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.

Margaret Cho sings "Lice"

Margaret Cho, comedian extraordinaire, performed a soulful song on The Late Show with Stephen Colbert that I will be singing for days.  Anything that puts the lowly louse in the spotlight is welcome and refreshing.  It is musically lovely and a truly enjoyable performance. But as you listen, see if you can you find the misconceptions about how to manage this critter crisis.

 

• The song starts with an implication that you get lice from an impoverished nation. Lice has no nationality - wherever there are humans, you will probably find lice. Though, there are some populations which seemingly have a lower chance of getting head lice.  At least for now.
• In this song, Cho says you need shampoo, which I'm assuming means a pesticide treatment.  This is not true, especially when the pesticide in the most popular lice "shampoos" have been shown to be ineffective. Lice have built a resistance to them.
• Cho mentions a fine toothed comb.  If you have lice, this is your greatest weapon in the fight.  Combs with long, rigid, metal teeth are the best. Plastic fine toothed combs, while still somewhat effective on getting out adult bugs, are not as effective on eggs and nymphs.
• Shaving the head.  Drastic, yes. Not the way I would go but it is a way to get rid of your head lice in no time at all. Just getting an army buzz cut isn't enough - lice can still thrive on a scalp with very little hair. Did you watch the end of the song?  Cho totally rocks that look. In the song, shaving the head is mentioned in the context of having dreadlocks.  I have to say, I know of no truly effective ways to treat head lice on people with dreads. If I had dreads for religious reasons, head lice wouldn't be a good enough reason to shave my head. Since someone with dreads can't get a lice comb through the hair, the fast blowing air of a blow dryer might be their next best tool.
• With lice you don't have to 'go to the mattresses'.  In fact, you don't have to do anything with your mattress because lice don't live on your furniture. They live on your scalp.  Save the dragging of your mattress outside to bake in the hot sun for your bed bug problem. Lice also do not thrive in your garbage. Do they make apartments in your ears? No. Around your ears? Yes.
• Will lice seem like they are dead after a shower? Sort of.  When wet, lice sort of hunker down and close themselves off - they move more slowly and may seem like they are no longer a problem. But those suckers can hold their breath for a long time and can stay alive in water for a day. So, while your shower won't get rid of your lice problem, a wet louse, is easier to detect and comb out.  And if you add some hair conditioner, you can even get the nits out more easily too. 

Even though I disagree with some of Cho's lice premises, I still love the song. Head lice shouldn't be something that we freak out about. Some laid-back humour is just what we need to get through the pain-in-the-arse that head lice is. Anything to get us past the stigma of having this very common pest.

Now, if I could only find out where I can get that awesome louse hoodie.

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.

 

Oooh, I like this one...

Here is a Sept 2014 article from the CBC (that's the Canadian Broadcasting Corporation - if you are not from where I live).  I think it is a good article, but that's because of my personal bias towards wet combing with conditioner and a metal lice comb and my bias against using so-called "treatments". Check it out: http://www.cbc.ca/news/health/head-lice-most-used-treatments-no-longer-very-effective-scientists-say-1.2776917

Question period...

Many questions have come up in recent comments and conversations. I think that there are others that might have similar questions, so I thought I'd answer some questions here to the best of my ability.

Question: I combed and got rid of the lice but found no nits.  Am I lice free?

Answer: Where there's smoke there's usually fire and where there's lice, there are usually nits.  Not always, but you should keep on wet combing every few days just in case a missed nit turns into a unwanted bug.  When you have been regularly combing for 2 weeks with no new bug sightings, that's when I think you can breathe a sigh of relief and reduce your combing to routine lice checking.

Question: Two months ago we had head lice and we beat it but now my daughter has it again.  Why?

Answer: I don't know.  Either something was missed the last time your daughter had lice or she just got it again from someone else.  Beating lice once doesn't mean that you will never get lice again.  Just take a breath and start combing.  Remember, don't waste your time on ineffective busy work - no extra laundry washing, vacuuming, or bagging up toys.  Just get those suckers off the head.

Question: Is there anything I can do to prevent from getting head lice?

Answer:

Liceworld. Not Disneyland but still exciting for me!

In the effort to always give you the most up-to-date about head lice information, I want to show everyone a great website called "Liceworld".  I just found it and the information is great.  Lice researcher Ian Burgess is one of the contributors. From what I see now,  it seems this website has been created for the purpose of providing information.  However, most researchers (Ian Burgess included) have links to some type of product so I suspect that in the near future, we will see some links to some money-makers (It's the development part of R&D - research and development - that really pays the bills.)  Still, so far, it looks good. Check it out here.

Faster, higher, stronger

Here's a link to an article from the British newspaper, The Telegraph, where it says that a extra humid conditions led to an increase in the number of cases of head lice just before the Olympics.  The article quotes Ian Burgess, one of my favourite lice researchers, as saying one in ten children has head lice. It also says that over half of Britain's 4 to 11 year olds get lice every year. It mentions that 53% of people are asymptomatic (they don't know they have lice until the problem is really bad) and that lice are immune to over the counter products 80% of the time.  Interesting stats - I wish they would show the research to back this. Interesting that this increase happened just before the Olympics. These lice fit the motto of "faster, higher, stronger".

If head lice really creep you out, don't look at these pictures.

Rick Speare, who was a professor and researcher at James Cook University, developed a great slide show on the biology of the head louse. Check it out here. The pictures are amazing and show an indepth look at the louse's specialized parts. (In this picture, I imagine louse saying, "I'm a survivor!") These pictures and explanations can help you understand how a head louse operates. Very interesting stuff, but it also just goes to show that any bug, when you look at it closely enough, looks sort of like something from "Alien".

Why don't African-American/Canadian children get head lice?

It's true. It is extremely uncommon for African-American children to get head lice. What makes this strange is that Black African children get head lice. What's the difference?

This 2001 article from the University of California explains the reason behind this. North American head lice prefer hair that is round in cross-section - like the hair of Caucasian and Asians. But the hair of African-American's is ovoid (oval or egg-shaped) in cross-section. So they don't like it that much.

The hair of the Black African is also ovoid. But the head lice in Africa have adapted to this shape of hair. Because this is what head lice do. They adapt. In other words, given some time, I'm sure North American head lice will be equal opportunitiy parasites.

How do you get lice? From someone else's head.

Click on this link to a great study that supports the idea the head lice are NOT effectively spread through inanimate objects (clothing, furniture, pillowcases, hats, brushes, etc.). This study is from the Anton Breinl Centre for Public Health and Tropical Medicine at James Cook University, Austrailia. My favourite sentence from the conclusion is:

"We conclude that the control of head lice should focus on the head and not on the environment."

Incidently, this study also mentions how long lice can live without a meal:

What about nits (eggs) not right near the scalp?

Nice picture, huh? I like and encourage the reading of a variety of head lice fact sheets from a variety of research centres/universities. While the facts are usually (but not always) the same, they occasionally use different language that helps you understand an issue more clearly.

For example, here's an excerpt from the fact sheet from the Entomology Department of the College of Agricultural Sciences of Penn State University. It is regarding the viability of eggs that are not right near the scalp:

Beware the physician that makes a commission.

As a lice professional, I am happy to take your money. But I am also the first to tell you that while you may need my advice, you probably don't need my services.

What You Should Know About Head Lice

Here are some basic facts about head lice. You should really know what you are dealing with. As they say, knowledge is power.

Head lice are very small, and often difficult to find on the scalp, but they are not microscopic.
Lice and eggs are not like viruses - they can be seen with the naked eye. Their eggs are like tiny oval drops that are yellowish-white and are completely glued to the hair. The baby louse starts out as small as a speck of pepper. After hatching, it is completely clear in colour, but it turns red after its first meal, and it then turns a translucent brownish colour as it grows. Its colour can also be enhanced by the colour of the hair it is in – head lice look darker in lighter hair and can easily blend in with darker hair. A louse is as big as a sesame seed when it is fully grown.

The life cycle of lice lasts around 50 days.
They are in an egg for 7-10 days. After they hatch, they grow and molt their way to adulthood for another 10 days or so, and then once they reach adulthood, they live for about 30 days.

The female louse can lay about 3-10 eggs every day.
She can lay up to about 100 eggs in her lifetime. It sounds like a lot, but you can always pick her eggs off faster than she can lay them if you are diligent.

Lice are only passed from head to head through direct contact.
They cannot jump, they cannot fly, and you can’t get them just by being a room with someone who had head lice. The most current research shows that you also cannot get them from inanimate objects such as hats or brushes that have been used by someone who has head lice.

Head lice are a nuisance and a big inconvenience, but they are not a health issue. Unless you scratch your head so much that you create wounds that get infected, the head lice just create a bothersome itch, and that’s all.

Head lice like clean heads. They like dirty heads. They just like heads.
Having head lice does not mean that you have poor hygiene.

Head lice can only survive off the head for 2-3 days.
Otherwise, they starve.

Head lice can hold their breath and hang on.
This is why they are not affected when you go swimming or have a shower.

Head lice live on the human head (and sometimes they visit the neck for a snack).
You cannot give them to or get them from your pets. If you see bites on other parts of your body, you are dealing with something else and should seek medical attention. If you see bugs crawling around your home and you know that they didn’t just get shaken or brushed off of your head, then you can safely say that they aren’t head lice but a different problem to deal with.

Head lice are stopped by head cleaning, not house cleaning.There is no evidence to show that house cleaning or laundering will reduce your chances of reinfestation or will increase your chances of getting rid of the problem. They live on the head and are useless off of the head. So don't waste your energy by performing a marathon cleaning/laundry frenzy. Save your time for dealing with what's on the head.

No Viagra Required

Clients sometimes tell me crazy ideas about how lice reproduce. Some think that they are like viruses, that you can get infected just by being in the same room as someone with head lice. Some think that head lice are hermaphrodites - that they have both male and female sexual organs and fertilize themselves. Not true.

Both a female louse and a male louse are required to produce a fertilized egg. So, why then can you get lots of head lice from just one bug on your head? Well, if the bug is a male, not much will happen. But if the bug is a fertilized female louse, watch out, because a little sperm goes a long way.

The female louse mates with the male louse just once and receives all the sperm she will ever need. She stores all the extra sperm in her body in a receptacle called a "spermatotheca". Then her eggs just get fertilized as she goes. Not very romantic, but it gets the job done. Bow chicka wow wow!

This is your louse. This is your louse on drugs. Any questions?

It has been brought to my attention that on the post about head lice impostors, I forgot to actually show you a picture of the real deal. So, here is a picture of an adult louse. Like any insect, it has 3 pairs of legs. Each leg has a lovely hook that has been designed to grab on to human hair. Baby lice (nymphs) look like this, but they are smaller and can even look like a black or red speck of pepper. Because they are kind of see-through, lice blend in well with most hair colours (they look darker on darker hair). Sometimes, you will see that lice are darker in their nether regions - that's because they are full of your blood!

The lice life begins in an nit (egg) which will hatch after 7-10 days. Then, they are nymphs (I call them teenagers) and it will take them around 7 days to grow into egg-laying bugs. Once reaching adulthood, lice can crawl around your head for around 30 days. In other words, the complete life cycle is around 30-50 days.

Harvard U. has great information page on head lice, which include the following lovely pictures of nits at different stages.

Once an egg is hatched, the removal of the egg shell is not necessary, but I do it anyway, because I would hate to miss something. As you can see, the nits even take on different colours depending on their stages. In my fair-haired son, nits can look quite dark. In a dark haired person, nits can look white. That's why I just pick every nit. Remember, nits can look like other things, but if the object moves, it is not a nit.

As I have said before, lice can't fly (no wings), they can't jump (no Nike shoes), and they hang out on human hair only. And whether sober, or on drugs (the pesticides in lice "shampoos") the louse looks the same - alive. So you gotta pick. Good luck.