The Only Time I've Wanted To Shave Someone's Head. Carefully.

In dealing with head lice, there is a quick - almost immediate - solution.  Shave your head. Lice hold on to the scalp by holding on to the hair.  Eggs are laid on the hair.  Nits and lice need the warmth of the hairy scalp to develop and grow.  No hair, no lice.

But I'm not really recommending this.  Not because you wouldn't look good with a shaved head (I think you would probably look great) but because shaving your head is a very drastic response to a problem that is usually easily remedied with a few combings over a couple of weeks.  The time put into a bit of lice combing is significantly shorter than the time needed to grow your hair back.

However, there was one time that I wish I could have shaved a head.

I was asked to do lice removal on a wonderful woman who had long beautiful hair.  Her hair was her crown, her glory - she was so proud of her hair.  She had a really bad case of head lice; the kind that makes you think she has had it for years. From far away her hair was lovely but as soon as you got close, you could see rows and rows of dark brown lice, bug upon bug. It wasn't the worst case of head lice I had seen but it was clear that her head lice would not be dealt with in just a couple of combings. And as I started, it was also clear that her problem was bigger than expected.

Her head was one big scab.  Months, maybe years,  of bites and scratching had left her head inflamed and infected.  Puss oozed from the sores and every time I touched her head, she flinched with pain.  I told her she needed to see a doctor.  She refused and demanded that I comb which I did. I tried to be as gentle as possible but it was clear that she was very uncomfortable. As I continued, I noticed that the glands in her neck were swollen.  I asked her if she had any other unusual symptoms besides itching and she told me she had regular chills and body aches. She wasn't sleeping well and had no energy.  I told her I felt she was having an allergic reaction to the lice and that her scalp looked infected. This concerned me because I knew she also had other conditions that compromised her health.  I explained my concerns but she wouldn't see a doctor.  Maybe she didn't want anyone else to know about her head lice. Maybe she was afraid that the doctor would tell her to cut her hair. Either way, she was adamant that she would be fine with a bit of lice combing.

Because her scalp was in pain, she could not handle the combing for very long.  I gave her my lice comb and told her that she needed to comb her hair daily, as much as she could handle, and reiterated her need for medical attention.  She refused to see the doctor and had me come to her home for one more short visit the following week which was not enough to complete the lice removal process. I asked her if she had used the lice comb.  She said she had been too tired to do the combing.  I told her she absolutely had to see a doctor. She again refused. I suggested she shave her head to get rid of the lice and allow her scalp to heal. She got upset. I did what I could that day but there were no more follow up visits.

Head lice are not normally a health issue.  They are an annoyance.  But the wounds caused by this woman's scratching became infected and her body started reacting to the infection and all the saliva and feces they left there by hundreds of lice.  As I have said before, there are things much worse than head lice.  Please, never let the stigma of head lice or the pride of your appearance keep you from getting the help you need. If your head lice has been going on for months or years, you should get support.  Talk to a friend or family member. Find a trusted professional.  And if you are having any symptoms besides a bit of itching, please talk to a doctor.

Another Question Period

Still recovering from the busy holiday season, I'm trying to catch up on some questions I've received from commenters.  I have paraphrased and combined some questions just to get at the heart of what is being asked. Let's begin...

You say that a hair dryer is a good thing but I did a lice treatment and the instructions said a blow dryer is a bad thing.  Also, I've heard my child can't go swimming after a head lice treatment. Why?

I cover this in an earlier blog post but I still have been asked these questions recently.  The neurotoxic pesticide in many lice treatments doesn't kill lice instantly.  It kills over time.  But things like blow drying or the chlorination from going swimming may make the pesticide inactive. Which is fine by me because pesticides like permethrin are no longer that effective anyway which is why I never recommend them.

What is your personal lice checking routine with your family? Describe your spot checks?

My daughters get a quick lice check in the bath once a week. My son does his own lice checks now. When I say quick, I mean quick.  I don't even use a metal lice comb for it.  I have a regular plastic fine tooth comb and I comb through their detangled conditioned hair.  I check the comb after each stroke for signs of bugs. Takes about a minute. If I find an egg or a bug, then I bring out the lice comb and start combing while my child is still in the tub. This lice combing takes about 20 minutes. I used to then follow this up by blow drying my child's hair and then going through the hair strand by strand to get eggs but I honestly don't do this any more.  I just do another 20 minute combing in the bath 4 days later.  And another one 4 days after that.  And another one 4 days after that.  Though, I rarely find anything past the second lice combing.  As you know, that's all I do - I do no extra laundry, washing of bedding, vacuuming, braiding of hair, changing of schedules, staying up late - anything.  I find that routine lice checks make lice a non-issue.  You find the lice before anyone was even aware there was a problem and you deal with it while the problem is small and easily remedied.

I'd like to talk about spot checks because my position on these has changed.  If someone in the house was scratching their head, I used to stop everything and do a quick look at the scalp to see if there were any signs of head lice.  But now I think this is (a) paranoia inducing, (b) inconvenient, and (c) ineffective.  Visual lice checks only really work if you have a major lice problem and in my home, we never have major lice problems because we catch things early.  So, if someone scratches their head, I ignore it.  If someone scratches their head a lot or complains of itchiness, they get a quick wet combing because wet combings are way more effective than visual lice checks.

I cannot get a lice comb through my child's hair for various reasons.  (Or, I don't have access to a metal lice comb.) What do I do?

If your child is traumatized by the pulling of a metal lice comb even through detangled and conditioned hair, then just use a regular plastic fine toothed comb.  It will take out adult bugs and if you comb often enough you will get out the bugs before they lay eggs; this may take longer but you can still outrun their cycle. But if all combing is problematic, go through your child's scalp with your fingers and just take out what you can. Get under some good light (a head lamp is very helpful in this process.  My dollar store head lamp cost $2.50.) This is actually a very relaxing process for children.  We used to put on comfy clothes, put on a movie, and my children would lay down on the couch with their head on a pillow in my lap and I would just go through with my fingers.  For me, it was like knitting - very calming.  For my children, it was also relaxing - they would sometimes fall asleep and I would have to wake them up to turn over so I could look at the other side their head. As I mentioned above, you can also use a blow dryer; check out how here.  You know, if I knew of lice products that really worked so well that you didn't have to remove the bugs and eggs off the head, I would recommend them. Honest. But, I've been to homes where every lice product available in my country has been used correctly and repeatedly without success.  Manual removal is your best bet - it's cheap and can still be effective if you put in the time.

I'm combing with the lice comb and finding nothing but I feel still itchy.  I can feel something crawling on my head.  I'm sure I still have head lice!  What do I do?

The best thing you can do is to calm down.  Trust the comb.  Itching can be caused by many things that are not head lice, including hyper-awareness.  Everyone starts to scratch their heads at the thought of head lice, including me. If you are not finding anything in the lice comb, then you don't have a lice problem.  That said, still do regular combings once in a while just to make sure.  If the itching persists or gets worse, talk to your doctor.

My child has head lice and you say that I don't need to wash her bedding, vacuum her mattress,  or bag up her stuffed animals.  Are you $!#*% serious?

Yep.

I'm combing my head and this white flaky, sometimes sticky stuff is in my comb.  What is that?

It is "not nits".  It may be dandruff. It may be the build up of some hair product. It may be something gross that the wind blew your way or that your toddler wiped on you.  Nits are uniform in shape; not flaky but oval.  When you get them off the head, they can sometimes even seem to have a teensy little tail - this is not the egg but a piece of your hair that was ripped off with the egg. The bugs always look the same - they just change in size. A louse the size of a speck of pepper looks just like a grown up louse when you check it out under a microscope. So any particles of varying size or shape should not be a major concern. 

My daughter's friend's mom just told me she has lice. My daughter has played with her friend recently.  Does this mean my daughter has lice? 

No.  Whenever I find out that someone we have hung out with has lice, I actually wait until our weekly routine lice check to follow it up. (Unless we have been feeling particularly itchy, then I will do a wet combing to check within the day.)  If nothing shows up in the routine check, I just wait until the next week to do another routine check.  And if I do find lice, I start the routine of wet combing every few days until we have had no sightings of nits or bugs for two weeks.

These head lice wouldn't bother me so much if they didn't bite me all over my body?  What can I do to deal with that?

Talk to a doctor or public health nurse because your problem isn't head lice.  Head lice only bite on the scalp or a bit down the neck or around the ears.  If you have bites somewhere else, you may be dealing with bed bugs, fleas, scabies, or an allergic reaction to something else.

And lastly, my favourite question:

What makes you a candidate for head lice?

Being human.