Undoubtedly just mentioning the words "head lice" has already made you shudder in your seat, left you subconsciously scratching your head, or has made you say, "Ick!". The thought of parasitic bugs making a home in one's hair is enough to give anyone the heebie-jeebies. Few conditions come with such an undeserved social stigma attached. An infestation of head lice can happen to anyone regardless of hygiene, social or economic status. Anyone who has hair is susceptible to the wrath of these nasty little parasites.

Head lice are not an uncommon occurrence. In fact, The American Journal of Managed Care estimates there are between 6 million and 12 million infestations in the United States per year among children between 3 and 12 years of age. And since little ones enjoy being close when playing, resting, reading, or hugging, many of those infestations spread to family members since they are in close proximity to the child's head.

All the fuss is over a tiny parasitic insect called Pediculus humanus capitis. According to the Centers for Disease Control and Prevention (CDC), head lice can be transferred by coming in close contact (especially head-to-head contact) with someone who already has head lice. There is also a possibility of acquiring head lice from articles of clothing (coats, hats, scarves, etc.) or other personal items (combs, brushes, bed clothing, towels, etc.) that belong to an infested person. The CDC reiterates that personal hygiene or cleanliness in the home or school has nothing to do with getting head lice.

When it comes to head lice, "that little itch could be telling you something." The Directors of Health Promotion and Education (DHPE) note that there are specific signs and symptoms of head lice infestation. The signs include:

• A tickling feeling of something moving in the hair.
• Itching, which is caused by an allergic reaction to the bites.
• Irritability
• Sores on the scalp caused by scratching. In some cases the sores may become infected.

Head lice are found in three forms: the egg (called a "nit"), the nymph, and the adult (called a "louse"). The CDC describes the egg or nit of the head lice as very small, about the size of a knot in thread. Nits are laid by the female at the base of the hair shaft, close to the scalp. The yellow to white eggs are firmly attached to the hair shaft and usually take one week to hatch. Nits within 1⁄4 inch of the scalp are the most likely to hatch. When a nit hatches, the baby louse resembles an adult louse (but smaller) and is referred to as a "nymph." The nymph needs to feed on blood from the scalp to live and matures in about seven days after hatching. An adult louse is roughly the size of a sesame seed, is tan to grayish-white in color, and has six legs. The adults also need to feed on blood to live and can live up to thirty days on a person"s head. If a louse falls off a person, it dies within two days. An adult female can lay upwards of 100 eggs. Head lice are typically found on the scalp, near the neckline at the back of the neck, and behind the ears. The CDC adds that head lice are rarely found on the body, eyelashes, or eyebrows.

An infestation is detected and diagnosed by a physical inspection of the hair and scalp for any evidence of nits, nymphs, or adult lice. Nymphs and adults may be hard to detect since they are typically few in number and move quickly away from probing fingers. In the absence of crawling lice, nits found within ¼ inch of the scalp are sufficient evidence to confirm the person is infested and should be treated. If, after examination, you are unsure whether the person is infested or not, the DHPE recommends that a diagnosis should be made by personnel at your local health department, by your health care provider, the school nurse, or an agricultural extension service worker. If an infestation is present, all members of the family will also need to be examined.

Once an infestation has been confirmed, treatment with over-the-counter or prescription lice-killing medicine is required to rid the person of head lice. All lice-killing products are pesticide based and should only be used on infested individuals following the product instructions. The DHPE adds that such medications should not be used by women who are pregnant or breast feeding and that a health-care provider should be consulted before lice-killing products are used on any person who has allergies, asthma, or other medical conditions. Only the prescribed quantity of medication should be used (do not use extra amounts) and recommended treatment and re-treatment timeframes must be adhered to.

The treatment procedure outlined by the DHPE includes the following steps:

• Remove all clothing.
• Apply lice-killing medication according to package instructions. Do not use a crème rinse or combination shampoo/conditioner before applying lice-killing medicine and do not re-wash hair for one to two days after treatment.
• Have the infested person put on clean clothing after treatment.
• If some live lice are found but are moving more slowly than before treatment, do not re-treat. Comb dead and remaining live lice out of hair. The medication may take longer to kill lice than noted on the package.
• Nits and lice may be removed from the hair shaft using a nit comb (often included with the lice-killing medication). Flea combs used for dogs and cats may also be used.
• Check, comb, and remove nits and lice from hair every 2 to 3 days after treatment.
• If necessary, re-treat in 7 to 10 days.
• Continue to check all treated persons for 2-3 weeks until you are certain all lice and nits are gone.

In addition, the household must be treated to eliminate any lice and nits that may be harbored elsewhere in the household. Steps include:

• Machine wash all washable clothing, and bed linens that were touched by the infested person during the two days before they were diagnosed. Wash clothes and linens in the hot water cycle (130° F) and dry items on the hot cycle for at least 20 minutes.
• Dry clean any clothing that is not washable (hats, coats, etc.) or seal non-washable items (comforters, stuffed animals, etc.) in a plastic bag for 2 weeks.
• Wash combs and brushes with soap and hot water or soak them for 1 hour in rubbing alcohol or disinfectant.
• Thoroughly vacuum floors and furniture.

With persistence, patience, and a keen eye, your family will soon be free from pesky intruders. As with any situation relating to your family's health, please consult with your family physician for diagnosis and treatment options.

Sources:
American Journal of Managed Care—www.ajmc.com
Centers for Disease Control and Prevention—www.cdc.gov
Directors of Health Promotion and Education—www.dhpe.org

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