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Lice

If you have children, there’s a good chance you’ve had experience with head lice. Head lice affects as many as 12 million people in the US each year, mostly children. Compared to other health conditions, it is a trivial problem; but it is common and annoying. It can cause itching, notes sent home from school, and often a strong “yuck” reaction. Fortunately, several effective treatments are available, including enough “natural” options to please any critic of Big Pharma.

Louse diagram, Micrographia, Robert Hooke, 1667

Louse diagram, Micrographia, Robert Hooke, 1667

The critter

Pediculosis humanus var capitis is a bloodsucking parasitic insect specific to humans. It is 2.5-3 mm long and flattish. It can’t jump or fly or even walk efficiently, but is easily transferred, usually by head-to-head contact with an infected person or less often with an infected person’s headgear, comb, towel, or other object. Infestation is not a sign of poor hygiene.  Lice bite and suck blood 4-5 times daily, injecting an anti-coagulant in their saliva. Mommy lice live for up to 3 months and lay up to 300 eggs at a rate of 3-4 a day. They glue the eggs individually to a hair shaft, usually close to the scalp but in warm climates as far as 6 inches from the scalp. They hatch in 6-10 days, after which the empty egg cases move further and further from the scalp as the hair grows out. The diagnosis can be made by seeing live, moving lice and finding nits (the egg or young lice) on the hair. The best place to look for them is behind the ear and at the nape of the neck. Nits can be confused with dandruff and debris, but these can usually be brushed away while nits remain firmly stuck to the hair shaft. Nits alone are not enough to make the diagnosis of active infestation. They may be either alive or dead: empty or nonviable egg cases may still be present long after the infestation has resolved.

Non-drug treatments

Combing . Removal by wet combing with a fine-toothed lice comb every 3 days for at least 2 weeks produces reported cure rates of 47-75%. Downside: time-consuming, especially if hair is long and thick. Upside: no risks, quality time with kids, satisfies primate grooming urges (chimps pick lice for social bonding and they eat what they find). Shaving the head also reliably removes lice, but it is a rather drastic solution that few people would choose.

Desiccation. Hot air kills both lice and eggs. A study of hot air devices found that the LouseBuster was the most effective: a single 30 minute session was well-tolerated and essentially 100% effective. Only one treatment is needed, and the lice aren’t likely to develop resistance. The device is expensive and requires special training; using a regular blow dryer is not recommended because it can propel live lice airborne to infest other people.

Suffocation. If you can block its air intake, the critter dies. Nuvo lotion was 95% effective in a study that was questioned because it was non-randomized, uncontrolled, unblinded, and had other design flaws. It turns out the doctor who headed the research was re-packaging Cetaphil Skin Cleanser and selling a $10 product under a new name (Nuvo) for $285. That means he’s sneaky, but it doesn’t mean it doesn’t work. More studies are needed.

Home remedy suffocants have included Vaseline, mayonnaise, olive oil, and almond oil. Vaseline and mayonnaise are no longer recommended because they are messy and hard to wash out. Essential oils have also been used, including tea tree oil, lavender oil, neem oil, clove oil, eucalyptus oil, aniseed oil, cinnamon leaf oil, red thyme oil, peppermint oils, and nutmeg oil. There have been a few promising pilot studies of some of these treatments, but the studies have not been replicated; the research is far from conclusive and success rates have been as low as 3.3%.

Drug treatments

Most effective drugs are neurotoxic, designed to paralyze and kill the lice. They do not reliably destroy the eggs, so repeat treatment is typically needed after 7-10 days. Available neurotoxic options include ivermectin, lindane, malathion, permethrin, and pyrethrins. Since 2006 a prescription suffocant, 5% benzyl alcohol lotion, has also been available. The drug of choice today is permethrin; lindane is discouraged because of neurotoxicity concerns but is a good second-line choice in areas where lice have become resistant to permethrin and pyrethrins.

Permethrin (Nix). Generally recommended as a first-line treatment, permethrin is a synthetic version of a natural insecticide that is more effective and less allergenic than natural pyrethrins. Advantages: the most studied pediculicide and the least toxic, reported side effects are mild (itching, redness, and swelling), low cost: $8-9. Disadvantage: resistance is increasing and treatment failures are becoming more common. For treatment failures with 1% permethrin, using a 5% solution and leaving it on the hair overnight under a shower cap may be effective.

Pyrethrins with piperonyl butoxide shampoo (Rid). A natural extract from chrysanthemum flowers, pyrethrins are less effective and more allergenic than permethrin. Advantages: sold over-the-counter, no prescription required, low cost ($5-6). Disadvantage: treatment failures are common.

Benzoyl alcohol 5% lotion (Ulesfia). This is a suffocant that is applied to dry hair, left on for 10 minutes, then rinsed; the treatment must be repeated after a week. Advantages: approved for children 6 months and older, OK for pregnant or lactating women, two double-blind studies showed it to be 75% effective, resistance is unlikely to develop. Disadvantages: not as effective as some other treatments, and higher cost than permethrin ($60).

Malathion (Ovide). An irreversible cholinesterase inhibitor, malathion is the fastest-killing, most effective head lice treatment ever marketed. Advantages: safe and effective, kills eggs, resistance has been reported in other countries but not yet in the US. Disadvantages: not recommended for children under 6 or for women who are pregnant or nursing, long application time (8-12 hours), objectionable odor, flammability, high cost ($150). An earlier version was removed from the US market by the manufacturer but a new formulation was reintroduced and approved by the FDA in 1999.

Lindane (Kwell). An organochlorine insecticide similar to DDT, lindane is stored in fat and nerve tissue. There are concerns about contamination of drinking water, rivers, and lakes, with hazards to fish and wildlife. The FDA issued a public health advisory about the risk of neurotoxicity and seizures, and lindane is banned in California. It is a shampoo applied to dry hair for 4 minutes as a single application; it costs $136. The Medical Letter cautions against its use because there are safer alternatives. It is usually safe when used as directed, but seizures and deaths have occurred with overuse, misuse, or accidental ingestion, and in rare cases death has reportedly followed a single application according to directions. It should be used with caution by those who might be more susceptible to side effects, including infants, children, women who are pregnant or breast-feeding, people who weigh less than 110 pounds, HIV-positive patients, the elderly, and patients with skin conditions like atopic dermatitis or psoriasis. It is contraindicated in premature infants and patients with seizure disorders.

Ivermectin lotion. Two double-blind studies showed this was 76% and 71% effective. It is not recommended for children under 33 lbs. or for women who are pregnant or nursing. Side effects include dizziness and itching. It costs $260.

Ivermectin pills. The pill form of ivermectin is not FDA approved for head lice, although it has been reported to be 95% effective and has been used successfully when all other therapies have failed. The tablets are taken as a single dose repeated after a week. The cost is around $10.

Spinosad (Natroba). A new neurotoxic drug approved by FDA in 2011, spinosad provokes hyperexcitation and eventually paralyzes the lice and kills them. Two comparative trials showed it was twice as effective as permethrin, and it is safe. Side effects are mild and infrequent: irritation at the application site, eye redness, dry skin, etc. It is approved for age 4 and up. It is expensive ($240) but it usually requires only one application and does not require nit combing.

Comparing effectiveness

It’s hard to draw any firm conclusions about the relative effectiveness of different treatments. Comparing results from different studies is problematic. Different endpoints are used. The incidence of treatment-resistant lice varies with geographic location. Home treatments may not be administered uniformly. Did they follow instructions precisely? Did they leave the product on for the recommended time? Did they comb out all the nits? Did the study measure clinical cure or death of lice?

Back to school

Some schools have had no-nit policies where a child couldn’t return to school until all nits were removed. International guidelines say these policies are unjust and should be discontinued because they are based on misinformation rather than on objective science. Dead nits remain after effective treatment, so finding nits in the hair doesn’t mean the child can infect others.

Conclusion

Head lice are more of an annoyance than a health problem. There is a wide choice of treatments to fit every budget, philosophy, and personal preference. Permethrin is a safe, effective first choice; other remedies can be used if treatment with permethrin fails. Even the most potentially toxic product is seldom hazardous when used as directed. The hot air treatment is a new but very promising non-drug option; I’m staying tuned.

Posted in: Pharmaceuticals

Leave a Comment (66) ↓

66 thoughts on “Lice

  1. Missmolly says:

    Thanks for the summary- love the idea of air-frying the little suckers! But where is the evidence explaining why my head started itching as soon as I read this? :)

    1. Frederick says:

      Yeah, i know, I also started to doubt that my dandruff are only dandruff. :-)

  2. Windriven says:

    Lice. Reason number 47 to never have kids.

    Actually, only one of my little darlings ever got lice – though one was enough. My wife at that time was mysophobic and the appearance of lice on the child sent her into full freakout mode. The actual treatments weren’t the problem but everything in the house had to be washed about 23 times before the next great disease-of-the-week broke her fixation with ghost lice. I think it was the Alar scare with apples and apple juice. Sigh…

  3. ChristianB says:

    In Europe we use a product called Hedrin, that I guess would be under the suffocation category. The active ingredient is dimeticone.

    More information here:

    The mode of action of dimeticone 4% lotion against head lice, Pediculus capitis
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652450/

  4. Sean Duggan says:

    We went through this at least once when I was in elementary school. I remember Mom bundling up all of the clothes in the house and running them in the dryer for a while. I also vividly remember the fine comb and my father guiding me through the shampooing process with very strict warnings to not let any of the shampoo get in my eyes because it could permanently blind me. I don’t remember what we used, although Rid sounds familiar.

  5. CHotel says:

    I would always focus my patient (well, parent in this case most of the time) counselling on the nit comb use. Pretty hard to screw up the shampooing bit if you follow the instructions, very easy to not use the comb properly as people don’t understand how intensive you have to be with it. Talk to your pharmacist! (/plugging my peers)

    It has always seemed, to me at least, to be far more taboo a topic than something this common should be. Mothers in hushed voices asking for recommendations, at times almost embarrassed over the situation. Unfortunate. That’s why I like that head shaving is curative; no one would ever do it nor would I recommend such a drastic option, but opening with it in a humourous way has always been a great ice-breaker to ease such interactions in my experience.

    1. Sean Duggan says:

      Lice, scabies, bedbugs… they’re all things that we associate with lower classes and a lack of hygiene and thus people fear revealing that they’ve suffered them. It’s one of the reasons bedbugs are spreading so rapidly in the cities these days (that and bedbugs really are very hard to eradicate completely without a lot of intensive work); people don’t admit to having them until they’ve managed to pass it along to a few friends.

      1. Richard Abbott says:

        Ugh Scabies. Takes me back to when I was school aged. (35-40 years ago)

        I happened to be at school with a lot of children of prison officers. There was an outbreak in the prison, which inevitably came to school, and onwards to almost every child in the school.

        Very very indiscriminate, and I recall my mother having to boil wash sheets daily for a while, to ensure the infestation went away.

        Not even sure what we were treated with, but I recall I didn’t like it much.

    2. MTDoc says:

      I’m old enough, and grew up in a poor rural community, to remember when head shaving was the universal treatment for head lice. Can vaguely recall classmates with shaved heads being rather self conscious about the process. Suspect it doesn’t do much for a child’s self image.

      1. Sean Duggan says:

        I was going to chime in with a “could be worse… one kid where I was growing up contracted mange from his dog” but it turns out that “mange” is the non-human term for “scabies” and “demodicosis”, which refer to infestations of the skin and hair follicles respectively. So, ultimately, he did sort of have the same thing… resulted in him having random bald patches until they got it all cleared out.

  6. goodnightirene says:

    My older children never had them (what changed in schools between mid 70’s and mid 80’s?), but the younger ones (to my utter horror at the time) did. We used something prescribed (premethin I presume) and seemingly got rid of them on the first attempt, but I was VERY thorough and followed directions very carefully. Treatment was always followed by washing everything in the house in very hot water–more from irrational disgust than anything else. I remember the doc laughing at me and saying, “it’s just bugs!”. But echoing Missmolly, I always ended up treating myself because nothing else would stop the sympathetic itching even though I was assured I did not have them!

    My husband got the ones that look like tiny crabs when he was a “weekend warrior” in the Reserves. I was very pregnant at the time, caught them, and it took us ages to figure out what the awful itching was from!–I finally, literally saw one jump on his chest! The ob didn’t want to prescribe the stuff, but I convinced him I would take the risk.

    It’s distressing to read of drug resistance and I’m glad my parenting days are done. I don’t think the grandkids have had them–or perhaps the kids’ memories of my hysteria prevent them telling me! It’s unfortunate, but I was brought up being distinctly taught that lice were a sign of “filth” and rational thinking simply was overridden at the time.

  7. stanmrak says:

    Has anyone ever done a long-term study (like, 30 years) about the health effects of putting insecticide on a small child’s skull, multiple times? I don’t care what the manufacturers, or the FDA claim. Safety not adequately proven for me.

    1. CHotel says:

      Has anyone ever done a long-term study (like, 30 years) about the health effects of most interventions? And even if there were, would you just change your tune to inane chatter about the trials being shrouded in the biases of Big Pharma cherry-picking resultz (FYI: that’s hilarious as Resultz is the brand name of a lice treatment in Canada)? Have there been 30-year long studies for any of the useless CAM interventions you recommend?

      OH NO, THEY HAVEN’T PERFORMED CONTROLLED TRIALS WAY LONGER THAN NECESSARY! ABANDON EVERYTHING! TREATING MY CHILD’S LICE MIGHT MAKE HIM HAVE A MID-LIFE CRISIS IN HIS EARLY 40S. THAT AMOXICILLIN FOR HIS EAR INFECTION IS PROBABLY GOING TO GIVE HIM CARDIAC HYPERTROPHY. I TOOK SOME ADVIL THE OTHER DAY, HOPE MY ARMS DON’T FALL OFF A FEW WEEKS AFTER I RETIRE.

      “Safety not adequately proven for people who hold no ability toward logic and reason, and have a complete misunderstanding of drug safety reporting”

      There, I fixed the last bit for you Stan. Even without a long-term study, if there were issues the adverse effect case-reporting systems would pick up trends and trigger re-evaluation of the product, as they are designed to do.

    2. WilliamLawrenceUtridge says:

      So…don’t use it then.

      Seriously, did you miss that the first three treatments were non-drug?

      Unless you consider essential oils to be drug treatments – which you should since lavender and tea tree oils has been shown to cause gynecomastia. Not to mention – what if they get into the brain?!?!?! Why, your children might turn into credulous loons with no appreciation for the toxicity of natural products.

      Do essential oils count as insecticides? Becuase that’s their primary use – irritants or poisons to prevent insects, or even mammals, from eating the plant.

      1. Windriven says:

        ” Why, your children might turn into credulous loons with no appreciation for the toxicity of natural products.”

        Also Spracht Darwin.

        1. irenegoodnight says:

          ” Why, your children might turn into credulous loons with no appreciation for the toxicity of natural products.”

          This is likely by virtue of nature and nurture.

    3. weing says:

      We should go back to the natural way of picking the lice out of your child’s or partner’s hair and eating them.

      1. agitato says:

        I’ll bet the Paleolithic people did this. If so, head/body lice should be included in the Paleo diet.

    4. Frederick says:

      So you want someone to use that stuff for 30 years non stop? What a great idea… not. you just shown, again, how much you don’t understand about reality.

    5. irenegoodnight says:

      Feel free to shave you and your kids’ heads Stan.

  8. Nick says:

    I use ClearLice on my twin girls. It’s a natural formula that got rid of their lice in one treatment.

    1. Harriet Hall says:

      You offer a testimonial for ClearLice. Here’s an anti-testimonial: http://www.ripoffreport.com/r/Clearlice/Boca-Raton-Florida-33487/Clearlice-Clearlice-Clearlicecomscamrippoffwwwclearlicecom-Boca-Raton-Florida-1048167 The stuff costs $85, they don’t tell you what is in it, and it has not been scientifically studied. Caveat emptor.

  9. Alia says:

    I had lice once, in primary school. And I was also very proud of my long, thick hair. My mother bought something in the pharmacy, without prescription, I believe, put it on my head, covered it with a towel for a long time – and then was very meticulous with the comb. Fortunately, it was only once and I was very ashamed, although I was a clean kid generally.

  10. Calli Arcale says:

    I found one louse on my daughter’s head once, but never found more than that and never found nits; we were quite anxious for a few days, but it seems she just picked up a single louse from somebody else and that louse either didn’t have time to lay eggs or was a boy. I squished it, of course.

    I had lice when I was little, as did my brothers. I remember the nit comb and running everything through the dryer and keeping it in a plastic bag for a while. I don’t remember what other treatments were used; it was a long time ago.

    There is a local business here that opened up recently attempting to dispel some of the shame of lice. They have bright, cheerful advertising and they use a multiple-pronged approach to lice eradication, but will tailor for parents who are concerned about chemicals, on the rationale that they’d rather the parents came to them than tried something worthless. I believe they do offer the heat treatment, and they also will do the nit-combing for parents who are either too grossed out or too worried about doing it wrong.

  11. steney01 says:

    At first glance homeopathy may appear to be an implausible treatment for lice colonization. However, if you consider the utter implausibility of the basic handshake, where atoms are not actually in contact with one another although they appear to be, you can see that we are ill equipped to understand what is or is not plausible. It follows from this argument that homeopathy is therefore a very reasonable remedy to try.
    - Dr. Kitty Katz

    1. Harriet Hall says:

      There are homeopathic remedies for lice, but I elected not to dignify them by including them in my article. I didn’t include prayer, either.

      1. Sean Duggan says:

        I suppose that if you heated the homeopathic method to boiling and then used it on the clothing, then it will work. Water being what it is. :)

      2. Calli Arcale says:

        Heh; the comment is a sly reference to Gorski’s recent post, paraphrasing a pretty loony defense of integrative medicine by Dr Katz.

    2. WilliamLawrenceUtridge says:

      At first glance homeopathy may appear to be an implausible treatment for lice colonization. However, if you consider the utter implausibility of the basic handshake, where atoms are not actually in contact with one another although they appear to be, you can see that we are ill equipped to understand what is or is not plausible. It follows from this argument that homeopathy is therefore a very reasonable remedy to try.

      Wow, that’s…insanely wrong.

      Also, we know that handshakes are not implausible. On an evolutionary level, we know how bodies are shaped to be able to move, and how social forces are shaped by underlying neurology. On a body-level, we know how the nerves generate forces that act on levers (bones and muscles). On a tissue level, we know how bones add or remove calcium, and how muscles generate forces. On a molecular level, we know how minerals form stiff, slightly-flexible bonds and how actin and myosin pivot against each other due to the action of ATP. On an atomic level, we know how inter-atomic bonds form molecules. On a sub-atomic level, we know how electromagnetic attraction and repulsion keep atoms together or force them apart, allowing the transmission of forces without actual contact.

      We understand all of this, from the femtoseconds of inter-atomic activity to the billions of years it took life to evolve from single-celled organisms to multi-cellular groups of social organisms. Nowhere in that vast chain of time and matter is there any evidence that homeopathy can work. Except for one place that is – placebo effects within human neural matter. There, we know for certain it is possible for belief to over-ride our perceptions of reality.

      Reality, of course, doesn’t change at all.

    3. cloudskimmer says:

      Thank you for that. It gave me a good laugh, especially the signature.

  12. Kiiri says:

    from my 10 years experience (and counting) working outbreaks in LHD the one thing that would send my phone ringing off the hook is lice. Lice in a school is apparently the most awful thing to happen if you listen to some parents. I have sat on the phone with parents in full on tirade (30 minutes or more) about why we aren’t shutting the school down and fumigating to get rid of the lice. Or why we aren’t excluding ‘those people’ (usually poor and brown) who brought the lice in? I can tell you that it’s not fun or pretty. On a personal note I and my siblings all had lice as children, at the time I sported hair down past my waist. My mom spent hours nit combing all my hair and I remember myself and my two sisters in the tub with the shampoo on our heads after the dire warnings about not getting it in our eyes, while my mom timed it with an egg timer. Good times. Scabies also freaks people out and everyone gets phantom itch after a scabies call. personally I am more freaked out by bed bugs mainly because they are so terribly difficult and expensive to eradicate. Great article Dr. Hall.

    1. Chris says:

      “Or why we aren’t excluding ‘those people’ (usually poor and brown) who brought the lice in?”

      Possibly those “brown” did not have lice. When I was trying extract the lice from my blond kids a fellow PTA friend told me that it was not common among her Asian folk. This was because the lice did not attach to the very round straight hair common in her family.

      1. Sean Duggan says:

        Huh. I hadn’t considered different hair types. Unfortunately, following that line of thought would probably weigh the argument against black people, at least from what I understand of the general phenotype. I suppose (somewhat humorously) that one could argue that the typical hair care regimen there, with oils and creams and poisonous rinses, is likely to counter it in a lot of cases, assuming one throws out outliers like dreadlock styles…

      2. WilliamLawrenceUtridge says:

        a fellow PTA friend told me that it was not common among her Asian folk

        Methinks this has more to do with positive racial self-image than any reality…for instance, prevalence in the presumably straight, round-haired Thai population, 23%. In the straight, wavy or curly Turkish population, 13.1%. Blond/blonde, wavy Poland? 1%.

        Hugely contaminated research findings given the differences in public health. But still.

        1. Chris says:

          Perhaps. She could have been relating stories from her family, some who were in internment camps during WWII. Her father was in the 442nd Infantry group.

  13. Deborah says:

    Ivermectin pills saved the day.

  14. steney01 says:

    Based on the homeopathic principle that “like cures like”, homeopathy would seem to be the perfect remedy for an infestation of blood-sucking creatures.
    I kid, I kid..

  15. Tsu Dho Nimh says:

    Desiccation. Hot air kills both lice and eggs Using a straightening iron, or drawing the strands slowly through a curling iron, also kills the nits.

    You can combine suffocation and a hair conditioning treatment in one: slather on the oil or lanolin, wrap it up and leave it overnight. Shampoo out like any conditioner. It is NOT any harder to wash out than other conditioners.

    1. kia says:

      Agreed. My kids have never had them and nor have I, but the go-to treatment around all the mums I know is smothering by conditioner, and then heat by hair straightener and using a nit comb. That’s been the recommended solution here for a while now. The general consensus being that none of the pharmacy solutions work as well.

    2. Chris says:

      Just make sure to not use vaseline.

      When my daughter was still in diapers her grandmother forgot to put the top on the vaseline, which we used as butt cream. Dear daughter found it and managed to cover herself and a section of the kitchen wall with vaseline.

      Picking up and cleaning a greased toddler was not fun. And it took several days to wash it out of her hair. But her skin was very soft and lovely.

  16. Zoe says:

    Omg, I never knew I was so alt-med, I did actually use coconut butter. ;-) I tried the shampoos too and they didn’t really work. So we combed with coconut butter for two weeks. I’ve never been through anything this annoying in all my years of parenting like I did a few weeks ago, wish this article were here then!!!!

    Here’s a good article. http://www.slate.com/articles/life/family/2014/03/lice_in_school_let_em_stay.html

  17. Laurenak says:

    I was hoping to get some advice on two questions I had about lice:

    1. Are there any factors that increase your chance of getting lice? As a child I never got lice and my youngest sister I think only got it once but my other sister had multiple cases of lice within a few years. I remember my mother diligently combing all of our hair but I never had a single nit despite living in the same house and going to the same school. I could never work out why that was.

    2. Also I have heard a rumour from parents that not washing your hair means you are less likely to get nits, apparently nits are more attracted to clean hair. Is there any truth in this or is it just another urban legend?

    Thanks for the great article :)

    1. Harriet Hall says:

      The major risk factor is direct head-to-head contact. It’s not very contagious, and it may be more a matter of luck than anything you did differently. Nits are not attracted to hair; they are attached to hair by mama lice. I don’t know of any evidence that lice are more attracted to clean hair, and I certainly don’t think it would be worth having dirty hair just to avoid lice.

  18. Irreducibly Simplex says:

    Has anyone ever done a long-term study (like, 30 years) about the health effects of putting a hat on a small child’s skull, multiple times? I don’t care what the manufacturers, or the FDA claim. Safety not adequately proven for me.

    Stanmrack One day you will post a comment here that is not so absurd that it sounds like a poe, I’m still waiting.

  19. Birdy says:

    My son’s school is fortunately not overly paranoid about lice in that they don’t forbid kids from attending when they happen. However, last year many parents weren’t bothering to check so the problem lasted far longer than it should have. I check my kids every week then every couple of days if the school or daycare has had any cases. That’s how I found the lice very early on last year and managed to have them gone after a single shampoo and careful combing with the nit comb. Didn’t need to do any more cleaning than just their bedding and hats/coats. My daughter has fairly long hair so I’m surprised we managed to avoid them this year.

    Fortunately, Nix has proven effective for us. This is a very helpful review of the available options. Love he idea of frying the little annoyances. I’d like that option!

  20. angela says:

    I’m disappointed in the lack of studies on using oil (olive, mineral, coconut). As a kid, I had a friend whose mother never fully eradicated lice for her, so she would reinfect me over and over. By round six we had the perfect procedure – wash and dry (with heat) or seal in a plastic bag all clothes, bedding, and stuffed animals. And then oil the head overnight. Worked like a charm.

    Rid and nix failed me for weeks until someone recommended that we use mayonnaise, and my dad rationalized that any oil should work. Sad that the chemicals get enough research to cite real numbers on efficacy, but not generic olive oil.

    Sadly, this is one area that makes me sympathize with quacks – research does seem to be focused on things that can be patented or otherwise profited from. :(

    1. irenegoodnight says:

      No one profits from olive oil?

    2. Frederick says:

      There’s also the fact that a lot on Alt-med do not have any possible mechanism to work. We know enough about physics and chemistry to know that something will never work, so nobody waste money on those. And you don,t need patent to make money, otherwise no alt-med will exist, they make billions, so that irrelevant, it is even easier to make money when you don’t need patent, because the way Alt-med work right now, you don’t need to do any research nor any proof that what you sell works. Just tag “NATURAL” on it, and 2-3 testimony, and you are golden. you can also say it is proven scientifically even if it is false.
      Any this topic is covered on all level here on SBM.

    3. Sean Duggan says:

      You may be commenting in response to this, but Dr. Hall does mention the oil treatments as well as linking to a study on them which shows that efficacy has been pretty low when tested.

      1. Calli Arcale says:

        The mechanism with the oil is reasonably plausible; insects do need oxygen to survive, after all, so suffocating them should work. But because of their relatively slow metabolism, they take longer to die than we do. And you’d have to be thorough enough and persistent enough to get all the ones that were eggs when you started. So the low efficacy rates in studies may reflect not so much the effectiveness of the method but the difficulty in carrying it out. If a method is too hard to carry out consistently, then it’s not exactly worthless, but it’s probably impractical to routinely recommend since for most people it would just be a messy waste of time. The potential for human error should always be considered part of the overall efficacy analysis, since we’ll always have human error.

        1. WilliamLawrenceUtridge says:

          And here’s the rub – angela’s comments and apparent success are based at least in part in repetition. Non-pharmacological treatments work just fine, as long as you’ve got practice or are otherwise willing to put in the time and put up with the mess.

          Most drugs take pretty much none of that, though with greater risks.

          There is research supporting suffocation, in principle there’s no real need to go through every single oil to determine if one is superior to another when the real problem is technique.

          1. angela says:

            The study that Dr Hall cited about 3.3% efficacy was specifically about ovicidal efficacy (egg killing) and compared different types of oils. Some oils were as low as 3.3% and others were up around 68%. So yes, apparently the oil does matter.

            Also, I think it’s worth pointing out that it does take time for the newly hatched to breed, so if you drench a head in oil for a few hours on day 1 and again on day 7 you can suffucate them as lice (louscidal efficacy) and not allow them to lay more eggs. I think the low risk, plausibility, and ease of use really makes it worth promoting.

            However, olive oil can’t be marked up as much as rid or nix. If alt med nuts try to sell a “special blend” that is really just olive oil then the consumer can just buy the cheaper item – generic olive oil. You could really only profit on oil during louse outbreaks in specific localized contexts.

            I just want to see more research on louscidal effect, minimum hours of application, minimum schedule (day 1 and 7? Or more? Less?), and adherence. Once we have real numbers, we can send kids home with information from schools endorsing a louse treatment method as non toxic as shaving a head and nearly as effective – just grab your cooking oil.

            1. Sean Duggan says:

              Hmm… I wonder if, were one to use the lice comb every day for the same week, if you’d get a similar level of efficacy with less greasy hair. Among other things, you have to consider the ecological impact of using up that much water to get the oil out of the hair every night (I have a sneaking suspicion that many people would balk at wearing said oil 24/7). As stated by Harriet, combing every 2-3 days for two weeks does have middling efficacy, and if you have the discipline to do it every day…

      2. Frederick says:

        yes, i know, but in that case oil had a possible mechanism to work, ( that’s why i was tested) but nobody will test if reiki work for lice. because we know it cant do nothing, that is is what i meant.

  21. lkr says:

    Lice mature fast, but they do NOT “copulate as early as 10 hours after they emerge from the egg”. Minimum generation time is about a week from hatching from the egg. There are 3 molts, the last the adult stage which CAN copulate within 10 hours, and then for hours and hours…. This is a rather important detail, since it means there’s a week to treat people who’re exposed, eg, in school, before the more resistant eggs are produced.

    1. Harriet Hall says:

      Thanks for that information. The website I consulted apparently confused the stages.

  22. Kathy says:

    Might be worth mentioning that there are three different lice infesting human beings, head, body and pubic (crab) lice. They have different habitats (obviously!), lifestyles and treatments. Don’t want any confusion here.

  23. Yodel lady says:

    Straying a bit off topic, but the FarSide cartoonist had a great cartoon of two crab lice walking hand-in-hand through a forest of long, straight hair with the caption, “Toto, I think we’re not in Kansas anymore.”

    Never had head lice but I don’t know why. As a child I was forbidden to share combs and hats; I guess that helped. I’m pretty sure my mother would have poured kerosene on my head.

    The bedbugs got me, though, recently! I can recommend a cheap motel not to stay at.

    1. Sean Duggan says:

      If it’s the one I’m thinking of, I believe those were supposed to be ticks, although I could be wrong. ^_^

  24. FastBuckArtist says:

    Head shaves.
    Easiest way to get rid of the suckers, preferred solution in prisons and military.

    1. WilliamLawrenceUtridge says:

      The easiest way to ensure vaccine-preventible diseases are eliminated is universal, mandatory vaccination. Are you in favour of this as well?

  25. CS says:

    The real public health challenge is ridding the stigma and hysteria that surrounds this mostly minor and aggravating condition. My daughter had lice only once but I received a panicked and angry call from the school that I had better come pick up my daughter NOW and that she was forbidden to remain in her classroom until i got there. I found her sitting forlornly in the school entrance. I tried to educate the school on the real public health impact of lice (minimal) and the APA recommendation NOT to exclude children from school because of lice, and the response was, “We make the lice policy here. We don’t need to listen to the APA.” The real impact of lice is repressive school policies that lead to educational, social and psychological damage.

  26. Old Muley says:

    Our school nurse swears by a product called “Licefreee”. The label says it is homeopathic and contains Natrum Muriaticum 2X (Sodium Chloride), Benzyl Alcohol, Fragrance, Poloxamer 188, Purified Water.

    What puzzles me is can a product really be called homeopathic, when is actually contains measurable amounts of a real active ingredient (Benzyl Alcohol) that is approved for treatment of head lice?

  27. M Welinder says:

    You missed a non-drug treatment: cut the hair off. I have no idea if it is directly effective, but *nothing* hides in hair that 3mm long.

    1. Harriet Hall says:

      No I didn’t. I wrote “Shaving the head also reliably removes lice, but it is a rather drastic solution that few people would choose.” Perhaps you read too quickly and missed that.

  28. Sonysunshine says:

    When my children were attending an overseas private school, they got lice several times. Everyone did; must have been the long winters and sharing of hats. Lice is much less stigmatized in Europe. We bought a product with dimethicone, and it worked like a charm! We used it, then blew dry the hair after every shower for two weeks while also checking for nits. Worked every time. Plus, the dimethicone leaves the hair incredibly soft.

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