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Daily Dose

Lice is Tough to Treat

1:15 to read

What are kids bringing home from school besides their homework? Lice! The good news is: lice are obligate parasites and don’t jump, or fly…they are transmitted by direct contact.  But, the smart louse has found another way to drive parents crazy…they are becoming more and more resistant to all of the over the counter products containing permethrin. 

A recent study has shown that 25 states now have a big problem with lice and permethrin resistance.  It seems that the lice are smart and they have developed “genetic mutations” which has made them drug resistant. Texas has had a problem for several years and I have had many patients coming into the office with bags full of “stuff” that they have used to treat their children’s head lice to no avail!!!  Many a mother has told me she is ready to try anything…including some things that might be considered unsafe, but you know a desperate mother.

While about 12 million children a year get head lice, the louse itself does not cause any disease, but just uncomfortable itching.  Parents spend multi millions of dollars each year trying to eradicate head lice. In states like Texas, California, Florida and Virginia the lice are immune to over the counter products, while in New York, New Jersey and several other states they are partially resistant. 

But don’t despair, despite the resistance to the over the counter products such as Nix, there are other prescription products available. Products such as benzoyl alcohol (Ulesfia), ivermectin (Sklice), malathion (Ovide), and spinosad (Natroba), may all be used to treat a case of head lice, but will require a prescription to obtain them.  Although prescription drugs typically are more expensive, treating head lice with an over the counter product may be an exercise in futility. It is likely to be more cost and time effective to start with a prescription product if you live in one of the 25 states which has shown drug resistance.

So, if you get a note that your child has head lice, pick up the phone and call your doctor’s office to see what advice they give you. 

Your Child

Lice Is Going Around

How to treat lice.I keep hearing that there are lice out there! Lice are a part of childhood, albeit the gross part, but it really has nothing to do with where you live or go to school or how often your kids take their baths, its about hair.

Lice are obligate human parasites and require a human scalp to live, they can only live off the host for 6 -25 hours.  Lice most commonly infect children between the ages of 3 – 12 years and there estimated to be between 6 – 12 million cases of lice in children per year. So, if your child has lice, you are not alone!  Transmission of the louse is most commonly from close personal contact especially head to head.

Lice do not have wings so they are not flying around a classroom or on the playground.  The most recent issue with lice is that they are becoming resistant to the over the counter products like Rid and Ni, which have been the gold standard for years. These are still used for first line treatment, as well as removing the nits (egg casings) from the hair with a nit comb. It is often easiest to do this with a dark towel or sheet draped over your child’s shoulders so that you can see the nits as they are coming off of the hair shaft.  It is very hard to see nits in light hair.   Nix and Rid do not kill the eggs, so it is recommended that a second application be used in a week to 10 days. Once you have treated your child appropriately they may return to school, there are no longer “no nit policies”. If you notice that your child still has lice after a couple of days despite appropriate over the counter treatment, call your doctor. Don’t try to smother the lice with mayo, olive oil, Vaseline  or a shower cap, as lice don’t have lungs, so this does not work!  Never think about applying  kerosene to the child’s  hair or even shaving their heads. There are some newer treatments available. I have had success using Ovide, which is only available by prescription in the United States (but is an OTC product in the UK, in case you are traveling).  Another new product, Ulesfia, is also available. It is made of benzyl alcohol and inhibits the louse respiratory spiracles (no lungs remember) and thereby does result in asphyxiation of the louse. The only problem with this product is that it takes quite a few bottles to cover a child with a thick head of hair, and this may make it cost prohibitive. Another product that is being used in Canada (again if you are wanting to pick up some lice treatment while away) is Resultz which is isopropyl myristate, and it is in phase 3 trials in the US.  Other products such as Bactrim and Ivermectin have been used “of label” with some success. At time parent’s are willing to travel to Canada to find “the cure” as they become so frustrated with re-occuring lice problems. Remind your children not to share combs, bows, hats etc with their friends.  Lastly, some people advocate treating all household contacts (even without symptoms of itchy head) to eliminate an outbreak within a family. Now, stop scratching your head.  We'll chat again tomorrow!

Daily Dose

Head Lice & Hollywood

Do not take Hollywood's advice when it comes to treating head lice.Over the weekend, I dragged my family to see The Switch. It was a great escape movie and a perfect “chick flick” with a happy ending. What does this have to do with kids’ health? Well, one of the scenes was related to an elementary school child who had a case of head lice.

I listened intently while Jennifer Aniston instructed her best friend on how to treat her son’s head lice. And guess what? The information was somewhat incorrect! The writers must have missed the 2010 American Academy of Pediatrics abstract on lice and treatment recommendations that not only endorsed banishing the “no nit” policy (which had prevented children from returning to school), but also stated that “no healthy child should be excluded from or allowed to miss school time because of head lice.” By the time a case is diagnosed, the child has probably had the infestation for at least a month, so why keep him home now? Nothing causes more angst and disgust than when parents find that their child has lice, yet it has nothing to do with cleanliness. It’s not unusual for everyone in the family to start scratching their heads and thinking they’re infested, too. The latest recommendations begin with properly diagnosing the infestation; it is thought to be both “misdiagnosed and overtreated,” which may be causing resistance to over-the-counter products. The two most commonly used products are Nix and Rid. It is important to know if your community is believed to be resistant to these two products. Depending on that information, you can start treatment; make sure to repeat the treatment in a week or 10 days to prevent new lice from repeating the life cycle. Current recommendations advise washing all bedding and hair-care items used by the child within the previous 48 hours. In one study, changing the pillowcase alone was enough to minimize head lice transmission — but if you are washing, you might as well throw in all of the bedding. Louse survival off of the scalp beyond 48 hours is extremely unlikely, so it is not necessary to call in the “lice busters” to exterminate your house. Washing, soaking or drying items at 130 degrees will kill stray lice or nits — and simply vacuuming the couch, car seat or other fabrics should be more than sufficient. The perfect lice treatment would be both pediculicidal (killing the louse) and ovicidal (killing the eggs, too). The perfect treatment also would be safe, easy to use, inexpensive and would not have potential for developing resistance. But there currently is not a treatment method that fits this description. Oh, by the way: We all enjoyed the movie, and the little boy is precious (and lice free by the end). That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

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