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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Tuesday, September 19, 2006

Lice: Not So Nice

Within a few weeks of the beginning of school, medical providers around the country start seeing the return of head lice, not unlike the Swallows returning to Mission San Juan Capistrano. I have no idea where head lice go for summer vacation, but we sure see these unwelcome guests in the fall of each year. I like to call our local variety “California Scalp Crickets”.

Lice affect up to 9 million children (who’s counting?) per year. I briefly addressed this topic in a past Blog, but I feel it deserves a bit more attention.

The misconceptions about head lice are truly amazing! Here are some fast facts:

  • Head lice are true HUMAN parasites; you do not get them from the dog; even a dog of dubious character.
  • Head lice do not fly or jump; but they will scurry from one head to the next if those heads are touching together long enough, or they can be transferred by combs, brushes, and hats.
  • Unlike ticks, head lice do not carry diseases. They are just looking for a comfortable place to reside and to suck some of your extra blood. They don’t eat very much, but you certainly don’t want to be their restaurant.

The diagnosis of head lice in my office often receives the same horrified reaction if I told someone that had a venereal disease — total shock and denial. Oh my God, we will have to move.

Head lice are light-shy, so they may be difficult to see crawling around on the scalp, especially in dark, thick hair. Although lice can live off of the scalp for up to 55 hours, it would be unusual to contract them in this manner. Adult lice live about a month. During this period, the females will lay about ten eggs per day. These eggs will hatch in 10-15 days, and a new and rapidly-renewable generation of sexually-active lice. Seeing live lice is a sure sign of an active infestation, but finding the sesame seed-sized eggs, or nits, are usually the first thing we see.

Hair grows an average of 1/2 inch per month. Since lice hatch in two weeks, any nit that is found more than a 1/4 inch (two week hair growth) from the scalp is most likely already hatched.

I remember finding lice on a little pre-schooler during a routine exam, but I failed to inform my nurse. After administering her needed vaccines, I saw my nurse hugging and stroking the hair of the crying child. After I told her about the lice, my nurse went into an instant panic and headed for our clinic pharmacy for some Nix. The rest of the day, she walked around with treated, wet hair; periodically glaring at me with a look that only a scorned woman can usually achieve.

Faced with exclusion from school, parents are desperately seeking an instant cure. It is not going to happen. Although children can return to school immediately after a successful treatment with an approved pediculicide (the medical name for chemicals that eradicate lice and their eggs/nits), many schools have an illogical, if not punitive, “no nit” policy. That is the origin of the term, “nit-picky”.

The American Academy of Pediatrics and the National Association of School Nurses concur that no child who has been effectively treated should be excluded from school.

Lice lay eggs on the base of the hair using a type of biological glue that is basically impervious to chemicals. People have used everything from mayonnaise to hot vinegar, to the dangerous practice of using motor oil or gasoline to remove the adherent nits, to no avail. When all of these folk remedies fail, it will eventually come down to picking or combing them out the non-viable nits, one at a time. Or, hire a trained baboon to do it for you.

Only one of our five children ever brought home head lice, but while doing volunteer work with homeless children, it was a daily occurrence.

Head lice do not recognize or respect socioeconomic classes; they are equal opportunity parasites. I must admit that I have some perverse pleasure in informing a snooty, affluent mother that her child has head lice. This sort of makes all of us a bit more equal. After my daughter’s case, I offered to go to the school for free head checks (so she wouldn’t get them back), but was told this was against school policy.

WebMD has some nice resources for head lice, so I am not going to go into specific details of treatment, but I would like to offer this precaution: Do not over-treat.

Carefully follow the recommended directions on the pediculicide of choice; and only use safe and approved methods. Lindane (Kwell), once used exclusively in this country for head lice treatment is banned in California. Not only did the cooties develop a resistance to this dangerous insecticide, it had a nasty habit of causing seizures in children. It also can contaminate water sources — a single treatment can pollute six million gallons of water; the equivalent of 300 swimming pools. In August, the federal government banned lindane as a pesticide, but it is still approved in some states and countries as a medication.

The vast majority of head lice medications are safe, even the ones that contain malathion — an insecticide that California uses quite often to spray for mosquitoes that carry West Nile Virus, or the dreaded Mediterranean Fruit Fly. There is even a new treatment method (Nuvo) designed to suffocate, rather than poison, these little lousy critters.

I know that many of you will be calling your kids in a few minutes for a home head check, so I will not banter on.

Happy hunting.

Related Topics: When to Keep Junior Home from Day Care, Lice First Aid and Treatment

Technorati Tags: head lice, Nuvo

Posted by: Rod Moser, PA, PhD at 10:46 am

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