Nicole, a mother of three daughters comes into the pharmacy looking a little panicked, she asks for some advice, as she is on her way to pick up one of her daughters from school. Her grade 1 teacher called her up to inform her that her daughter was scratching her hair quite frequently this morning, so she proceeded to check her hair and has seen some lice. Nicole is obviously concerned the whole family may be infested with lice and would like to know what is the best method of treatment.
When you step into a pharmacy and look at your options for treating lice, where do you start? It is quite overwhelming as to how many head lice products there are, should I treat chemically? Should I treat naturally? Do they actually work? Do I use one of those funny looking combs? What’s that electronic zapping device? Do I treat everyone in the family? I’m pregnant, can I be treated? Are these treatments safe? You really do need to take a deep breath after these questions flood your brain. I aim to give you a systematic approach to treating lice, explaining the options I gave Nicole; the method of treatment, what works and what doesn’t.
To begin with it’s important to understand the following:
- Lice don’t have wings and cannot fly. They are only caught by head to head contact and sharing of hats, brushes, combs etc.
- Lice lay eggs called ‘Nits’ at the base of the hair shaft and take 6-9 days to hatch leaving behind the egg case.
- Many cases of head lice go unnoticed as your child may not be scratching, therefore it is important to do regular hair checks for lice.
- Lice is not a sign of poor hygiene, it doesn’t matter whether you have clean, dirty, straight or curly hair, all the lice are looking for, is their next meal, and what they feed on is the blood from the scalp.
- A louse can live for 48 hours once it has left the host ie on a brush or hat etc and the eggs/nits can survive for up to 10 days
- Lice can live for approximately 4-6 weeks
How to detect head lice and ‘nits’? What do they look like?
Head lice can be anywhere from 1 to 4mm long. Their colour depends: If they have just hatched, they are colourless and if they have just had a feed, they can vary between a grey and reddish brown colour.The best way to detect 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 releasing their claws off the hair shaft. 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. 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.
As a parent, you want to know your options and then be able to make an informed decision based on what you believe is right for you and your family. So here goes.. I hope this is useful for you:
There are 4 methods that you can choose from:
1) Conditioner method
As discussed above when diagnosing lice, you can remove lice and eggs 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 less 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 also requires motivation, 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 include Banlice and Paralice. Banlice comes as a moose and also takes only 10 minutes to apply. It is 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 in resistant lice and would definitely be my recommendation and first line choice:
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. Pharmamum loves both these products, so your choice of either will give you a great result.
b)Herbal products ie essential oils
Brands include Moov head lice solution and Neutralice head lice solution.
There is some evidence that 3 applications, one week apart is 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 everyday for at least two weeks. It is a useful non-drug alternative but not my first line recommendation.
- 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.
- Place items that cannot be washed eg. hats in a sealed plastic bag for at least 2 weeks
- 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.
- To reduce the risk of catching lice always tie back your child’s hair. You can place a few drops of tea tree oil in a spray bottle and spray your child’s hair each morning before creche/school to help reduce the risk. 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.