Treatment of human head lice
The treatment of human head lice infestation is a process for removing head lice parasites from human hair and it has been debated and studied for centuries. However, the number of cases of human louse infestations (or pediculosis) has increased worldwide since the mid-1960s, reaching hundreds of millions annually. There is no product or method which assures 100% destruction of the eggs and hatched lice after a single treatment. However, there are a number of treatment modalities that can be employed with varying degrees of success. These methods include chemical treatments, natural products, combs, shaving, hot air, and silicone-based lotions.
Lice eggs hatch 6–9 days after oviposition. Therefore, a common recommendation is to repeat treatment with a pediculicide at least once after 10 days, when all lice have hatched. Between the two treatments (Days 2–9) the person will still be infested with lice that hatch from eggs not killed by the anti-louse product. Between the treatments, it is advised[by whom?] to wet the hair and comb daily with a louse-comb to remove the hatching lice.
If no living lice are found, the treatment was successful, even if nits/eggs are visible on the hair. If living lice are still present, repeat the treatment using an anti-louse product with a different active ingredient. Prophylactic treatment with pediculicides is not recommended. Itching may persist for up to a week after head lice eradication.
Devices blowing heated air onto the scalp have been tested for efficacy in killing lice and eggs and shows up to 99% mortality of eggs and 88% mortality of hatched lice. The louse loses body moisture to the heated air and within the treatment period becomes desiccated and dies. Currently, there is only one FDA approved medical device that offers this technology.
A standard home blow dryer will kill 96.7% of eggs with proper technique. To be effective, the blow dryer must be used repeatedly (every 1 to 7 days since eggs hatch in 7 to 10 days) until the natural life cycle of the lice is over (about 4 weeks).
A special fine tooth comb that can pick out lice is used. For a treatment with louse comb alone, it is recommended to comb the hair for an hour to an hour and a half (depending the length and type of the hair) daily or every second day for 14 days. Wetting the hair especially with water and shampoo or conditioner will facilitate the combing and the removal of lice, eggs and nits.
Electronic lice combs use a small electrical charge to kill lice. The metal teeth of the comb have alternating positive and negative charged tines, which are powered by a small battery. When the comb is used on dry hair, lice make contact with multiple tines of the fine-toothed comb, thereby closing the circuit and receiving an electrical charge. A non-peer-reviewed letter has been published in a dermatology journal claiming effectiveness based on personal experience (total of 6 uses). For those with long or fine hair, the metal long tooth combs seem to snag and pull hair. Metal combs may be better for thick hair, while plastic short-tooth combs are best used for treating long and fine hair.
Today, insecticides used for the treatment of head lice include organochlorines (lindane), organophosphates (malathion), carbamates (carbaryl), pyrethrins (pyrethrum), pyrethroids (permethrin, phenothrin, bioallethrin), and spinosad (spinosyn A and spinosyn D).
The only agents approved by the FDA for treatment of pediculosis are topical ivermectin lotion, lindane, and malathion.[needs update]Tea tree oil has been promoted as a treatment for head lice; however, evidence of its effectiveness is weak. A 2012 review of head lice treatment recommended against the use of tea tree oil for children because it could cause skin irritation or allergic reactions, because of contraindications, and because of a lack of knowledge about the oil's safety and effectiveness. Other home remedies such as putting vinegar, isopropyl alcohol, olive oil, mayonnaise, or melted butter in the hair have been partially disproven, The use of plastic bags may be dangerous. Similarly, the Centers for Disease Control and Prevention reports that swimming has no effect on treating lice, and can in fact harm the treatment by commercial products. Ethanol (ethyl alcohol, common alcohol) is toxic to arthropods including lice and an external application of it is harmless to humans.
The journal Pediatrics has published a study in which lice can be killed by suffocating them using a non-toxic face cleanser to effectively "shrink wrap" them over an extended period of time achieving a success rate of roughly 95%. The procedure in the study used application of the product Nuvo lotion (Cetaphil), thoroughly combed in with a regular comb and blow dried, and then hair was shampooed after 8 hours. This was repeated once per week for 3 weeks using two study groups: one that followed up by removing nits and the other that did not. There was no appreciable difference in success rates in the groups. In its conclusion, the Journal stated, "Dry-on, suffocation-based, pediculicide lotion effectively treats head lice without neurotoxins, nit removal, or extensive house cleaning. These results are comparable or superior to the results previously reported for treatments with permethrin, pyrethrin, and malathion."
Shaving the head or cutting the hair extremely short can be used to control lice infestation. Short hair, baldness, or a shaven scalp are generally seen as a preventive measure against lice infestation. This will also eliminate – particularly if maintained for the length of the parasites' reproductive cycle – lice infestation.
Infestation with lice is not a disease and the medical symptoms are normally minimal. In any case, health providers and parents should try not to create emotional problems for children during examination and treatment.
Shaving of the area above and behind the ears and the upper part of the neck while leaving the crown of the head with hair is commonly used to prevent lice among tribes in Africa, Asia, and America (in America – Mohawk style).
Schools in the United States, Canada, and Australia commonly exclude infested students, and prevent return of those students until all lice, eggs, and nits are removed. This is the basis of the "no-nit policy". Data from a primarily American study during 1998–1999 found that no-nit policies were present at 82% of the schools attended by children suspected of louse infestation. A separate 1998 survey revealed that 60% of American school nurses felt that "forced absenteeism of any child who has any nits in their hair is a good idea."
A number of health researchers and organizations object to the no-nit policy. Opponents to the no-nit policy mention that visible nits may only be empty egg casings which pose no concern as transmission can only occur via live lice or eggs. This has led to the perception that the no-nit policy serves only to ease the workload of school nurses and punish the parents of infested children.
Proponents of the no-nit policy counter that only a consistently nit-free child can be reliably shown to be infestation-free. That is, the presence of nits serves as an indirect proxy for infestation status. Proponents argue that such a proxy is necessary because lice screening is prone to false negative conclusions (i.e., failure to find lice present on actively infested children). For example, a 1998 Israeli study found that 76% of live lice infestations were missed by visual inspection (as verified by subsequent combing methods). Although lice cannot fly or jump, they are fast and agile in their native environment (i.e., clinging to hairs near the warmth of the scalp), and will try to avoid the light used during inspection. Lice colonies are also sparse (often fewer than 10 lice), which can contribute to difficulty in finding live specimens. Further, lice populations consist predominantly of immature nymphs, which are even smaller and harder to detect than adult lice.
- Gratz, N. (1998). "Human lice, their prevalence and resistance to insecticides.". Geneva: World Health Organization (WHO).
- Frankowski, BL; Bocchini, JA Jr; American Academy of Pediatrics. Council on School Health and Committee on Infectious Diseases. (August 2010). "Head Lice (October 1, 2010 Clinical Report)". Pediatrics. 126 (2): 392–403. doi:10.1542/peds.2010-1308. PMID 20660553.
- [old info]Mumcuoglu, Kosta (2006). "Effective Treatment of Head Louse with Pediculicides". Journal of Drugs in Dermatology. 5 (5): 451–452. PMID 16703782.
- [old info]Mumcuoglu, Kosta Y.; Barker, CS; Burgess, IF; Combescot-Lang, C; Dagleish, RC; Larsen, KS; Miller, J; Roberts, RJ; Taylan-Ozkan, A. (2007). "International Guidelines for Effective Control of Head Louse Infestations". Journal of Drugs in Dermatologist's. 6 (4): 409–414. PMID 17668538.
- The Key To Keeping Lice At Bay? A Lot Of Hot Air, Steve Henn, April 09, 2012
- Goates, Brad M.; Atkin, Joseph S; Wilding, Kevin G; Birch, Kurtis G; Cottam, Michael R; Bush, Sarah E; Clayton, Dale H. (5 November 2006). "An Effective Nonchemical Treatment for Head Lice: A Lot of Hot Air" (PDF). Pediatrics. American Academy of Pediatrics. 118 (5): 1962–1970. doi:10.1542/peds.2005-1847. PMID 17079567. Retrieved 2010-08-01.. A number of clinics across the country have popped up in recent years specifically offering the heated air treatment.
- Abdel-Ghaffar, Fathy; Semmler, Margit (10 August 2006). "Efficacy of Neem Seed Extract Shampoo on Head Lice of Naturally Infected Humans in Egypt" (PDF). Parasitology Research. Würzburg: University of Würzburg. 100 (2): 329–332. doi:10.1007/s00436-006-0264-2. PMID 16900389. Retrieved 2008-01-03.
- Mumcuoglu, Kosta Y. (July–September 1999). "Prevention and Treatment of Head Lice in Children". Paediatric Drugs. Yardley, Pennsylvania: Adis International. 1 (3): 211–218. doi:10.2165/00128072-199901030-00005. PMID 10937452. Retrieved 2008-01-03.
- Bingham, P; Kirk, S; Hill, N; Figueroa, J (2000). "The methodology and operation of a pilot randomized control trial of the effectiveness of the bug busting method against a single application insecticide product for head louse treatment". Public Health. Amsterdam: Elsevier. 114 (4): 265–268. doi:10.1038/sj.ph.1900645. PMID 10962588.
- Plastow, Liz; Luthra, Manjo; Powell, Roy; Wright, Judith; Russell, David; Marshall, Martin (April 2001). "Head lice infestation: bug busting vs. traditional treatment". Journal of Clinical Nursing. Malden, MA: Blackwell Publishing Inc. 10 (6): 775–783. doi:10.1111/j.1365-2702.2001.00541.x. PMID 11822849.
- Resnik, Kenneth (February 2005). "A non-chemical therapeutic modality for head lice". Journal of the American Academy of Dermatology. Conshohocken, Pennsylvania: Elsevier Inc. 52 (2): 374. doi:10.1016/j.jaad.2004.07.032. PMID 15692498. Retrieved 2010-06-06.
- "Natroba (Spinosad) Topical Suspension, 0.9%". Retrieved 2011-01-18.
- Amy J. McMichael; Maria K. Hordinsky (2008). Hair and Scalp Diseases: Medical, Surgical, and Cosmetic Treatments. Informa Health Care. pp. 289–. ISBN 978-1-57444-822-1. Retrieved 27 April 2010.
- Jacobi, Tillmann (22 September 2011). "The Basics – The management of head lice". GP: 38.
All in all, the evidence for alternative treatments, such as tea tree oil and neem seed oil, remains weak.
- "Tea tree oil". Medline Plus, a service of the U.S. National Library of Medicine from the National Institutes of Health. 27 July 2012.
- Eisenhower, Christine; Farrington, Elizabeth Anne (2012). "Advancements in the Treatment of Head Lice in Pediatrics". Journal of Pediatric Health Care. 26 (6): 451–61; quiz 462–4. doi:10.1016/j.pedhc.2012.05.004. PMID 23099312.
- "Elsevier". Pediatricnursing.org. Retrieved 2012-11-22.
- "Massachusetts toddler dies after lice treatment goes awry". Yahoo News/Reuters. February 5, 2015.
- "CDC – Frequently Asked Questions – Healthy Swimming & Recreational Water – Healthy Water". Cdc.gov. 2012-10-22. Retrieved 2012-11-22.
- JF Marriott. 2010. Pharmaceutical Compounding and Dispensing. p.77: https://books.google.com/books?id=J5vE3Z_ZXJcC&pg=PA77#v=snippet&q=lice&f=false p.77:"ALCOHOL. After water, this is probably the next most important solvent used pharmaceutically. Although ethanol (ethyl alcohol) is rarely used as a lone solvent for preparations for internal use, it is used in the manufacture of some of the galenicals used in pharmacy (e.g. tinctures, see Chapter 2). In extemporaneous dispensing it is normally used for the production of lotions for external application to unbroken skin. It is particularly useful if rapid evaporation is required (e.g. for insecticidal lotions applied to hair for the treatment of lice)..."
Ethanol as an arthropod killing solution, e.g. Szinwelski, N., Fialho, V. S., Yotoko, K. S. C., Seleme, L. R., & Sperber, C. F. (2012). Ethanol fuel improves arthropod capture in pitfall traps and preserves DNA. ZooKeys, (196), 11–22. Advance online publication. http://doi.org/10.3897/zookeys.196.3130 "...It has been shown that at concentrations higher than 95%, commercial alcohol preserves DNA (Nagy 2010), but the use of highly concentrated commercial alcohol as a killing solution may be prohibitively expensive when needed in large quantities, such as in large-scale biodiversity sampling. In Brazil, for example, it is illegal to carry large amounts of commercial alcohol on long journeys, which could hinder its use in extensive field expeditions. Here we propose the use of ethanol fuel as a cheaper and logistically feasible alternative..."
Sociedad Argentina de Pediatria. Actualización en pediculosis. http://sap.org.ar/docs/publicaciones/pediculosis.pdf: "La cuasia amarga (palo amargo) se extrae de un arbusto que crece en el norte de la Argentina. El principio activo que se extrae de la madera es la cuasina y químicamente es un hidrocarburo soluble en alcohol. Popularmente se lo usa como repelente de piojos y como pediculicida. Es efectiva únicamente en solución alcohólica y no en solución acuosa. Así es tan efectiva como una solución pura de alcohol por lo cual se duda de su efecto pediculicida “per sé” y es irritativa."
- "A Simple Treatment for Head Lice: Dry-On, Suffocation-Based Pediculicide". Pediatrics – Official Journal of the American Academy of Pediatrics. 2004-09-01.
- Mumcuoglu, Kosta Y. (1991). "Head Lice in Drawings of Kindergarten Children". The Israel Journal of Psychiatry and Related Sciences. 28: 25–32.
- Mumcuoglu, Kosta Y.; Meinking, Terri A; Burkhart, Craig N; Burkhart, Craig G. (2006). "Head Louse Infestations: The "No Nit" Policy and Its Consequences". International Journal of Dermatology. International Society of Dermatology. 45 (8): 891–896. doi:10.1111/j.1365-4632.2006.02827.x. PMID 16911370.
- Pollack RJ, Kiszewski AE, Spielman A (2000). "Overdiagnosis and consequent mismanagement of head louse infestations in North America". The Pediatric Infectious Diseases Journal. 19 (8): 689–93. doi:10.1097/00006454-200008000-00003. PMID 10959734.
- Price JH, Burkhart CN, Burkhart CG, Islam R (April 1999). "School nurses' perceptions of and experiences with head lice". The Journal of school health. 69 (4): 153–8. doi:10.1111/j.1746-1561.1999.tb04174.x. PMID 10354985. Retrieved 2008-10-10.
- Frankowski, Barbara L.; Leonard B. Weiner; the Committee on School Health; the Committee on Infectious Diseases (September 2002). "Head Lice: American Academy of Pediatrics Clinical Report". Pediatrics. American Academy of Pediatrics. 110 (3): 638–643. ISSN 0031-4005. PMID 12205271. Retrieved 2008-10-10.
- Frankowski, Barbara L. (September 2004). "American Academy of Pediatrics guidelines for the prevention and treatement of head lice infestation". The American Journal of Managed Care. 10 (9): S269–S272. PMID 15515631. Retrieved 2008-10-10.
- National Association of School Nurses (July 2004). "Pediculosis in the School Community: Position Statement". Silver Spring, Maryland: National Association of School Nurses. Retrieved 2008-10-10.
- "The No Nit Policy: A Healthy Standard for Children and their Families". The National Pediculosis Association. 2008. Retrieved 2008-10-12.
- National Health and Medical Research Council (December 2005). Staying Healthy in Child Care: Preventing infectious diseases in child care (PDF) (4th ed.). Commonwealth of Australia. ISBN 0-642-45631-3.
- Mumcuoglu KY, Friger M, Ioffe-Uspensky I, Ben-Ishai F, Miller J (2001). "Louse comb versus direct visual examination for the diagnosis of head louse infestations". Pediatric dermatology. 18 (1): 9–12. doi:10.1046/j.1525-1470.2001.018001009.x. PMID 11207962.
- Hootman J (April 2002). "Quality improvement projects related to pediculosis management". The Journal of school nursing : the official publication of the National Association of School Nurses. 18 (2): 80–6. doi:10.1177/10598405020180020401. PMID 12017250.
- Bacot A (1917). "Contributions to the bionomics of Pediculus humanus (vestimenti) and Pediculus capitis". Parasitology. 9 (2): 228–258. doi:10.1017/S0031182000006065.
- Nuttall, George H. F. (1919). "The biology of Pediculus humanus, Supplementary notes". Parasitology. 11 (2): 201–221. doi:10.1017/S0031182000004194.
- Mumcuoglu KY, Miller J, Gofin R, et al. (September 1990). "Epidemiological studies on head lice infestation in Israel. I. Parasitological examination of children". International Journal of Dermatology. 29 (7): 502–6. doi:10.1111/j.1365-4362.1990.tb04845.x. PMID 2228380.
- Buxton, Patrick A. (1947). "The biology of Pediculus humanus". The Louse; an account of the lice which infest man, their medical importance and control (2nd ed.). London: Edward Arnold. pp. 24–72.
- "Head lice and nits – Treatment". NHS Choices. 17 May 2016. Retrieved 31 August 2016.
- Centers for Disease Control and Prevention: Division of Parasitic Diseases
- James Cook University, Australia: Head Lice Information Sheet
- MedicineNet.com: Head Lice Infestation (Pediculosis)
- Phthiraptera Central: Bibliography of Lice
- University of Nebraska: Head Lice Resources You Can Trust
- National Pediculosis Association