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Chapter One: "Know Thy Enemy": from Head Lice to Dead Lice - the book
Lice or "cooties", as they have affectionately been dubbed, have been with humankind as long as man has been capable of scratching. Cave men were crawling with the little creatures and scientists have found lice on the scalps of ancient Egyptian mummies. Why, even Cleopatra, Queen of the Nile, had her own solid gold nit comb. Rumor has it that Queen Elizabeth's elaborate white neck ruffle was worn to protect her clothing from lice. And haven't you ever wondered about those elaborate headdresses that covered the heads of women in medieval and Elizabethan times? In Williamsburg, Virginia, we learned that men wore wigs partly to protect themselves from head lice but since some wigs were made from infested human hair, it didn't always help.
There are three species of human lice: head, body and crab (pubic) lice. Lice are ectoparasites which means they infest the surface of the body but do not invade tissues. Body lice, infesting the body but not the head, are closely related to and similar in appearance to head lice. Body lice are currently uncommon in the United States. Crab lice infest the pubic areas of the body and differ greatly in appearance from head and body lice. Crab lice are more common than body lice but less common than head lice in the United States today. Control of body and crab lice differs from that of head lice.
Yup, lice have always been with us human types and it looks like they always will be. The ubiquitous head louse (Pediculus humanus capitis) the subject of this book, seems to be spreading at epidemic proportions. While the U.S. Centers for Disease Control do not routinely track head lice infestations (pediculosis), many school nurses, various nonprofit groups, some health departments and the pharmaceutical companies do. And according to these sources, in the United States, anywhere from 12 to 25 million Americans, mostly children, will be scratching their heads from a head louse infestation this year alone. Worldwide, "the number of cases of head and body lice infestation has been estimated to be over 100 million."1
The above statistics make head lice more prevalent than chicken pox. In fact, head lice rival the common cold for the most common childhood ailment.
According to an article in Knight-Ridder, 65% of English School Children have head lice. 2
Who gets head lice?
"Ordinary lice may be turning into 'super lice,' developing immunity to over-the-counter treatments that are parents' chief weapons. A group of Israeli researchers said their tests have proved that head lice...are overpowering the over-the-counter treatments." (Los Angeles Times)3
Rich, poor, royal or not, anyone can get head lice. The head louse is an equal opportunity parasite. Although school-age children get head lice more often than adults, girls slightly more than boys, the fact is that the pesky head louse can and does infest anyone. And now that head lice have become so difficult to get rid of, they are that much more likely to spread. Head lice don't like to be crowded. We like to think of them as pioneers, heading out to the wide, open spaces of the Old West to settle new territory. And they like clean, healthy heads the best! Wouldn't you?
Just think of the possibilities for migrating head lice! If a child gets head lice by playing on the floor with other children, and has it long enough, that child is likely to infest his siblings. Once the siblings have it, the parents likely will get it. The siblings can pass it on to their classmates and their teachers. Camp counselors can get it and then it's in the high schools and college campuses. Just like one great, big, out-of-control snowball, rolling rapidly downhill! Pretty soon everyone gets a turn.
So, if your precious darling is sent home with head lice, don't be embarrassed. You are in excellent, and most likely, very clean company. Check out the fanciest private school in your area - it probably has the worst head louse problem because the people there are least likely to admit it!
Why do people get so upset about a few insects on the head?
Well, nobody likes the idea of "bugs" on their head especially ones that itch as much as head lice do. Sometimes children itch so much that they have a hard time concentrating. Thus the expression "nit wit!"
Besides, head lice are hard to get rid of, and they can be seriously disruptive to family, school and work life. A head louse infestation can make children irritable and cause parents to become exhausted, hysterical and ashamed. And if that is not enough, head lice can cause finger pointing in a community and rifts among friends. Most of these problems are caused by a lack of information, a problem this book will help to eliminate.
Managing a head louse infestation also takes considerable time and effort. It involves shampooing, nitpicking, and housecleaning. Working parents can have a difficult time managing a head louse infestation, especially if their employer will not or can not give them the necessary time off from work to get the problem under control.
Some of the shame and embarrassment associated with head lice comes from a mistaken confusion with body lice, a whole different animal. Body lice lay their eggs in the seams of clothing and bedding (as in bed bugs). They are spread by crowded conditions associated with poverty and the inability to wash and dry clothes and bed linen. In the U.S. today, body lice are usually only found on itinerant people or the homeless. However, we have encountered a few cases where callers have described finding them on their mattresses. So, if you buy a used mattress or have guests that don't have high standards of hygiene, you may, in fact, encounter body lice. But body lice do not infest the head and do not lay eggs on the hair shafts, so it is easy to tell the difference.
When you tell your kids, "Good night, sleep tight, don't let the bedbugs bite!" you're telling them to pull the sheets tight over the mattress so the body lice won't bite!
Body lice were responsible for spreading epidemic typhus, especially during World War I. In fact, more people died of typhus during World War I than from bullets. One major reason we won World War II was because the Swiss invented DDT, which killed the body lice and kept the allied soldiers from acquiring typhus. Axis troupes were kept from gaining access to DDT.4
The reason we bring this up is not to freak you out, but to explain the confusion between head lice and body lice. It is probably this confusion which causes uninformed people to associate head lice with a lack of hygiene.
- Like clean, healthy heads the best.
- Don't transmit diseases.
- Are nearly as common as the common cold.
- Anyone can get them.
- Can carry diseases.
- Are associated with conditions where clothing cannot be regularly washed and dried or from infested mattresses.
- Are uncommon in the US at the present time.
Meanwhile, it is important for everyone to remember that:
Head lice are not life threatening - just annoying!
Please, don't blame the person who gave your child head lice. Next time it might be your child who passes them along. And we all need to work together if we want to defeat these annoying insects.
Pediculicides are the insecticidal shampoos and creme rinses used to treat head lice. These products contain pesticides and should be used with caution.
Pesticides - the real problem
Today, the big problem related to head lice may be the chemicals used to treat them. Because most people want head lice off their heads sooner rather than later, they spend millions of dollars on louse treatment products. The makers of pediculicides (the chemicals used to treat head lice) take in over 150 million dollars a year from assorted insecticidal louse shampoos, creme rinses, and sprays. 5
Any toxic chemical that kills pests is a pesticide, and all pesticides have the potential to cause serious side effects. The general consensus among public health professionals is that people need to worry more about the pesticides they are pouring on their children's heads than about the lice themselves. And if parents are going to use pesticides on their children's heads, they need to check with their physician or pharmacist, to make sure the brand they choose is effective and safe for their child.
Why are there more head lice these days than 20 and 30 years ago?
Head lice are most often spread through head to head contact. Children, who are less inhibited than older people, tend to play together, tumbling around like puppies. These days children also go to school younger and remain for a longer time each day. They have more frequent and closer contact with other children outside their own families. Our classrooms are more open and children move around the class more freely instead of sitting quietly at separate desks. While this is great for kids' social and intellectual development, it also means kids are exposed to head lice and other childhood illnesses at a younger age.
According to the Common Sense Pest Quarterly, there are also a surprisingly large number of people willing to tolerate the existence of head lice on their heads.6 This may be a result of the increased amount of work and the difficulty involved in eliminating the infestation.
Another major culprit in the head lice wars appears to be the rise of new strains of chemically tolerant, pesticide-resistant head lice. For several years the media, mothers, school nurses, and entomologists have been reporting that many head louse populations have become resistant to the chemicals used to treat them (see Chapter 3).
"We've been getting reports from school nurses from all over the country," said Terri Meinking, a University of Miami researcher who co-wrote a 1986 report on head lice treatment. "When they say it doesn't work the way it used to, we have to take that seriously." (Los Angeles Times)7
While there remains doubt among some scientists and public health professionals about the existence of resistant head lice; anecdotal and scientific evidence about the growth of such strains is now overwhelming. A group of Israeli researchers claim that their tests show that head lice are definitely overpowering the chemicals used to treat them. And in April of 1998, the Wall Street Journal reported that a study by the Harvard School of Public Health determined that head lice appear to have developed resistance to permethrin, the active ingredient in Nix.8 Because the molecule in permethrin is almost identical to the molecule in pyrethrin, the active ingredient in Rid, Pronto, A200, and most other pediculicides, there is almost certain to be crossover resistance.
Reports of treatment failure when using Nix, Rid, and Clear (the most commonly used over-the-counter pediculicides) have been widespread and persistent despite assurances from the companies that their products are 99-100% effective. Prescription medications such as Kwell, whose active ingredient is the neurotoxin Lindane, have also shown indications of being ineffective in eliminating many louse populations. (Lindane is toxic to humans and has been known to cause seizures, temporary paralysis and death).
Where once a single treatment of a pediculicide was sufficient to get rid of head lice, parents across the country now report treatment failure after multiple doses of pediculicides.
The idea of resistant head lice is not surprising. Living creatures are resilient. Over time, they can become resistant to any chemical. Check out the long shelf life of cockroaches, bacteria, fire ants, mosquitoes, etc. It seems that no matter what we humans do to control them, they just keep coming back for more.
Unfortunately, conflicting information over the existence of strains of pesticide-resistant head lice has caused tremendous confusion and frustration for parents. Depending on whom a parent talks to, the recommended treatments for a head louse infestation can range from the ineffective to the potentially dangerous. And some of that misinformation can come from the medical establishment, which receives much of its information about head lice from the manufacturers of pediculicides.
In order to protect children's health, parents and health professionals would be wise to adopt a conservative approach when dealing with head lice.
"Products that have been working aren't working anymore," -John Erdmann, entomologist, University of Massachusetts 9
Why you should stay away from the Chemical Warfare Approach.
There may be a few doubting Thomases or very frustrated parents who, when confronted with head lice on their children, say, "I don't care, just give me drugs, lots of them." It's the old chemical warfare, "a pill for every purpose" or "better living through chemistry" approach. The problem with the CW approach is that we are dealing with children. There are no long-term studies to prove that repeated doses of most insecticides on children's scalps are safe. In fact, the BBC recently reported that children's scalps are more absorbent then previously believed and that pesticides are eliminated from their bodies more slowly.
If you are tempted to ignore long-term health concerns and decide to give the chemical warfare (applying multiple doses of pediculicides) approach a try, think about this as well: the CW approach doesn't seem to be very effective. The authors have personally talked to thousands of parents who have used pediculicides six or seven times and still find live lice on their children's heads.
We are not suggesting that a pediculicide, used as directed by the manufacturer, can't be part of an effective treatment program to rid your child of a head louse infestation. But in the case of pediculicides, stronger or more often is not better. Exceeding the recommended dose or increasing the amount of time you leave a pediculicide on the head does not increase your chances of eliminating head lice, but it might compromise the health of your child. So, don't let this little creature freak you out so much that you lose your common sense when it comes to your children's health.
Use caution with pediculicides and be aware that there are safer and easier ways to get rid of head lice then turning your child's scalp into a chemical dumping ground.
But, if you feel you must try a pediculicide, be aware that head louse infestations usually cause itching and scratching. Therefore, it is important to check each person's head carefully for open wounds before applying any chemical. Never use a pediculicide on anyone with cuts, abrasions or inflammations. Follow the three steps listed below for specific guidelines on how to apply pediculicides safely.
" According to the U.S. Environmental Protection Agency, 'All pesticides are toxic to some degree, this means they can pose a risk to you, to your children and pets...'" 10
3 Steps to follow when you feel you must use a pediculicide:
1. Make sure that your child actually has head lice before you treat with pediculicides. Misdiagnosis of head lice occurs more often than you think. Do not treat unless you see nits (tiny oval eggs attached at an angle to one side of the hair shaft) or live lice. And never use a pediculicide as a preventive.
2. Check with your pharmacist and only use an over-the-counter pediculicide appropriate and safe for each member of your family. Follow the manufacturer's dose and application directions exactly. Never apply any products containing Lindane (Kwell) - a powerful neurotoxin with the potential for serious side effects.
3. Be prepared to take additional (non-chemical) steps to get rid of those head lice that have developed resistance to the pediculicide. There is an excellent chance that the pediculicide will not kill all the lice, and it only takes one pregnant louse or two amorous ones to create a whole new generation of head lice.
Never use pediculicides on infants under six months of age or if you are pregnant or nursing.
"The Consumer's Union petitioned the FDA to outlaw this (Lindane)neurotoxic, possibly carcinogenic pesticide as a lice treatment sixteen years ago." Consumer Reports 11
What exactly does a pesticide-resistant head louse mean to an itchy public?
If resistant head lice are on the rise, as many experts now believe, schools and parents may have to deal with widespread and difficult-to-contain infestations. Parents will need to take a deep breath and realize that there are no more overnight solutions to the problem of head lice. Schools will have to plan ahead in order to prevent school-wide infestations. And everyone will have to avoid blaming others for not containing the problem.
However, encountering resistant head lice does not mean that families have to live with them. A case of resistant head lice simply means that people cannot rely on a quick chemical fix. Instead, families and schools will have to follow an integrated, multi-step treatment protocol like The Five-Step Battle Plan outlined in this book, to get rid of head lice.
Yikes, we can hear the groans all over America. "What do you mean I can't just shampoo my kid's head, and wake up when it's all over?"
Sorry folks, the days of wham, bang, shampoo your head, Ma'am, the wicked lice are dead, is a treatment option of the past. New treatments are on the horizon, but they will take time to reach the drug store. Even if these treatments do work, and they are proven to be safe enough to be approved by the Food and Drug Administration, it is almost inevitable that head lice will eventually become resistant to these new chemicals as well. And before we blithely pour these new pesticides on our children's heads, remember it takes about 25 years to see the complete consequences of any new chemical. If a chemical kills lice on contact, what is it doing to our children? Is it worth the worry and guilt, when, with a little extra effort, we can eliminate head lice with a non-toxic treatment program that also happens to make your hair look fabulous? Call us crazy, but we believe this one is a no-brainer.
Good News About Head Lice...
Yes, Virginia, there is a Santa Claus. While head lice are adaptable and hard to get rid of, they are not invincible. You don't need a nuclear bomb to treat them. You just need to arm yourself with a few basic facts and outsmart these persistent critters. By learning what head lice and their eggs look like; understanding how they operate and proliferate, and following sensible treatment and prevention steps, you can make sure these annoying creatures go away and don't come back to play another day.
It may seem like a lot of work to wade through all this information, but the alternative could be a battle with head lice that lasts for months, or even years. Weigh the cost of becoming a louse expert with the cost of lost workdays, missed school days, and thousands of dollars spent on chemicals and dry cleaning. We have had people tell us that they have spent over $2,000. on shampoos, louse sprays, combs and cleaning services. Then they call us hysterically because they still have head lice.
So if head lice have invaded your nest - think war. Lock and load by arming yourself with the basic facts about head lice. Prepare for battle against the "the creepin blastit wonner."
Know Your Enemy!
What Are Head Lice?
Very simply, the head louse is an ectoparasitic, blood-sucking parasite from the insect order, Anoplura. It is adapted to live on the human scalp and neck. About the size of sesame seed (or smaller), head lice can range in color from light brown to dark gray or black. They have six legs, are wingless and burrow their mouthparts into the scalp to feed once or more each day.
Head lice have three growth stages - nits (eggs), nymph (larva) and adult.
Where Do Head Lice come from?
Head lice do not live in the air or the dirt; they live on human scalps. They have been found on prehistoric mummies, and they will probably be around as long as there are humans to act as hosts.
While some scientists speculate that lice may have come from monkeys, others say humans gave lice to monkeys!
However, household pets do not transmit their lice to us and we can not give our lice to our pets. So, don't treat your pets with treatments meant for humans and vice versa.
The Louse is approximately 2.4 -3.3 mm long
The Life Cycle of the Louse
A louse lives around 30 days. It takes 8-10 days for an egg to hatch and another 8-10 days for a louse to mature enough to lay eggs of its own. During the 8-10 day maturation process, the young nymphs molt 3 times, growing larger with each molt. The nymphs are very hard to see because they are very nearly transparent and only about the size of a period. Adult lice are very fast on a hair shaft and hard to see because they hide from the light. When you part the hair to take a look, they've already moved on. That's why most people diagnose a head louse infestation by finding nits.
A mature louse lays about 6 eggs a day. When dealing with a head louse infestation, you want to make sure to check for nits and remove them. The only way to know if you still have head lice is to remove all the nits, then see if you find more nits a day or two later. If this is the case, you still have live lice on your head, whether or not you have seen them in their travels.
How Do You Get Head Lice?
No matter what anyone tells you, head lice cannot hop, jump or fly. While they can crawl fairly quickly on a hair shaft, once a louse is off the head, it is strictly slow motion. If you see a creature jumping or flying off a head, it is not a louse.
People generally get head lice through direct contact with an infested person. Head to head contact is the most common way to spread head lice.
There is some disagreement among entomologists and other experts about whether head lice are commonly spread through vectors, that is through an infested persons' belongings - brushes, combs, hats, jackets and to a lesser extent towels, pillows and earphones.
In England, entomologists say vectors cannot spread head lice. Therefore, they do not feel that it is necessary to do any cleaning as part of a program to eliminate an infestation. English health officials felt our video "Head Lice to Dead Lice," emphasized cleaning the environment too much and they chose not to endorse the video on that basis. Health officials there were concerned that if they told people to clean, that they might focus on cleaning and using louse sprays instead of on the heads. However, according a Knight-Ridder article, 65% of English school children are infested with head lice. 12 And England even has a National Bug Busting Day to encourage everyone to attack that country's burgeoning head louse epidemic at the same time. Also, we have received letters from many parents and nurses in England desperate for advice on how to control their widespread problem. All this makes us believe there may be a problem with English entomologists' confidence on this issue. (See Chapter 4 for an opinion from MAry Ward, professional nit picker, who has treated thousands of children for head lice.)
Because lice can live off a human head for up to 36 hours, most entomologists and health professionals in the U.S. recommend a moderate cleaning program (see Chapter 5) to remove lice from the environment.
Lice can live off a human head for 24-36 hours. They live longer in warm, humid climates.
The authors suggest that people take a middle-of-the-road position regarding the possibility of vector transmission. Lice prefer human heads and don't live very long when they are off the head. So concentrate most of your lice removal efforts on the head. But, for those hardy lice or nits which manage to land on a comb and stay alive for awhile, a sensible and moderate program like the P-V-P program outlined in Chapter 3 should take care of the problem.
What are the symptoms of a head louse infestation?
The most common symptom of a head louse infestation is itching, primarily at the base of the neck, behind the ears and at the crown of the head. The itching is caused by an allergic reaction to the saliva that head lice inject into the scalp to keep the wound from closing. People, who are not allergic to the saliva, never itch at all. Other people continue to itch even after the lice have been eliminated. After all, a mosquito bite doesn't stop itching just because the mosquito has flown away.
Repeat infestations can cause some people to become super-sensitive to the bites. Individuals experiencing persistent, intense itching and discomfort should be referred to a dermatologist.
More severe symptoms of head lice include swollen glands and a feeling of malaise, hence the term "nit wit". And people may easily get a secondary bacterial infection because of the scratching. This should come as no surprise. We all know that children don't always wash their hands before they scratch an itch. These infections should be treated under a physician's supervision.
It often takes about a week before symptoms of a head louse infestation appear.
That's why it's a good idea to check your child's head every day for a couple of weeks if your child has been exposed to head lice.
How do you check for head lice?
Diagnosis of head lice is usually made by finding lice eggs (nits). Nits are tiny, oval, yellow or gray translucent eggs firmly attached to one side of the hair shaft at an angle. If you can blow or flick it off, it is not a nit.
Viable nits are usually, but not always, found within a half-inch of the scalp. The mother louse lays the eggs close to the scalp to provide warmth. In warmer climates or seasons, you are more likely to see viable eggs further from the scalp.
To check for nits: Use natural or other bright light. Look all through the head, particularly behind the ears, at the crown and at the back of neck. Check the scalp for lice as well as nits. A magnifying glass can be helpful, particularly for those people with over-forty eyes. Make sure you do a thorough head check because lice and nits can be difficult to find.
You can also comb through the hair with a nit comb. If you are an adult and have no one to help you look, Lennie Copeland, author of the Lice-Buster Book recommends that you comb over a white towel, making sure to catch everything that falls. Use your magnifying glass to make a correct diagnosis of head lice. If you see something moving, and it's not flying or jumping, look closely to determine if it is a louse. 13
People who have been treated for lice over an excessive amount of time can develop DEC plugs (Desquamated Epithelial Cells.) This is oil produced by the scalp compensating for excessive dryness. DEC plugs can be the result of too many pediculicidal treatments. They are white, greasy clumps stuck to a hair shaft and they usually stick all the way around the hair shaft instead of being attached at an angle to one side.
People can also mistake hair casts (dandruff) and hair spray droplets for nits. But, if it comes off easily, or flakes off, it is not a nit.
if you have to pull a suspected nit the whole length of the hair shaft to get it off, and it doesn't crumble in your fingers, it is probably a nit.
How Do You Get Rid of Head Lice?
Getting rid of head lice is a 3-step process. First, you must kill all the nymphal and adult lice. This can be tricky business in the age of pesticide resistance. Pediculicides can no longer be relied upon to do the complete job. But, if you don't get rid of these adult lice you could be nitpicking forever, a tiresome occupation. That's why using olive oil treatments to smother lice, or slow them down enough to be caught in a nit comb, is proving to be a safe and effective treatment option for many families. (For a complete list of louse killing methods read Chapter 2: The Thrill of the Kill.)
Second, manually remove all nits and continue to check frequently and thoroughly for nits over a 21-day period - the life cycle of the head louse. This is a critical step. Experts agree that if you skip this step you could be battling your head louse infestation for a very long time. (See Chapter 5 for a good description of this process.)
Third, you should do a reasonable, but not obsessive job, of cleaning the home environment. See Chapter 3 for the P-V-P method of housecleaning.
- P- Personal Items First.
- V - Vacuum the Right Stuff.
- P - Planes, Trains, and Autos, etc.
How do I know if I am Louse Free?
You have successfully managed to get rid of a head louse infestation if your child is nit free for 10-12 days straight. That means you, as a parent, have to be responsible to check for and remove nits. You should not expect the school nurse or another child to do this job.
Remember that getting rid of head lice takes time and effort. The more you know, the faster you will get rid of them. And don't forget to smile!
Footnote notations can be referenced in the book, Head Lice to Dead Lice.