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Causes: Head lice is easily transferred through contact with clothing, carpets, bedding, pillows cases, combs, hair brushes, hats, caps and towels. Lice can live in these environments for up to 10 days and their eggs can survive for 2 weeks. (1). Lice can also spread through contact with another person who is infected. For these reasons, head lice is easily spread among young, school age children.
"Head lice are more common in close, overcrowded living conditions...Having head lice is NOT an indicator of poor hygiene or low social status." (1)
Occurrence: Head lice affects an estimated 6 to 12 million people in the United States annually. It is more common in school age children who are likely to share items and come into contact with each other and each other's clothing through playing and games. Head lice is more common in girls then boys and more common in Caucasians then African-Americans. (2)
Symptoms: The first signs of head lice may be intense itching on the areas where head lice and nits are most likely to live; back of head, neck and near the ears. Adult lice, nymphs (baby lice) and the nits (eggs) are usually visible on the scalp.
According to KidsHealth.org, "Nits look sort of like dandruff, only they can't be removed by brushing or shaking them off. Unless the infestation is heavy, it's more common to see nits in a child's hair than it is to see live lice crawling on the scalp. Lice eggs hatch within 1 to 2 weeks after they're laid." (3)
An adult louse is approximately the same size as a sesame seed and brown or tan in color. Nits are usually yellow, tan or brown.
If left untreated or unobserved by a parent, the scratching can lead to small, red bumps or sores. Crusting and oozing may develop in severe cases. This scratching and red bumps could be the beginning of a bacterial infection which may need to be treated with topical or oral antibiotics.
Treatment: Head lice is easily treatable with special, over the counter lotions or shampoos and special metal combs known as bug busting combs. Some of these name brand shampoos sell the comb in combination with the shampoo. These combs have long teeth which are very close together to pull out the eggs, nits and any live lice. The most common ingredient in these shampoos is Pyrethrum or Permethrin.
Common name brand head-lice treatment shampoos and lotions include Pronto, Rid, and AV200. It is important to follow the directions for these products EXACTLY.
"The products that kill head lice don't usually kill all nits. To reduce the risk of another lice infestation, pick the remaining lice and nits by hand or by using a special comb... Comb through all of the hair one section at a time every 3 days or more often, for at least 2 weeks or until you stop seeing head lice and nits." (4)
Recently, malathion based topical lotions were re-approved by the FDA (Food and Drug Administration) as a prescription topical drug for the treatment of head lice.
The second phase of treatment involves a thorough cleaning of all clothing, bedding, furniture and other items which may have come into contact with the head lice. This should include:
Washing all bed linens and clothing that may be infested with nits in water that is hotter then 130 degrees Fahrenheit and dried in a dryer for more then 30 minutes.
Have clothing, stuffed animals and other items that can't be machined-washed, dry cleaned.
Vacuum carpets thoroughly or have cleaned by a professional carpet cleaner.
Upholstered furniture should also be vacuumed or professionally cleaned. To eliminate infestation of furniture and bedding that cannot be washed or dry cleaned, a hard surface lice spray may be used.
Soak all brushes, combs, hair ties, barrettes, headbands, etc. in a solution of rubbing alcohol or medicated shampoo over-night. (2,3,4)
In severe cases, or cases that do not respond to the above OTC self-treatment, patients should see their doctor who may prescribe prescription-strength medicated lotions or shampoos.
Shampoo Warnings: Medicated shampoos can be quite strong and over-use can cause skin irritation. They should not be used in children 2 years of age and younger. Do not use near the eyes or permit contact with the inside of the nose, mouth, or vagina. Irritation may occur. Ask a doctor before use if you have an allergy to ragweed. If you suffer from allergies or asthma, or are pregnant or nursing, consult with your doctor before using medicated head lice shampoos.
Prevention: Besides the above mentioned second-phase treatment plan, head lice can be further prevented by educating your child to avoid head to head contact, sharing items such as combs, caps, scarves, barrettes, brushes or head related gear.
Since head lice follow a specific life-cycle from nits to nymphs to adult lice, you should continue to inspect your child and other family members every 2 to 3 days for up to 30 days following an infestation.(4) Treatment with medicated lotions or shampoos should be implemented if a single nit is found.
(1) MedlinePlus Medical Encyclopedia, Head Lice, March 2006
(2) The Cleveland Clinic Foundation, Head Lice, 2006
(3) KidsHealth.org, Infections - Head Lice, April 2005
(4) American Academy of Family Physicians, Head Lice - What They Are and How To Get Rid of Them, October 2005
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