Head Lice (Nits)

Images courtesy of medline

Q. What are headlice?
A. Headlice are tiny grey/brown insects. They are the size of a sugar granule, they cling to hair but need to live near the scalp. They lay eggs which take 7-10 days to hatch. Nits are the empty white egg cases left behind on the hair when the lice have hatched. They look like dandruff but unlike dandruff, they donot easily brush out.

Q. How do you catch them?
A. They are NOT a sign of poor hygiene or being dirty. They cannot jump or fly. They are only caught by close head to head contact. If they are away from their food source, the scalp for more than twenty minutes, they die.

Q. How do you know if you have headlice?
A. These may vary from person to person but can include any or all of the following:
Rash on the scalp.
Droppings, a fine black powder like pepper on pillowcases.
Head itching - this is not always the first sign. Lice may have been on the scalp for quite sometime before the head starts to itch.
Nits - pinhead sized white shiny balls firmly attached to the hair shaft. Often found in warmer parts of the scalp eg behind the ears.

Q. How do I get rid of them?
A. There are two main schools of treatment. Wet combing and lotions.

Wetcombing.
Wash the hair using ordinary shampoo.
Use lots of conditioner and comb through the wet hair with a fine comb. Make sure you go from the roots to the tip. (Combs can be purchased from the chemist)
Clean the comb between each stroke with a tissue or paper towel.
This should take thirty minutes or so to do it thoroughly making sure every part of the head has been combed.
Rinse well and dry as normal.
Repeat every three to four days for the next two weeks so emerging lice can be removed.

5-6 cases out of every ten can be treated using this method and it is also useful if you are looking for lice. Remember the nits (whitecases) may remain in the hair long after any live lice have been killed.
Bugbusting kits and more information can be obtained from www.nits.net

Lotions.
You should use these only if you see live lice. Nits may remain in the hair long after the lice have been cleared.
8-9 out of ten cases can be cleared using lotion. There are various brands. The active ingredient is usually malathion or phenothrin. Shampoo, cremes and mousses are less effective than lotions and are not recommended.
Water based lotions are safer as some people with asthma, eczema or broken skin cannot use alcohol based lotions.
Always ask your pharmacist, GP, practice nurse, school health adviser or health visitor for advice if you are uncertain about a treatment.
Follow the instructions on the packaging.
Reapply the lotion again after 7 days unless directed differently.
Inspect the head using the wet combing method described above 2-3 days after the second application. If live lice are still present seek advice.

Q. Any problems?
A. Sometimes lice may be resistant to a lotion so repeated treatment using the same active ingredients may not solve the problem.

Q. Do preventers or deterents work?
A. These have not been subjected to research so the effectiveness of eg teatree oil, herbal remedies etc is unknown.

Q. What about dimeticone?
A. This is a silicone based product and it is thought may clear lice in 7 out of ten cases. It works by a physical rather than chemical effect. It doesnot kill unhatched eggs so two treatments are needed 7 days apart. The lotion in this case is left on overnight for eight hours before washing off.

Q. Can my child still go to school?
A. This varies on the individual school's policy. If your child has been treated then yes, they can. It would be good practice to tell the parents of your childs close friends that you have treated your child as they may have either passed on the lice or caught them from each other during play.

Main points
Check your childs hair regularly.
Only use lotion if you see live lice.
Check all the family if lice are discovered.
The itch may take two or three weeks to go after the lice have gone.
Nits may be seen after the lice have gone.
Alcohol based lotions are flammable - safety first!

If in doubt ask your GP practice, health visitor, pharmacist or school health advisor.