HEAD LICE INFORMATION SHEET

Professor Rick Speare Anton Breinl Centre for Public Health and Tropical Medicine James Cook University Townsville AUSTRALIA 4811 Phone: 07-47815959 International: -61-7-47815959 Fax: 07-47815254 International: -61-7-47815254 Email: richard.speare@jcu.edu.au

HOW DO I KNOW IF MY CHILD HAS HEAD LICE?

Many head lice infections cause no symptoms, and probably less than half cause itch. So you have to LOOK to find out if your child has head lice. Do not rely on itching and scratching.

Eggs are not difficult to see; use a strong light and look on the hair shafts. Newly laid eggs are usually within 1.5 cm of the scalp while older eggs are higher up the hair shafts. If you are not sure whether an object you find is a head louse egg, try sliding it up the hair shaft using your fingers. Eggs are usually quite difficult to move, whereas hair muffs and other items slide easily. Live, dead, hatched eggs? How can I tell?

However, finding live lice can be difficult since the climbers move away quickly from disturbances in the hair, and they are very difficult to see.

An easy way to find the climbers is to use the conditioner and nit comb technique:

Apply conditioner to dry hair aiming to cover each hair from root to tip with a layer of conditioner. Detangle the hair using an ordinary comb. Immediately comb the hair with a fine tooth comb. The best comb for this is the Lice Meister comb. However, plastic nit combs with conditioner are also very effective for detecting climbers. Wipe the conditioner off the fine tooth comb onto a paper tissue and look for lice and eggs. Repeat the combing for every part of the head at least 5 times. Also examine the comb for lice and eggs. Conditioner stuns lice for 20 minutes. So once the hair is properly covered with a layer of conditioner, do not delay in combing those little suckers out!

If you find lice, your child should be treated.

If your child has not been treated for head lice before, and you only find eggs, you should consider treating for head lice. However, another option if you do not want to use insecticidal treatments, is to check again the next day using the conditioner and comb technique.

If your child has been treated recently, and you find only hatched eggs, but no lice, you may not need to treat since the eggs could be from the old infection.

You should check your child every week using conditioner, a fine tooth comb, and paper tissue as described above. Head lice detection kit

HOW DO I TREAT HEAD LICE?

Head lice live in the hair and come down to the scalp to feed by sucking blood. So head lice formulations must be applied to all parts of the hair. A complete regime consists of two treatments 7 days apart, the first to kill the climbers, and the second to kill the juvenile lice hatched from the eggs over the intervening 6 days. No product currently available kills all eggs.

1. Apply the product to all areas of the head and coat all hairs from roots to tips.
2. If you are using lotions, apply the product to dry hair. For shampoos, wet the hair, but use the least amount of water possible.
3. For long hair apply the treatment formulation near the scalp and then use an ordinary comb to carry the formulation down the hair shaft to the tip. If product is left on the comb after one sweep, it should be wiped onto the same or a new area of hair at the base and the process repeated. By repeating this process several times for hair all over the head, one can obtain an even coverage of all hairs from roots to tip. In addition the hair is tangle free and use of a fine tooth comb is subsequently simplified.
4. Leave the preparation on the hair for at least 20 minutes.
5. Cover the child's eyes while the treatment is being applied. Ask them to hold a towel against their eyes.

HOW CAN I TELL THAT THE TREATMENT HAS KILLED THE LICE?

1. After 20 minutes, use a fine tooth comb to comb the hair, and after each sweep from roots to tip, wipe the combings onto a tissue.
2. Repeat this many times until the whole head has been combed at least twice and little treatment formulation is visible on the hair.
3. Examine the tissues and see if lice are alive or dead. A magnifying lens is not needed to do this, but will help in the visually impaired. Grade each lice as dead (no movement at all), inactive but alive (louse is stationary, but is moving legs or antennae), or active (louse is crawling on the tissue).
4. Assess success of treatment and possible insecticide resistance.
   1. If all lice are dead, infestation is sensitive to product used.
   2. If some lice are inactive but alive, infestation may be partly resistant to treatment, but regard the louse population as "sensitive" if no lice are active.
   3. If some lice are active, infestation is resistant.
5. For a sensitive population of head lice, the current treatment has been successful, but embryos in eggs will most likely survive. Retreat in 7 days using the same product.
6. For resistant lice, the current treatment has been unsuccessful. See section "If lice aren't killed, what should I do?".

IS A SECOND TREATMENT NECESSARY?

If lice are found at the second treatment, and they are killed by this treatment, there are two options:

1. retreatment with same preparation a third time in 7 days to verify complete cure, or
2. 7 days after the second treatment, put conditioner in the hair, comb with a fine tooth comb and check for lice.

If no lice are found at the second treatment, the case has been cured.

HOW DO I KNOW IF LICE ARE RESISTANT TO INSECTICIDES?

Wash off the first product. Retreat as soon as possible using a product from a different active group than the one used. Although there are over 20 head lice products they fall into four groups based on the active compound:

1. pyrethrins
2. synthetic pyrethroids (permethrin and bioallethrin)
3. organophosphates (malathion or maldison), and
4. herbal and essential oils.

WHAT ABOUT THE NYMPHS THAT HATCH BETWEEN TREATMENTS?

A good strategy to manage this situation is to use the conditioner and fine tooth comb technique between treatments. If conditioner is applied and then immediately combed out, the nymphs that have hatched will be removed. Do this at least twice in the 7 days between treatment 1 and treatment 2.

NOTHING WORKS!

1. Inadequate application of the product
2. Lice are resistant to insecticide
3. Failure to retreat to kill nymphs emerged from eggs
4. Reinfection.

ARE HEAD LICE TREATMENTS SAFE?

The active ingredient of all Aust R products have low acute toxicities for humans. Please note that lindane and carbaryl are not licensed for use in Australia. Lindane as a treatment for pediculosis has been removed from many developed countries because of concerns about acute toxicity if used too frequently. Carbaryl is available in the UK only by prescription. The chronic toxicities of the active ingredients are less well recognised. The aim should be to keep exposure to insecticides to the minimum required to eradicate head lice.

WHAT IS DANGEROUS?

• Using insecticidal head lice products to prevent head lice.
• Using other insecticidal products on the head. Using pet flea or tick treatments, fly spray and insecticidal surface sprays is dangerous.
• Using keroscene.

DO I NEED TO SPRING CLEAN THE HOUSE?

We searched the floors of 118 primary school classroom carpets for head lice while the pupils were out of the classroom. We also checked the children's heads. We found no lice (ZERO!) on the floors and 14,033 lice on the heads of the 2000 or so children using those classrooms. To treat head lice concentrate on the head!

A small number of lice do move down to pillow slips at night. So change the pillow slip when you are treating your child, or heat it up (hot wash, iron, hot dryer) to kill any head lice that may have walked across to the pillow slip. However, focus your main efforts on the head, not on the environment. The head is where the action is!

If you are unable to eradicate head lice speak to your pharmacist, general practitioner or contact Rick Speare on richard.speare@jcu.edu.au.

[Links to Additional Information] [ DeLouse Interactive Web Site]