As many as one in ten primary school children are affected by head lice every year, and ten to twelve million Americans aquire a case of head lice yearly.

Because head lice are not common carriers of communicable disease are not given funds to fight and prevent this nuisance. Serious sores and bacterial infections as well as anaphylaxis type reactions. Recently the incidence of resistance to routine medications has risen and the continued- ued spread within daycares and public schools can get out of hand.

Head Lice or Pediculus humanus lay eggs that us attached to the patient's body hairs (as well as fibers on stuffed toys clothing or bed sheets).These eggs are called nits. They appear as small oval protrusions or bumps from the hair shaft. OId open ones may take on a clear to white appearance but are firmly attached requiring effort to re- move. Eggs hatch in approximately one week. These nymphs feed off the host and in two to three weeks mate. An adult female lays from 250-300 eggs every 20-30 days.

HOW ARE THEY TRANSMITTED

Head lice are transmitted through personal contact with an infected patient or close personal article of clothing such as hats, combs, hairbrushes, bedding, stuffed animals, pillows etc.

SYMPTOMS

They most often congregate on the scalp in the temporal and occipital areas of head along the hairline (the sides and back) but they can involve the beard, eyebrows snf even armpits in severe cases. The louse is sometimes not seen but the nits are readily found. Other signs can be intense itching of the scalp, swollen lymph nodes in the neck, as well as a rash to the upper extremities and trunk (chest and abdomen).

TREATMENT

Non Drug - Wet Combing: after washing or treating with medication, combing the hair with a fine toothed "nit" comb available separately or in medication kits to remove eggs. Using conditioner may help slide the comb through the hair easier. This may be done alone or with other therapy (most affective) but should be done daily until infestation is gone.

Petroleum jelly: The patient should cover their hair with a thick coat of jelly and place a shower cap over scalp over night.This method is very effective in suffocating the mites and nits. Making it the treatment of choice when medication fails to prove affective. Although it requires several shampooing's over a period of two weeks to remove the jelly completely.

Olive oil: An alternative to Petro-jelly, it is easier to remove and applied the same way but tends to fail more often.

Drug Therapy - These medications are low dose pesticides and are generally low risk when used as instructed although resistance (inability to kill insect) is on the rise. A common drug is Permethrin. Two dosages available. 1% available over the counter at drug stores and 5% prescription dosage (Elimite) medication is synthetic and remains active for 2 weeks or more. It is poorly absorbed through the scalp and rap- idly metabolized by the body and excreted in the urine.

Standard treatment should consist of washing the hair with shampoo then applying the lotion and leaving in scalp for ten minutes, then rinse out and follow with a THOROUGH COMBING WITH A NIT COMB. A second treatment is necessary in 7-10 days to kill newly hatched lice.

Resistance or continued failure should be addressed by Family Doctor.

Wash all toys, bedding and for serious infestations carpets should be steam cleaned as well as the whole family treated. If a high heat dryer is not available you may bag materials in garbage bags "air tight" and leave seated for 30 days.

After initial identification of infestation you should notify school or daycare and child should be instructed to avoid close contact or sharing of items. Shaving of head brings on stigma and is not effective in removing lice since eggs are attached at base of hair shaft, Schools should avoid having coat hooks that allow clothing to touch and should cleanse all dress up clothes daily.

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