Something old, something new

The American Academy of Pediatrics just put out a new report on Head Lice.  It is a doozy - it covers everything from lice biology and life cycle, to transmission, diagnosis, and treatment.  It looks at the different pesticides you can use on lice in the United States (which I do not recommend) and non-chemical treatments such as the very expensive machine from Lareda Sciences and in-expensive lice combing.  It doesn't give you all the info from all the studies that are out there, but it tries to provide an overview of what is going on in the lice world today.  Most of what you read here you probably have read before.  However, there are a few new nuggets of interest.

Check it out here.  Of course, there are things I like and things I'm not so keen on in this report.  I'm not going to go through all of it with you here; review it for yourself. Here's just a few things that caught my eye:

"Additionally, because lice infestation is benign, treatments should not be associated with adverse effects and should be reserved for patience on whom living lice are found." 
LIKE - Lice are benign, people!  They are a nuisance to be sure, but they are not the health risk that many schools and parents make them out to be. 

DISLIKE - I really like that it says you should only do a "treatment" when lice have actually been found on the head. However, this paper later says that perhaps you should also do a treatment on people who don't have head lice if they share a bed with someone who does.  Which contradicts the statement above. They say this is prudent but don't back this idea up with research.  I say this is not prudent but I don't recommend any chemicals anyway. What I recommend is that when lice are found on one person in the home, everyone should get a lice check through wet combing. Low cost, no side effects, proven effectiveness.

" Note that some experts refer to "eggs" as containing the developing nymph and use "nits" to refer to empty egg casings; others use the term "nits" to refer to both eggs and the empty casings."

LIKE - I simply like statement his because I have heard other lice professionals say that those of us who use "nits" for both developing eggs and egg shells are wrong.  I use "nits" for both because most people, myself included, should not be wasting any time trying to guess if the egg shell is full or empty.  It is much quicker just to get everything out of the hair.

 

"Pruritus results from sensitization to components of the saliva". - Don't get worked up about this.  Pruritus simply means itching.

 

"However, there are reports that combing dry hair can build up enough static electricity to physically eject an adult louse from an infested scalp for a distance of 1 m."

DISLIKE - I have never heard this before, but it seems there is a study to back this up. Still, mentioning this seems like fear mongering. What are all the factors that would have to be in place for this to happen?  And if it did happen, so what?  If a louse gets ejected off my head due to static electricity, great! One more louse off the head.  It is unlikely that it will be thrown perfectly onto someone else's head.  Wherever it goes, this paper reminds us that the louse cannot live off of the head for very long.  Static electricity is a not a significant factor in the spreading of head lice and mentioning it in this paper will probably cause some panicked parents to keep their children away from static-electricity-causing balloon animals.  This is just one more thing that will distract people from the important work of getting the lice and nits off the head.

 

"A regular blow dryer should not be used in an attempt to accomplish this result [the same results as the modified hair dryer created by Lareda Sciences] because investigators have shown that wind and blow dryers can cause live lice to become airborne and potentially spread to others"

DISLIKE - This statement really concerns me. It is research done by Lareda Sciences that showed the effectiveness of a home blow dryer in the fight against head lice, but they have been trying to suppress this information ever since their report.  In their original research around their product, which you can read about here, they showed that a regular blow dryer at high speed, directed at small sections of hair, killed 98% of the eggs - which was the same result that their modified machine produced.  The notion that we should abandon the hair dryer as a tool in the fight against head lice in the chance that a louse may be blown off the head is ridiculous.  When I am blow drying the dry hair of someone who has head lice, I am directing the air in a controlled way on one section of hair at a time.  I'm not blow drying the hair all over the place in a crowded room. I'm usually in a bathroom or a kitchen and the air is blowing in the opposite direction of me and most people in the room.  If a louse were to be blown off, where would it go?  The bathroom floor?  How will that louse get on someone else's head?  If this is a significant way of getting lice off the head, why are we not recommending it as a removal technique?  Again, the effectiveness of using a blow dryer as directed in the original Lareda study far outweighs the minimal risk of blowing a louse on to someone else's head. As with the notes on static electricity, I find statements like these to be more hurtful than helpful.

 

So, much like most broad papers, this article still recommends the use of chemicals, and surprisingly, it still recommends he use of products like Nix and R&C.  This is astounding to me as there are so many studies showing that these chemicals have lost their effectiveness in Westernized nations. It also recommends doing some extra cleaning and laundry, which is disappointing. However, unlike older papers, this paper recommends that schools DO NOT adopt "no-nit" policies and that such policies might even be human rights violations. Now that I agree with.

 

Anyway, here are my favourite parts of this article:

 

"There is an obvious benefit of the manual removal process that can allow a parent and child to have some close, extended time together while safely removing infestations and residual debris without using potentially toxic chemicals on the child or in the environment...Because none of the pediculicides [chemical treatments] are 100% ovicidal [egg-killers] nits (especially the ones within 1 cm of the scalp) should be removed manually after treatment with any product."

LIKE - No matter what you use, you still have to manually remove the eggs!  But most people buy chemical treatments because they think that it will allow them to avoid this step -they don't want to have to do the work of nit picking or combing. And yet, no matter what so-called "treatment" you choose, you still have to do the work. Of course, you know that in my experience, it is the wet combing that actually solves the problem in the first place, so I think you should save your money and energy by skipping the "treatment" and go right to the wet combing.

 

"As new products are introduced, it is important to consider effectiveness, safety, expense, availability, patient preference, and ease of application."

LIKE - I agree. Keep these things in mind when dealing with your head lice.  I've said it before, effective doesn't have to be expensive. You don't have to put your family at risk for side effects - remember, head lice are benign! The various chemical treatments listed in this study are often not effective, can have side effects, can be very costly, not readily available, and can have confusing instructions for use. In my mind, lice/nit picking, wet combing, and safe blow drying (don't use high heat - the lice can dry up without the scalp getting burned!) are the only treatments that cover all the criteria for effectiveness, safety, and accessibility.