Stories from the Pharmacy:
Head Lice treatment and prevention options for your children
Nicole, a mother of three daughters comes into the pharmacy asking for lice advice. She is on her way to pick up one of her daughters from school as she just received a phone call to inform her that the school nurse has discovered lice in one of her girl’s hair. Nicole is obviously concerned the whole family may be infested with lice and would like to know what is the best method of treatment and if there is any way to prevent lice in the future.
To begin with we discussed how to find the lice?
The best way to detect lice besides parting the hair and having a close look is applying conditioner (any brand) to dry hair, covering from root to tip. The conditioner ‘stuns’ the lice for about 20 minutes, releasing their claws off the hair shaft and making it difficult for them to move around. With a fine tooth comb, comb a 3-4 cm section of hair from the top roots of the hair and after each stroke wipe the comb onto a paper towel and inspect for lice and eggs.
The ‘eggs’ or the ‘nits’ are a whitish creamy colour and are about 1-2mm long. If the eggs are about 6mm away from the scalp that is a sign it is an active infestation as they require warmth from the scalp to survive. If the eggs are more than 1 cm away from the scalp, it will be an empty casing and the egg will have already hatched. A viable egg will pop when squashed between the fingers.
When chatting to Nicole about treatment, I informed her about all the options in order for her to make an informed decision. I did explain that unfortunately there is no single treatment that kills 100% of lice or eggs and which ever treatment you choose, it does take patience and persistence to get rid of head lice. I stressed to Nicole that all lice treatments need to be repeated after 7 days as it is very easy to miss removing every single egg in the first treatment. It does take 6-7 days for eggs to hatch so treating the second time will ensure to kill any lice that have since hatched from the eggs.
There are 4 methods that you can choose from:
- Conditioner method
As discussed above when checking for lice, you can also treat the lice by applying any brand of hair conditioner from the roots to the tip of the hair and combing the hair thoroughly using a fine-toothed comb every second day until no lice are found for 10 days. This method may be the way to go if there are five or fewer lice detected, however, if you want your child to return back to school/childcare the following day, they need to be lice free and this method can take a few weeks to completely remove the lice. This would be the safest method if you have a child under 2 years of age or you are pregnant or breastfeeding. This method requires patience, as it relies on you physically removing the eggs and lice.
2) Neurotoxic insecticides
There are three different chemicals available in Australia at most pharmacies, but resistance to them is becoming a problem and hence you need to check the following day that the lice have been killed by using the conditioner method described above. If the lice are not killed you will need to use a different treatment. If the treatment is successful, it will need to be repeated after 7 days to ensure any newly hatched eggs are killed. The three different chemicals are:
a)Permethrin 1%- Brands include Quellada and Pyrifoam lice-breaker. They are safe and effective. They need to be applied for 10 minutes only and are the chemical treatment of choice in pregnancy and breastfeeding.
b)Maldison– Brands include KP24. It is safe and effective if used as directed, however, it has a very unpleasant smell and should not be used in pregnancy and avoided in children under 12 months of age.
c) Permethrin with piperonyl butoxide– a combination product- Brands includes Banlice and Paralice. Banlice comes as a mousse and also takes only 10 minutes to apply. It is as effective as the above chemicals.
Physical insecticides kill lice via a physical action like disrupting the water balance in the lice. They are effective treatments for resistant lice and would definitely be my recommendation for treatment:
a)Dimeticone/ Dimethicone- Brands include Nyda and Hedrin 15. They both work by coating the lice and affecting their water balance causing the lice and eggs to suffocate. They are both well tolerated and safe in children, they are both odourless and safe in pregnancy and breastfeeding. The only difference is Nyda takes 1 hour to apply to the hair but you only require 1 application and Hedrin 15, requires 2 applications, 1 week apart, but only takes 15 minutes to leave in the hair.
3) Herbal products ie essential oils
Brands include Moov (11% Eucalyptus oil) head lice solution and Neutralice (Tea tree oil 10% Lavendar oil) head lice solution.
There is some evidence that 3 applications, one week apart are effective. But again the downfall is 3 applications vs other products which only require 1 or 2 applications.
4) Electronic combs
They kill the lice via electrocution but does not kill the eggs which need to be removed manually. The electronic combs are good to detect the lice but they need to be used every day for at least two weeks. It is a useful non-drug alternative but not my first line recommendation.
It there a way to prevent lice?
There’s no guaranteed way to 100% prevent lice but taking preventative measures will be better in the long run, saving time, money and discomfort. Getting into the habit of regularly checking your child’s hair with the conditioner and fine tooth comb method discussed above will make it a lot easier to get on top of treating if you find it early.
Teach your child about the importance of tying their hair back each day (a braid is great), as this is one of the best ways to help prevent head to head transference of lice.
Some studies have shown that ingredients in plant oils such as rosemary oil, citronella oil, eucalyptus oil, tea tree oil and lemongrass oil may work to repel lice, which means they can help prevent an infestation as essential oils are very fragrant and their strong scent may deter the lice. The evidence is promising but not yet conclusive. Moov makes a hair spray called Moov head lice defence hair spray which you spray in the hair daily However I’ve recently come across a product called ‘Nit Clips’. ‘Nit Clips’’ are cute hair clips designed to deter lice throughout the day. These hair clips have a special absorption area on the back where you add two drops of a concentrated essential oil (Rosemary and Vitamin E) and pop the hair clips in your child’s hair as they go off to kinder/school. I like this product as it contains the essential oil on the clip and is not directly placed on the skin as essential oils placed on the skin can be irritating. My daughter’s like this product too as they enjoy wearing the clips (with beautiful colours/patterns) in their hair.
- Soak combs and hairbrushes in hot water (>60°C) for 30 seconds and wash pillowcases in hot water or put in a clothes dryer for 15 minutes.
- Don’t treat as a preventative, only treat if live lice are found as frequent use can irritate the scalp and make lice resistant to chemical treatment
- Children can be sent back to school after the first treatment.
- If your child is old enough teach your child to avoid sharing brushes combs, hats, towels and pillows.
Please feel free to leave comments on this blog and if there are any questions I am more than happy to answer them. Also, if you tried a remedy that worked well for your children that was, or wasn’t mentioned above, let me know. I hope this information does help.
Disclaimer – The material on this blog is only to be used for informational purposes only. As each individual situation is unique, you should use proper discretion, in consultation with a health care practitioner, before applying the methods, medicines, techniques or otherwise described herein. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained herein. The names of people mentioned in this blog have been changed to protect the real patient’s confidentiality.