The Ultimate Intruder: Head Lice

Head lice invade over one million scalps per year, most of which tend to be kindergarten and early school age children, and quickly invade the rest of the family! There are many myths out there, like a lice infestation means you are unhygienic, but that actually isn’t true.  The wingless, tiny parasites that live on your scalp and the blood source to your scalp, actually prefer a cleaner home, and is spread by close contact and sharing clothes (hats) and other personal items (towels, brushes, etc.) The official name is pediculosis capitis, and there are some ways to prevent your little ones from bringing home this infection, and what to do when they do bring it home!

The Symptoms of Lice:

Usually an intensely itchy scalp is the first sign of lice, but you also might notice red itchy bumps on your head and neck. When the lice bite into your scalp to get the blood to feed off of, it can cause a small allergic reaction, which leads to the bumps and itchiness.  Also, when the lice lay eggs, people notice a increase in “dandruff” which is usually little yellow lice eggs that line the hair shafts. Adult lice tend to cause more itching around the back of the ears and neckline. And although you might see the eggs on the hair shafts,  that is not enough to truly diagnose the infection, but if you do have a lice infection, the way to truly diagnose is to visualize lice moving on the scalp.

What are some Treatments?

If you notice any of these symptoms, you should try an Over-the-Counter (OTC) treatment shampoo, to try and kill off the parasites early. The OTC shampoos either have pyrethrin (like Rid) or permethrin (like Nix). If that does not work, you can call your Healthcare Practitioner (HCP) to prescribe a stronger treatment.

Malathion (Ovide) is a medication that should only be used on people older than 6 years old, rubbed into the hair and scalp, but it is highly flammable! Benzyl alcohol lotion, is also applied the same way as the malathion, and is a newer treatment that cannot be used on those less than 6 months old, and even in adults, the FDA does warn of risk of seizures and other pretty serious side effects. As with any treatment, make sure that your HCP is aware if you are pregnant or breastfeeding, as some of the drugs are absorbed into the skin and can be excreted in breast milk.

If you are worried about absorbing the chemicals, you can also just wet your hair, and comb it, using a fine tooth comb, every 3 days for 3 to four weeks, which allows you to remove the lice and eggs, and this is the best method with really young children. It obviously takes longer to get rid of the infestation, but it does so without chemicals, and could be an option for those wary of chemical use. As lice can live for up to around two days without a food source, and nits (the eggs) need to live at scalp temperature, combing the bugs and lice out can help to stop the parasites from further breeding.

Also, this won’t work for girls, but young boys, you can cut their hair short (as long as they aren’t opposed) to help remove the lice and nits!  One of my good friends (who happens to also be an RN) JUST had this lovely experience, and was nice enough to send along the pics of their experience:

with hair.....

with hair…..


without hair...and getting the combing treatment!

without hair…and getting the combing treatment!

How do I prevent the spread in my home?

Heat and lack of food sources help to end the infestation in your home: 

-Wash all clothes, sheets, towels, etc in hot water (at least 130F/54.4C) and dry on high for a minimum of 20 minutes.

-Brushes, combs, hair care products should be soaked in very hot water for at least 10 minutes (make sure to use insulated gloves to protect yourself from burns!)

-All comforters, pillows, bedding, and other items that are tough to wash, should be placed in air tight bags for 3-4 days to cut off air supply to the parasites and kill them and the nits.

-Vacuum all rugs and couches to remove any possible lice or nits

Also, remind your children not to share hats or scarves, helmets (if playing sports), or any brushes or other hair care products. This can’t always be avoided, and kids will be kids, but it is a good reminder to help and prevent an infection. And remember to tell them, if they do get lice, that it doesn’t mean they are unclean or dirty, but it is something that happens to many people, and with some quick treatments, a lot of laundry, and some parental strife, all will be back to normal soon!  Plus, tell your child’s school nurse, coaches, etc to make sure that the infection isn’t spread and other parents know to look for symptoms.

Yours in Good Health



What is the most contagious STD?

I was quite shocked that crabs (AKA pubic lice) is as prevalent as it is. But in the past week I have been asked about it three different times from people all over the US, which made me think that this topic needed a little discussion related to what crabs are, how you get them, and how to treat them.  I wasn’t sure how prevalent they are, but they are clearly around, and infections are on the rise.

What are crabs?

Crabs are also known as pubic lice (Pthrius pubis) and they are parasitic insects that feast off the blood of humans and live in coarse hair (i.e. pubic hair, eyebrows, eyelashes, chest hair, armpits, mustaches, & beards) causing itching, discomfort, and rashes. So you can understand how they can not only be really irritating, awkward, and kind of gross to think about, right?  They pass from person to person usually through sexual intercourse (or sexual acts) but they can also jump from person to person through hugging or other close contact (sharing towels, clothes, bedding, etc.) Despite the fact that crabs can’t live very long away from the warmth of a human body, they are still the most contagious STD, and if an infected person has sex with a non-infected person, the risk of getting crabs is about 90% for that previously non-infected person.  That is pretty shocking, and horrifying…a 90% chance?!?  Plus the lice live from about 1 to 3 months, and in that “lifetime” the average female lice has about 300 eggs, which means they breed quickly and frequently! These parasites spread quickly.

What are the signs and symptoms of infection?

Usually the only symptom is itching….extreme itching.  Sometimes you can visualize the bite marks on your skin, they are bluish in color, due to the bruising from them sucking your blood to the surface, but it is very hard to see. Sometimes there are little red bumps from the bites, and then scratching them. Most often the itching and discomfort brings people in to their HCP.

How do I treat it?

First, when you find out that you are infected, let the people you live with and sexual partners know about the crabs, and clean all sheets, clothing, towels, etc in water that is at least 130F and dry it thoroughly in a dryer to kill off the lice living in the sheets.  If some of these items cannot be washed, then have them dry cleaned.  You can also buy an over the counter (OTC) treatment from your local pharmacy, like Permethrin 1% creme, that you apply to the affected areas (not near eyes), leave on for 10 minutes, then wash out and with a fine toothed comb, comb through the hair to remove all eggs and dead lice.  Usually this one time treatment works, but you MUST see an HCP to get treatment if the OTC doesn’t work, if you are pregnant, children under 2 years old, or teens under 18.  There are some treatments that are prescription only, so you need to see your HCP and get diagnosed. One other option, after you treat the area, is to shave off all affected areas (this is a little radical and not usually suggested by most HCPs) but if there is no hair to cling onto, there will be no pubic lice….just make sure to kill off the current infestation you have. Makes sense right?

Can I prevent it?

Well, you can ask partners if they have crabs, which I would hope they would abstain from sexual contact if they knew they had crabs, but its worth an ask.  Unfortunately, condoms do not prevent the spread of crabs, which is a total bummer.  If you have previously been infected (or are infected currently), make sure to wash or dry clean everything (as stated above, use the OTC treatment, and if symptoms are not cleared up, go see your HCP for further treatment, and bleach your bathroom/anything you use on your hair/body hair for grooming.

So unfortunately, it is highly contagious and can be an awkward treatment, but limiting your sexual partners, and asking about STD’s is a start at prevention.  Also, use your intuition: if you see someone scratching their crotch or just all over when you’re out with them, ask them if they have some sort of skin issue or lice.  If they say they are just super itchy and they don’t know why?  Steer clear!!

Yours in Good Health