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Lice Advice? Don't Panic!


Written by Maria Gaura

Healthy Living

SANTA CRUZ (January 2011) – New shoes, a blank notebook, and first-day jitters are classic signs of a new semester. But nothing says “back to school” like a note from the school nurse telling you that your child's class has been exposed to head lice.
Humans have shared their body warmth and blood supply with head lice for millennia, and our species have co-evolved to the point where our head lice are unable to survive on any other creature, or more than a few hours apart from our tender, tasty scalps.
Yet despite our intimate historical acquaintance with Pediculosis capitis, most parents come unhinged at the sight of these seed-sized villains milling about in their child’s hair.
“The parents that bring their kids to me are more upset about head lice than just about anything,” said Dr. Dale Pearlman, a Menlo Park physician whose research on non-toxic head lice treatment has drawn worldwide interest. “It seems like it just grabs at their souls.”
As many parents can testify, a diagnosis of head lice can bring feelings of shame, disgust, and frantic, phantom itching - even to non-infested family members. Uncertainty about where the little vermin are hiding can provoke days of crazed housecleaning. And even more wrenching for many adults is the question of whether to use pesticide-laced shampoo to treat their children, or to opt for less-certain non-toxic treatments.
First, Do No Harm
The first step in dealing with a possible lice infestation is to make a cup of tea, sit down and refuse to panic. Remember that head lice do not carry disease, and will do no lasting harm to you or your children. However, children have been harmed by freaked-out adults who have poured kerosene on their heads, sprayed them with pesticides such as Raid, or even applied flea and tick medications intended for animals.
While most parents opt for approved over-the-counter treatments such as Nix or Rid, which kill lice by poisoning them, research has shown that a non-toxic treatment that kills lice by suffocation can also be highly effective.
And as an additional bit of good news, research has also shown that extreme housecleaning measures are not needed to eliminate lice from the home. Despite what you may have heard from friends, or even your local health department, there’s no need to banish the stuffed animals, shampoo the carpet or shave your kid’s head. Lice can almost always be eradicated by one of several different scalp treatments combined with a wash of bedding and hairbrushes – and the use of pesticides in the process is strictly optional.
A Checkered Past
While the mild pesticides approved for over-the-counter lice treatments are generally considered safe for occasional use, skeptical parents have noted that numerous chemicals once considered safe have later turned out to be harmful.
In past decades, pesticides including DDT, Carbaryl, Lindane and Malathion were routinely used to kill head lice on children – before such use was banned or restricted. DDT was banned in the U.S. in 1972 due to its devastating effects on wildlife, but the chemical is also a suspected human carcinogen, and accumulates in human tissues. Carbaryl is a suspected carcinogen, and Lindane has been known to cause severe seizures in children. Malathion has been removed from the market twice in the U.S. due to various concerns, and is now available only by prescription, though it is not advised for young children.
The two main pesticides now allowed in over-the-counter lice remedies are pyrethrin and permethrin – both of which are neurotoxins, substances that kill by attacking the nervous system. Pyrethrin is derived from chrysanthemum flowers, and permethrin is a synthetic version of that substance. The small amounts of pyrethrin or permethrin required to kill lice are considered safe to use on most children, according to academic and industry research.
But in addition to concerns about safety, there is evidence that lice are developing resistance to these products.
Mutant Bugs
It was the question of pesticide resistance that first drew Dr. Pearlman’s attention to head lice.  “Some of my pediatrician friends said “hey, these lice chemicals have lost their kick – what are we going to do about it?” Pearlman said. “The lice had mutated, and the chemicals didn’t work anymore.”
Pearlman, a dermatologist who had little previous experience with head lice, devised a treatment that would smother the “little so-and-sos” instead of poisoning them. “I reasoned that lice can mutate in response to a chemical, but if they can’t breathe, they’re dead,” Pearlman said. “And there’s no way to mutate around that.”
Other traditional lice-control methods include slathering the scalp with thick applications of oil, mayonnaise or conditioner, and then combing the hair thoroughly with a lice comb. But information on these methods tends to be anecdotal, and the American Academy of Pediatrics further notes that herbal remedies are unregulated by the Food and Drug Administration, and can contain naturally-occurring toxins.
Pearlman, however, designed and ran an open clinical trial of what he called the Nuvo method, which involved coating the hair of infested children with non-toxic Cetaphil cleansing lotion, then drying the hair thoroughly with a hair dryer. The slightly sticky lotion, when dried, essentially shrink-wrapped and suffocated the lice, and Pearlman’s study resulted in cure rates of 96 percent after a series of three treatments.
Because neither Cetaphil nor pyrethrin-based insecticides reliably kill the tiny lice eggs (nits) that are glued to hair shafts, repeated treatments are necessary to kill newly-hatched lice before they get old enough to breed.
Follow The Instructions
Pearlman and others in the field suspect that many re-infestations are due to treatment instructions not being followed, rather than to pesticide resistance, or to stray lice lingering in the home environment.
Finally, misdiagnosis happens frequently, and is one of the reasons why the American Academy of Pediatrics has recommended that schools abolish “no nits” policies, which bar children from school if any nits are found in their hair. Studies of children sent home from school as a result of these policies showed that only about half had active lice.
“I see children wrongly diagnosed all the time,” Pearlman said. “I had one 13-year-old girl who hadn’t been allowed to have a sleepover for two years because of apparent resistant head lice. And she didn’t have head lice – she had dandruff, a condition that we call false nits. She was diagnosed by the school nurse, who had never looked at these things under a microscope.”
The take-home message to parents, according to Dr. Pearlman, is “don’t work yourself into a tizzy over lice. They’re not hard to cure, and we’re a lot bigger than they are.”