solutions with substances that are effective, inexpensive, and safe for your children, you, and the environment. However, treatment options change with time. Make sure you follow the doctor&rsquo;s directives regarding your treatment.&nbsp;

Remember, head lice and nits are nearly found on the scalp, especially around and behind the ears and around the rear of the head. Occasionally, they can be detected on the eyelashes or brows. You might want to be generous while applying your medicinal treatment to these areas.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Over-The-Counter (OTC) Head Treatments</h5>
	</li>
</ul>

An OTC head lice treatment is often in the form of a shampoo. These products can be differentiated based on their active component and the stages of head lice they target. Mostly, OTC head lice treatments do not kill nits in one application and require a second application to eliminate the nymphs once they hatch.

Also, they usually contain Pyrethrins, a compound that is naturally found in Compositae (Asteraceae) family flowers such as chrysanthemums. If your kid is allergic to these flowers, chances are he or she may also be allergic to the pyrethrin-based head lice treatment.&nbsp;

So, make sure you check out the active ingredient and do a test check for any OTC you buy to kill lice:

<ul>
	<li>Read the directions on the treatment label.</li>
	<li>Apply treatment to your scalp and massage the product throughout the hair on your head. Don&rsquo;t test the product on any other part of your body.</li>
	<li>Follow the treatment&#39;s advised directions regarding how much time you should leave the treatment on your hair before you wash it off.</li>
	<li>After washing, use a fine-tooth comb to get rid of dead lice and nits.</li>
	<li>Re-apply the treatment as suggested by the instructions or&nbsp;your healthcare professional.</li>
</ul>

Getting rid of all lice and nits could take up to 3 weeks. It takes numerous treatments to completely eliminate lice and nits from your hair. If one member of your household has head lice, make sure the rest of you are also checked and treated for it, as lice readily transmit from person to person. 
&nbsp;

The key to successfully treating this pest is to completely eliminate nits and lice that survive treatment. If you spot live lice a day after a treatment, then that means the lice are resistant to the medication you used, which is why it is advised that you discuss such issues with your doctor immediately who will change your prescription.

There&rsquo;s also a possibility that you skipped a portion of your hair while applying the treatment. Head lice reside in the hair and travel to the scalp to feed. Therefore, in order to treat head lice effectively, head lice products must be applied to all sections of the hair. Make sure to follow the directions that are given on the package closely. Then comb through the hair again with a fine-tooth head lice comb. This will help in getting rid of not only dead eggs and lice, but also any eggs or lice that are still alive. A combination of medications and comb is definitely better than using just medicine or just comb to deal with the lice.

&nbsp;

Note: All products have the potential to induce responses. Head lice treatment products, especially those taken OTC, are generally only avoided in case of infants. Nevertheless, adolescents and adults need to be careful, too. Consult your pharmacist or medical professional:

<ul>
	<li>If you are expecting or breastfeeding</li>
	<li>If you have allergies, open wounds on the scalp, or asthma 
	&nbsp;</li>
</ul>

<ul>
	<li>
	<h5>Wigs Spread Lice</h5>
	</li>
</ul>

<h5>False!</h5>

Head lice and their eggs (nits) quickly die when isolated from their human host. Adult head lice can survive only for a day or two without feeding, whereas nymphs survive for a few hours only and nits perish after a week. Moreover, the eggs cannot hatch at temperatures lower than that of the human scalp. For these reasons, the risk of head lice transmission via a wig or other hairpiece is extremely low, especially if the wig or hairpiece has not been worn within the last 48 hours by someone actively afflicted with live head lice.

&nbsp;

<ul>
	<li>
	<h5>Swimming Spreads Lice</h5>
	</li>
</ul>

<h5>False!</h5>

Data reveals that head lice can persist underwater for several hours, but there are very minimal chances of spreading in a swimming pool or by the water. Head lice cling to human hair and refuse to budge even when submerged in water. Furthermore, the amount of chlorine found in pool water does not kill head lice.

There&rsquo;s one catch, though &ndash; swimming or washing the hair within 1-2 days of treatment reduces the effectiveness of some of the treatments. In that case, consult your healthcare practitioner.

&nbsp;

<ul>
	<li>
	<h5>Lice Spread Diseases</h5>
	</li>
</ul>

<h5>False!</h5>

Fortunately, head lice are not categorized as a medical or public health risk factor<a href="#reference">6</a>. There is no proof that head lice spread disease. Head lice can be bothersome because they cause itching and sleep disruption. However, itching and, thereby, excessive scratching, might raise the risk of secondary skin infection.&nbsp; 
&nbsp;

Finding out that you or your children have head lice can be unpleasant. Head lice spread easily at educational institutions. It also implies that other members of your home may be infected with head lice. Therefore, make sure you follow the treatment as suggested by the directions on the treatment product or from your healthcare professional. Educate your family about head lice to prevent others from acquiring it and spreading it.&nbsp;

<ul><li>For thousands of years, people have had head lice.</li><li>Head lice can infect anyone.</li><li>Once a week, use a medicated conditioner and comb technique to help your family to control head lice.</li><li>In most cases, head lice do not transmit disease.</li></ul>

[1] Nutanson I, Steen CJ, Schwartz RA, Janniger CK. Pediculus humanus capitis: an update. Acta dermatovenerologica Alpina, Pannonica, Adriat. 2008 Dec;17(4):147-154,156-157,159.