Head lice

Contrary to popular belief, head lice are not linked to poor hygiene or an unclean environment. They are not carriers of bacterial or viral diseases and can affect anyone.

Girls are generally more at risk than boys because they tend to have more head-to-head contact, such as during play or socializing. Additionally, girls with long, thick, or curly hair may find it harder to detect lice.

Head lice cannot jump or fly; they can only crawl. As a result, transmission typically occurs through direct head-to-head contact. This is common within families or among children who have close contact in schools or other social settings.

Though indirect transmission is less common, lice can spread by sharing personal items, such as:

• Combs
• Hats or scarves
• Towels
• Helmets
• Bedding
• Hairbrushes or accessories
• Headphones
• Clothes

Due to their small size (2-3 mm), head lice can be challenging to detect. They are tightly attached to hair strands and move quickly, making it hard to spot them. The most effective way to detect head lice is through:

Thorough Combing:

Use a fine-tooth comb to carefully comb wet hair, especially at the back of the head where lice are typically found.

Manual Examination:

Look closely for nits near the hair roots. Nits resemble dandruff or dirt but are firmly attached and cannot be easily brushed away.

The most important thing to understand is that there is no guaranteed method to completely prevent head lice. However, there are steps you can take to minimize the spread of lice from one person to another. If someone in your household is infested with lice, here are some tips to help reduce the chances of transmission:

• Wash all clothes, bedding, and towels in hot water, and dry them on the hottest setting.
• If washing items at home isn’t possible, opt for dry cleaning.
• Use a vacuum cleaner to thoroughly clean furniture, carpets, and car seats.
• For items that can't be washed, such as soft toys and pillows, place them in a sealed plastic bag for at least two weeks.
• Avoid sharing a bed with someone who has head lice to prevent the risk of direct head-to-head contact.
• Do not use combs, brushes, or hair care products that have been used by someone with head lice.
• It's best to discard or disinfect such items for future use.
• Keep your child home from school if they have head lice.

Specialists to Consult

If you experience intense itching and discomfort from head lice or have trouble sleeping at night due to the infestation, it's advisable to consult a healthcare provider. You can visit one of the following specialists for treatment:

• General Physician
• Pediatrician
• Dermatologist

Once head lice infest the scalp, they won’t go away without treatment. Most treatments aim to kill the lice by suffocating them. Here are some common over-the-counter and prescription treatment options for head lice:

Over-the-counter treatments:

Pyrethrin

• This over-the-counter product contains naturally derived pyrethrin extracts. It kills only live lice, not the eggs (nits). As a result, a second application after 9-10 days is recommended to eliminate any newly hatched lice. It is safe for children over 2 years old.

Permethrin

• A synthetic version of pyrethrin, Permethrin 1% lotion is FDA-approved for treating head lice. Like pyrethrin, it kills only the adult lice and not the eggs. A second treatment is advised after 9-10 days to ensure effectiveness.

Prescription treatments:

Benzyl alcohol lotion 5%

• This FDA-approved treatment is safe and effective when used as prescribed by a doctor. It kills lice but not their eggs, so a second treatment after 7 days is recommended.

Ivermectin lotion 0.5%

• This treatment prevents newly hatched lice from surviving and can be applied directly to dry hair. After leaving it on for 10 minutes, rinse it out with water. Ivermectin is also available in tablet form for use when topical treatments fail to eliminate lice.

Malathion lotion 0.5%

• Known for its ability to kill both lice and some of their eggs, Malathion requires a second application after 7-9 days for optimal results. It is recommended for children over 6 years of age. As Malathion is flammable, avoid using electrical devices such as hairdryers while your hair is wet or after applying the lotion.

Spinosad 0.9% topical suspension

• This medication is effective at killing both live lice and unhatched eggs, meaning a second application is unnecessary. It’s approved for children older than 6 months.

Lindane shampoo 1%

• Lindane is typically used as a second-line treatment. Overuse or misuse of this product can cause serious side effects, particularly on the brain and nervous system. It is not recommended for people with HIV, seizure disorders, pregnant or breastfeeding women, or those with skin sores. Retreatment is not recommended.

If left untreated, head lice can lead to severe itching and scratching of the scalp. Continuous scratching can break the skin, leading to possible infections. In some cases, a visit to a dermatologist may be required to treat secondary bacterial infections caused by the lice.

Various household products are often used to treat head lice, but avoid using natural remedies like olive oil, butter, petroleum jelly, or mayonnaise. These methods may not be effective as lice are difficult to suffocate. Additionally, avoid using toxic substances like gasoline or kerosene, as they pose serious health risks, and there is no scientific evidence supporting their effectiveness.

If you prefer treating head lice at home, follow these tips:

• Wet combing is often the best method for removing lice from children’s hair. Before using a fine-toothed comb, detangle wet hair with a regular brush.
• Use a fine-toothed comb to carefully comb out nits and lice, starting at the scalp and working toward the ends. Make sure to comb through the entire head at least twice.
• Since nits mature in 5-7 days, it is essential to comb the hair every day for about two weeks to ensure that all lice are removed.
• If combing doesn't work or the infestation is severe, you may need a prescription treatment.
• Avoid using home remedies like olive oil, butter, or toxic substances such as kerosene, as these may cause more harm than benefit.

Head lice can be bothersome, but they are not harmful and do not transmit any diseases. They are also not a sign of poor hygiene. Lice survive by feeding on blood, which is not dependent on the cleanliness of the hair or environment. Various treatments and preventive measures can help manage lice infestations:

1. Avoid using the combs, hairbrushes, hats, towels, bedding, or clothing of someone who has head lice.
2. Lice and their eggs can be partially removed by using a fine-toothed comb on wet hair.
3. Pediculicides (medications that kill lice) with ovicidal properties (which eliminate eggs) are the most effective treatment.
4. To prevent re-infestation, use hot air (slightly cooler than a hairdryer) for 30 minutes to kill the nits.
5. Wash all clothing, bedding, and combs in hot water with detergent.
6. Repeat the treatment after 7 to 10 days to ensure all lice and eggs are eliminated.