Head Lice

Sep 7, 2018

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"It was just weird!" Doris and I have an agreement. Doris never stars in one of my articles. But this one was too good to pass up. Doris, our dog Sheldon and kids Emily and Eric were driving back from the lake. Doris had a sudden realization. Things weren't right. Everything was topsy-turvy. It dawned on Doris she was in the back seat of the van. Sheldon was strapped into the seat beside her. That wasn't the weird part. The weird part was our daughter Emily was driving. Our son Eric was in the front passenger seat beside his sister. Emily has her driver's license now and Doris was being chauffeured by her kids.

Kids are going back to school. They grow up so fast. But no matter what your age, you are never too old or too young for head lice. Let's go over the basics. Head lice are quite common. Having head lice doesn't mean someone has dirty hair. Lice actually seem to prefer clean hair. Children from 3 to 11 years old are the most affected age group. Girls seem to be more affected than boys. However, anyone can get lice, regardless of sex, race, age, hair length or socio-economic status.

What are lice? Head lice are parasites that live in humans' hair. The scientific name for them is Pediculus humanus capitis. Lice are wingless insects with six legs and range in color from white to brown to dark grey. They don't fly and they don't jump. A young louse matures in 10-12 days and the adult is 2-4mm long. They multiply very quickly. Females lay 7 to 10 oval and whitish eggs attached to the base of a hair shaft every day. The eggs are called nits. Seven to ten days later, the nits hatch and are called nymphs. The whole life-cycle is about 20-30 days. Lice are transmitted in two main ways. Lice can be transmitted directly by close contact from one infested scalp to another (e.g. touching heads together). They can also be transmitted indirectly by sharing personal articles that come in contact with the head (e.g. brushes, hats, etc). I was surprised to learn the transmission rate. Apparently, lice will only be transferred 10-30% of the time when someone is exposed. It is believed prolonged head to head contact, ie. over 30 seconds, is required for lice to move from one person to another. Quick head contact or transfer through inanimate objects like combs, brushes or hats is supposed to be uncommon. Adult lice need us for their blood meal. Nits need our head warmth for incubation. Lice and nits die when away from us humans for 55 hours.

What are the symptoms of having lice? Most people don't have any symptoms at all. If a person is going to have symptoms, the most common symptom is itching, especially around the ears and back of the scalp. This itching is from a mild allergic reaction to the saliva of the louse when it feeds on us. There can be small sores on the person's scalp or neck. If these sores get infected, there can be pus. How do you recognize head lice? First you should see nits (the eggs) attached to the base of the hair shafts on the warmer parts of the scalp (the back and sides). The egg or nit is oval and glued to the hair. Nits are laid close to the scalp for warmth, usually around the ears and the nape of the neck. Live nits are brownish in color, and dead ones are whitish. Nits found more than 0.6 cm from the scalp have grown out with the hair and have either hatched or are dead. To know for sure that someone has lice, though, you have to see the live adult louse. Combing with a fine toothed comb is supposed to be 4 times more efficient and twice as fast for finding adult lice as just looking through the scalp.

One non-drug treatment that can be used to treat lice is wet combing. Wet combing every 3-4 days with a fine toothed comb can help get rid of lice. This might not work as well as the lice shampoos, but it is completely safe. Using vinegar with wet combing should be avoided if using wet combing in combination with one of the lice shampoos as the vinegar can inactivate the shampoo.

The main product used to treat head lice is permethrin (one of the brand names is Nix). It stays in the hair for up to ten days after use to kill any more lice that hatch. It is generally the product of first choice because is very good at killing lice, it has low toxicity and it sticks around for about 10 days. Since no lice treatment kills 100% of the nits, it is recommended that one uses the permethrin again in 7 to 10 days. Permethrin can cause allergic reactions in ragweed or chrysanthemum sensitive individuals. There are older products on the market that contain lindane. Lindane is not as good as permethrin at killing lice. It doesn't stick around so you must do a second application in 7-10 days for it to be effective. About 10% of the lindane actually goes into the rest of your body and it can accumulate with repeated exposure. It can cause seizures and other neurologic disorders so lindane is not my favorite product.

There has been talk over the last few years about resistance to treatments like permethrin. Because of the resistance fears, there have been new products developed that don't work like permethrin. One of these is called Resultz. It contains isopropyl myristate. The permethrin in Nix attacks the nervous system of the louse. Isopropyl myristate is more like a soap. It dissolves the waxy outer coating on the louse and the louse dehydrates. The claim is that Resultz kills the louse within ten minutes. The down side to Resultz is it does not kill the nits or eggs in the hair. So you absolutely need to do the second treatment in one week. On the positive side, there is no documented resistance to Resultz. There were small studies where Resultz killed more lice than permetherin. One of these small trials was even done in Winnipeg, MB! I don't know if I am ready to say Resultz is definitely better than permetherin yet, but it is nice to have another tool in the tool box. Another proven treatment is oral ivermectin. Oral ivermectin has been shown to work better then permethrin, but is only available in Canada through the Special Access Program of Health Canada. That means it isn't available to most people.

I'm obviously biased, but my favorite alternative to permethrin is called Nice 'N Natural lice treatment. We compound Nice 'N Nature lice treatment at the Dauphin Clinic Pharmacy with a variety of natural oils. It coats the hair and suffocates the lice. It smells really nice and customers tell us it works really well.

"I Emily Shewfelt! I awake!" Three-year-old Emily was very cute. She would sometimes stand in the hallway outside our bedroom at 6 in the morning and let us know she was awake and everyone else should be. I'm not sure where the last decade and a half have gotten to. Times have changed from a mini-brawl with another mini-ballerina over butterfly wings during Emily's only ballet recital to Emily having a driver's license. The beginning of another school year will bring on big changes for everyone. But hopefully becoming a lice killing expert isn't one of them.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

As always if you have any questions or concerns about these products, ask your pharmacist.

 


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