How many studies will we need before we see pyrethrin/permethrin as ineffective with head lice?

These are the related pesticides in products such as Nix and R&C.  I don't know how many studies we will need before our health professionals stop recommending these products but here's another one. It basically says that almost all North American lice have developed a genetic resistance to this pesticide.  Please, please, please don't waste your money on it. The effectiveness quoted in the pamphlets of these products was true when they first came out in the 1980s but our overuse of these products have made them almost useless now.  The last line of this study's abstract says, "Alternative approaches to treatment of head lice infestations are critically needed." Enough said.

Thoughts on Tea Tree Oil

Let me start this post by saying I don't recommend, endorse, or even use any special lice shampoos or treatments.  If you've read this blog before, you know this.  However, you also know I'll let you know about lice research.  And one of the questions I get asked about most is tea tree oil. 

For years, I've looked, but never found any strong research on tea tree oil in relation to head lice.  But today I found the synopsis of a 2010 study done at the University of Queensland.    Follow the link to see the abstract. The catchy title says it all: "A randomised, assessor blind, parallel group comparative efficacy trial of three products for the treatment of head lice in children--melaleuca oil and lavender oil, pyrethrins and piperonyl butoxide, and a "suffocation" product."

This study seems to demonstrate that a shampoo with tea tree oil AND lavender oil has effectiveness against head lice.  Before you go out and buy a bunch of essential oils, please consider these points:

1. Just because something is seen as "natural", it doesn't guarantee safety.
The American National Institutes of Health offers these cautions about tea tree oil:

• Tea tree oil contains varying amounts of 1,8–cineole, a skin irritant. Products with high amounts of this compound may cause skin irritation or contact dermatitis, an allergic reaction, in some individuals. Oxidized tea tree oil (oil that has been exposed to air) may trigger allergies more than fresh tea tree oil.
• Tea tree oil should not be swallowed. Poisonings, mainly in children, have caused drowsiness, disorientation, rash, and ataxia—a loss of muscle control in the arms and legs causing a lack of balance and coordination. One patient went into a coma after drinking half a cup of tea tree oil.
• Topical use of diluted tea tree oil is generally considered safe for most adults. However, one case study did report a young boy who had developed breast growth after using a styling gel and shampoo that contained both lavender oil and tea tree oil.
• Tell all your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

And the University of Maryland Medical Centre says this about lavender oil:

• A small study published in the New England Journal of Medicine in 2007 concluded that lavender and tea oils in some shampoos, soaps, and lotions may cause gynecomastia, breast development in a male, in boys. 
•  Lavender oil is toxic if taken orally.
• There are no known scientific reports of interactions between lavender and conventional medications. However, because lavender promotes relaxation, it may make the effects of central nervous depressants stronger.

2. Effective once doesn't mean effective always.

It is now common knowledge around lice circles (though seemingly not common knowledge with our local school systems and public health authorities) that permethrin/pyrethrin based products, like Nix, have lost their effectiveness.  There are other products that are also losing their effectiveness and tea tree oil has also lost effectiveness in some parts of the world.  Lice researcher, Ian Burgess says, "‘Tea tree oil has a component that works in the same way as the insecticide malathion, so lice are also resistant to it.’  My own anecdotal offering is that I have been to many, many homes where people have tried a variety of products that include tea tree oil with no success. 

When trying to get rid of head lice, we often grasp for any miracle cure, and if that cure seems natural, then we often buy into it hook, line, and sinker.  You know my thoughts about this.  If you choose to use any "shampoo", you will still need to do manual lice and nit removal.  But manual removal, done with a proper comb on wet, conditioned hair is also proven to be very effective.  And it is much cheaper.  You know my vote.  Skip the tea tree oil.

Head lice are like clutter.

In his book, "It's All Too Much", home organziation guru Peter Walsh challenges the notion that the answer to clutter is more storage. To avoid having to get rid of items, or to avoid having to make decisions about all our stuff, we buy into new "storage solutions" - more baskets, file cabinets, shelving and boxes. However, in the end, these do nothing to deal with the real issue - the clutter itself. In the end, to really deal with clutter, we have to find a way to actually have less of it.

This makes me think of how some people deal with head lice. They want to deal with the problem, but they want to do everything they possibly can to avoid actually having to remove the head lice. They buy "treatments", "shampoos", and concoct home remedies. And then, when they still find bugs living on the head, they call me and ask, "Which treatment should I use next?" Or, they spend all of their energy on cleaning their home from ceiling to cellar because of head lice paranoia but can't be bothered to actually deal with the activity on the scalp.

To quote Peter Walsh, "Enough already!" Forget the expensive solutions. If you have head lice, deal with the real issue - the head lice itself. It is only when you take the time to actually remove the bugs and eggs off of the head that you will see progress. And by dealing with the real problem right from the start, you will save yourself time and money in the end.

Lice: 1, Nix:0

As I have mentioned in previous posts, ALL of my business comes from people who have already used some sort of lice "shampoo" or treatment with little success. Doctors, pharmacists, and Alberta Health Services almost always recommend a permethrin based-treatment such as Nix or R&C. Once again, I recommend against the use of such treatments, and not just because permethrin is a pesticidal neurotoxin. I recommend against them because, in my experience, they don't work well.

I just came from yet another home that where a treatment was used on the child about 4 days before my visit. The parents thought that they had solved their child's lice problem, but they wanted me to check through the hair just in case.

Why I don't like lice "shampoos" or "treatments".

In the fight against head lice, so many professionals state that permethrin based products are your first line of defense. They are touted as being necessary treatments when in fact they are not needed at all. Here is why I have a big problem with lice "shampoos":

1. These "treatments"are costly.
My heart always breaks when I hear yet another story of a family that spend hundreds of dollars on "shampoos" and "treatments" only to find that they didn't work. Most "shampoos" require a second treatment in a week. Bring out the credit card - cha-ching! But wait a minute - I charge for my lice checking/removal services - am I hypocritical?

Aaah...The Simple Lice

In her book, Simplify Your Life, Elaine St. James talks about how she used to take all sorts of medications for a cold - decongestants, expectorants, whatever. Then she decided to simplify her cold fighting strategy and traded all her medications for simple Aspirin. In doing this, she found that her colds were actually shorter in duration than they had been when they were being treated with those cold medicine cocktails.

When fighting head lice, I also like to simplify. I do not use any "shampoos" or medicines at all. I just pick and comb (with the proper comb), and I find that the problem actually goes away more quickly. People who use the pesticidal "shampoos" are often less diligent in picking out every bug and egg, and therefore do not get rid of the problem right away. Or, there are some who deal with head lice so severely with random treatments that they cause their scalps to be dry and itchy - and then they think that the problem is head lice, which makes them use more treatments, which cause more dryness and the problem continues.

By just combing and picking, you will not irritate your scalp, nor will you mask the real problems. You will focus your energies into a technique that works instead of wasting your energy (and money) on false promises. Just K.L.S.S. (Keep Lice Simple, Silly.)

Back In The Day...

Do you remember having head lice as a kid? I don't. I think I knew one kid who had head lice, and we just said he had "cooties" (kids can be cruel) and then the school sent him home. Most people I talk to never remember head lice being the epidemic that it is now. Why has the problem grown over the years?

My theory is this has happened because we've put our faith in pediculicides (pesticidal lice treatments). Back in the day, head lice was dealt with severely. Kids were sent home from school. Heads were shaved. Giving people the "leper treatment" probably increased our therapy bills (not good), but perhaps head lice was taken care of in fairly effective ways (with the exception of the turpentine and toxins that were poured on the children in residential schools, but that's another horrible blog post altogether.)

With the arrival of treatments that promised fast results as easy as shampooing your hair with no need to pick out the eggs, all that changed. But so did the lice. The more we shampooed, the more the bugs adapted. The less we picked, the more they spread. So many still believe these treatments are effective and the problem keeps growing.

So what do we do now? As I always say, we gotta pick it old school. Forget the treatments. Pick and comb (with a REAL lice comb, not those little green combs from the treatment packs).

You are the secret to your success.

Use your imagination for just a moment. Let's say your home had a cockroach problem - an infestation. What would you do? You would call an exterminator. What if the exterminator sprayed your house with pesticides and then told you that the spray wouldn't kill the cockroaches right away. Yuck. Then, what if the exterminator told you that you had to go and catch every roach, one by one, to prevent infestation from happening again. I know what I would think - I would think, "Why the heck did I pay that guy when I'm the one who has to solve the problem?"

This is how I feel about the makers of lice "shampoos". They tell you that their pesticides are necessary, but then, and I quote from the Nix website, "If your child has been diagnosed with head lice, you must remove every last one of them, including their eggs, to prevent reinfestation." And then you remove every louse and nit (which is what really solved the problem) and you declare, "The shampoo worked!" Right.

Don't fall for their lice advice. Since you have to go straight to the source of the problem anyway (i.e. you have to remove the lice manually), skip the middle man. Forget the "shampoos". If you really want to utilize a "middle man", I'm your gal.

Lice Lesson #4: Don't believe everything you read.

Or, a little misinformation goes a long way. Traditional lice treatments (pediculicides) say that they will kill all the nits. Don't believe it - nothing is 100% ovicidal. They say these treatments are safe. Then they give you a list of possible side effects. Like many, I used to think that the risks were worth it if it killed the lice. However, in North America, the lice have adapted to these pesticides and have reduced their effectiveness from 50 - 90%. Those lice that are affected lice may take up to 7 hours to die, which gives them time to lay a couple of more eggs. What really gets me, is that you have to pick all of the eggs whether you use lice "shampoo" or not? These pesticides are costly and don’t save you any time, so why use them?
What You Can Do: Kick it old school, or should I say, pick it old school. Go through every section of hair and remove every adult louse, nymph (baby louse), and nit (egg). And then keep checking every day for any new activity. Forget the "shampoos".