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The Management and Treatment of Head Lice

 

  Lice:

  • An adult louse is about the size of a sesame seed and usually pale gray or reddish-brown in color.
  • A female louse lives up to 3-4 weeks, lays about 10 eggs (nits) per day and “glues” them to the hair shaft, close to the scalp.  They are difficult to dislodge.
  • Live (viable) nits, about the size of a poppy seed, are camouflaged with pigment to match the hair color of the infected person.
  • Empty egg casings (eggs that are hatched) are easier to see, appearing white against darker hair.
  • With a first case of head lice itching may not develop for 4 to 6 weeks (it takes time to develop sensitivity to louse saliva).
  • Head lice usually survive less than 1 day away from the scalp at normal room temperature.
  • Eggs cannot hatch at an ambient temperature lower than that near the scalp.
  • Eggs cannot be spread from person to person.
  • Lice are host specific; they survive only on humans and cannot be spread by household pets.

 

Managing/Treating Head Lice:

  • If ‘nits’ are discovered in hair or the scalp is intensely itchy, inspect hair for live (crawling) lice.  The best method is to comb through wet hair with a fine-tooth louse comb.  (Also inspect other household members.)
  • If there are no live (crawling) lice on hair periodically re-inspect the hair for live lice for about 1 ½ weeks.

 

Combing:

  • If live lice are found and hair is readily combed with a fine-tooth louse comb (flea comb can be used):
  • Comb hair thoroughly with louse comb.  You may use hair conditioner to lubricate the hair and comb, only if you are not using a pediculicide.
  • Most lice should be removed during this first combing.
  • Repeat every day as each subsequent combing will remove a portion of the remaining lice and some that have hatched in the interim.  Note: the combing does not effectively remove the eggs and they may hatch.
  • Continue daily combing for about 1 ½ -2 weeks, until no live lice are discovered.
  • Treatment with pediculicides may be used to supplement or replace combing, but do not use a vinegar rinse, hair conditioner, or shampoo/conditioner combination if using a pediculicide.
  • Change or launder pillowcases, pajamas, towels, hats. Alternatively, you may choose to put these items, as well as blankets, bedspreads and stuffed animals in a dryer on high heat for 20 – 30 mins.
  • Wash combs and brushes daily in hot water.
  • Re-inspect hair for live lice for another 1 ½-2 weeks.

 

 

Shampooing with a Pediculicide:

  • If live lice are found and hair is not readily combed with a louse comb:
  • Apply an over-the-counter pediculicide that contains permethrin or pyrethrins. (Do not use in conjunction with hair conditioner which inactivates pediculicide.  Do not rewash hair for 1-2 days after treatment.)
  • Treat according to label directions.
  • Change or launder pillowcases, pajamas, towels, hats. Alternatively, you may choose to put these items, as well as blankets, bedspreads and stuffed animals in a dryer on high heat for 20 – 30 mins.
  • Wash combs and brushes daily in hot water.
  • You still need to comb daily to completely eradicate head lice, since pediculicides do not kill nits, and eggs are not removed.
  • If live lice persist, a second application may be necessary about 7 to 10 days after the first treatment.
  • Continue combing for 1 ½ - 2 weeks.
  • Periodically re-inspect hair for live lice.

 

NOTE:  Despite whatever treatment you choose to use, you MUST comb hair daily and thoroughly for 1 to 2 weeks with a fine tooth comb to remove any newly hatched lice.

 

 Persistent head lice:

  • If live lice persist after 2 treatments, consider:
  • Did I comb thoroughly every day, using a fine - tooth comb?
  • Did I follow the pediculicide directions exactly?
  • Did I NOT use crème rinses, combination shampoo/conditioners, or vinegar rinses if I used a pediculicide?
  • Consider manually removing nits.
  • Consult physician.
  • Consider prescription pediculicides and follow label directions.
  • DO NOT OVERTREAT.

 

Cleaning:

You may vacuum furniture, car seat cover, or other places where heads rest, but unnecessary and your time is better spent in combing and manual removal.

The above information and guidelines of management are taken from the recommendations of the American Academy of Pediatrics, Harvard School of Public Health, Vermont Department of Health, and National Association of School Nurses.

05/13