Frank James MD Health Officer San Juan County Head Lice Frank James MD Health Officer San Juan County

Lice Facts Adults are 2-3 mm long. Infest the head and neck and attach their eggs to the base of the hair shaft Lice move by crawling; they cannot hop or fly Head lice infestation (pediculosis) is spread by person-to-person contact Dogs, cats, and other pets do not play a role in the transmission of human lice

What are head lice? Pediculus humanus capitis, is a parasitic insect that can be found on the head, eyebrows, and eyelashes of people Head lice feed on human blood several time a day and live close to the human scalp Head lice are not known to spread disease

Who is at risk for getting head lice? Preschool children attending child care, elementary school children, household contacts 6 million to 12 million infestations annually in US among children 3 to 11 Head lice are spread by direct contact with the hair of an infested person Spread by clothing (hats, scarves, coats) or other personal items (combs, brushes, or towels) is uncommon

Relative size of stages of lice

Egg/Nit Nits are lice eggs laid by the adult female head louse at the base of the hair shaft nearest the scalp firmly attached to the hair shaft and are oval-shaped and very small (about the size of a knot in thread) Nits are often confused with dandruff, scabs, or hair spray droplets Head lice nits usually take about 8-9 days to hatch

Nits alive or dead? Eggs that are likely to hatch are usually located no more than ¼ inch from the base of the hair shaft Nits located further than ¼ inch from the base of hair shaft may very well be already hatched, non-viable nits, or empty nits or casings

Adult Lice Must feed on blood Can live about 30 days on a person's head Will die within one or two days if it falls off a person

Signs and symptoms of head lice infestation? Itching, caused by an allergic reaction to the bites of the head louse Irritability and difficulty sleeping; head lice are most active in the dark Sores on the head caused by scratching

How is head lice infestation diagnosed? Best made by finding a live nymph or adult louse on the scalp or hair of a person Because nymphs and adult lice are very small, move quickly, and avoid light, they can be difficult to find Use of a magnifying lens and a fine-toothed comb may be helpful to find live lice

If crawling lice are not seen Nits firmly attached within ¼ inch of base of the hair suggests a person is infested Nits attached more than ¼ inch from base of the hair shaft are almost always dead Nits are often confused with other things dandruff, hair spray droplets, and dirt particles

Infestation that are old and do not need to be treated If no live nymphs or adult lice are seen and the only nits found are more than ¼-inch from the scalp I still recommend the use of a fine tooth comb to remove all nits from hair

Do head lice spread disease? Should not be considered a medical or public health hazard Not known to spread disease Annoyance may cause itching and loss of sleep Sometimes secondary skin infection

Treatment: General Guidelines Recommended for active infestation Check household members and close contacts If use same bed should also be treated

Retreatment recommended Should occur after all eggs have hatched Before before new eggs are produced 9 days after initial application Malathion treatment should not be repeated unless directed to by physician

Environmental cleaning Hats, scarves, pillow cases, bedding, clothing, and towels used 2-day period before treatment washed and dried using the hot cycles Lice and eggs are killed by 5 minutes to temperatures greater than 53.5°C (128.3°F)

Items that cannot be laundered Dry-cleaned or sealed in a plastic bag for two weeks Vacuuming furniture and floors can remove an infested person's hairs that might have viable nits attached

TREATMENT WARNING: Do not use a combination shampoo/conditioner, or conditioner before using lice medicine Do not re-wash the hair for 1-2 days after the lice medicine is removed Put on clean clothing after treatment There are many unsafe ‘home’ treatments

Combs Should be used to comb nits and lice from the hair shaft Many flea combs made for cats and dogs are also effective Comb with a nit comb every 2-3 days (decrease the chance of self-reinfestation). Continue to check for 2-3 weeks to be sure all lice and nits are gone

Prevention Avoid head-to-head (hair-to-hair) contact during play and other activities at home, school, and elsewhere Do not share clothing such as hats, scarves, coats, sports uniforms, hair ribbons, or barrettes Do not share combs, brushes, or towels Disinfest combs and brushes used by an infested person by soaking them in hot water (at least 130°F) for 5-10 minutes

Prevention continued Do not lie on beds, couches, pillows, carpets, or stuffed animals that have been in contact with infested person Machine wash and dry clothing, bed linens, and other items used 2 days before treatment hot water (130°F) and the high heat drying Clothing and items that are not washable can be dry-cleaned OR sealed in a plastic bag and stored for 2 weeks

Prevention continued Vacuum the floor and furniture, particularly where the infested person sat or lay Do not use fumigant sprays or fogs; they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin

Over-the-counter Medications Pyrethrins combined with piperonyl butoxide; Brand name products: A-200*, Pronto*, R&C*, Rid*, Triple X* Permethrin lotion 1%; Brand name product: Nix

Prescription Medications Malathion lotion 0.5%; Brand name product: Ovide* Benzyl alcohol lotion (5%); Brand name product: Ulesfia lotion* Lindane shampoo 1%; Brand name products: None available

Malathion lotion 0.5%: Ovide* An organophosphate Lotion 0.5 A pediculicidal (kills live lice) and partially ovicidal (kills some lice eggs) A second treatment is recommended if live lice still are present 7-9 days after treatment Intended for use on persons 6 years of age and older Can be irritating to the skin and scalp; contact with the eyes should be avoided Flammable; do not smoke or use electrical heat sources, including hair dryers, curlers, and curling or flat irons

Benzyl alcohol lotion (5%): Ulesfia lotion Aromatic alcohol Lotion 5% Benzyl alcohol kills live lice but does not kill unhatched lice eggs A second treatment with benzyl alcohol lotion is necessary on day 9 after the first Intended for use on persons who are 6 months of age and older Can be irritating to the skin and eyes; contact with the eyes should be avoided

Lindane shampoo 1% An organochloride American Academy of Pediatrics (AAP) no longer recommends it as a pediculocide Lindane shampoo 1% is approved by the FDA for the treatment of head lice, it is not recommended as a first-line therap Overuse, misuse, or accidentally swallowing lindane can be toxic to the brain and other parts of the nervous system Should be restricted to patients for whom prior treatments have failed or who cannot tolerate other medications that pose less risk Lindane should not be used to treat premature infants, persons with HIV, a seizure disorder, women who are pregnant or breast-feeding, persons who have very irritated skin or sores where the lindane will be applied, infants, children, the elderly, and persons who weigh less than 110 pounds.

Do Not: Do not use extra amounts of any lice medication. The drugs used to treat lice are insecticides and can be dangerous if they are misused or overused. Do not treat an infested person more than 2-3 times with the same medication. This may be caused by using the medicine incorrectly or by resistance to the medicine. Do not use different head lice drugs at the same time

Many nits are more than ¼ inch from the scalp AAP and National Association of School Nurses: "no-nit" policies should be discontinued Many nits are more than ¼ inch from the scalp Nits are cemented to hair shafts and are very unlikely to be transferred The burden of unnecessary absenteeism to the students, families and communities outweighs risks associated with head lice Misdiagnosis of nits very common

New medication: Spinosad (Natroba) 0.9% Approved in Jan 2011 by FDA Highly Effective at killing both lice and eggs in one application Safe (few side effects) No known resistance

New medication: Spinosad (Natroba) 0.9% COST $270 per treatment