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

2. 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

3. 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

4. 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

5. Relative size of stages of lice

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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)

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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.

28. 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

29. 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

30. 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

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