With a multitude of over-the-counter (OTC) and prescription treatment products, is it hard to grasp why many of the 12 million annually reported1 cases of head lice seemingly go on forever despite herculean efforts. Ever-increasing occurrences have parents and medical professionals perplexed. In the nearly 20 years we have spent in the trenches of head lice exploration, our research shows that persistent cases are not due to a sole factor, rather, a combination of elements; a series of unfortunate events, if you will.
Over the last two years, the pharmaceutical industry has undoubtedly noticed the buzz around rapidly increasing cases of reportedly resistant head lice. Even if you do not work in the pharma industry, the commotion around super/mutant/über lice has had resounding affects; the media has taken this information and metaphorically “run” with it, sending parents, even medical professionals into a full-on frenzy. So what’s the story behind these so-called “super” lice? Herein lies the first factor of persistent head lice cases. A recent study2 has shown that head lice are no longer responding to traditional permethrin or pyrethrum treatments, meaning that approximately 70%3 of OTC products are potentially ineffective. Therefore, finding an effective treatment can be challenging, especially when the alternative means spending hours painstakingly combing out lice and nits (head lice eggs). Although, before pulling out the comb, parents should know, they have a few options in lieu of traditional treatments: choose an alternative over-the-counter treatment (i.e. non-toxic, free of chemical pesticides), or obtain a prescription treatment that comes with a hefty price tag, $200-$400.
Regardless of the chosen treatment option, another factor of persistent cases is the common mistake of head lice products being used in a way that does not reflect label directions. Often times, parents are so overwhelmed with treating their children for head lice, they mistakenly skip a step, fail to wait the recommended treatment period, or pilot their own process. For example, a product may not require a shower cap because it is not necessary for efficacy of the treatment; however, a frantic parent may have seen a cap used for a lice treatment in a YouTube video and decide to use one thinking it is a requirement for any lice treatment. Disregarding label directions not only jeopardizes efficacy of a product, it can be dangerous. A label’s drug facts are specifically crafted for the success and safety of the consumer, and should always be followed exactly as they are written. Unfortunately, this happens more often than not.
Another key factor in effective lice elimination is a thorough cleaning of the home. Again, the monumental task parents face when their children are infested with lice can feel like an unbearable burden, at best; but, it must be done. After treating the children, it is essential that the house is carefully treated as well. All bedding, linens, and clothing must be washed and dried. Carpeting/flooring, furniture, and mattresses need to be vacuumed; stuffed animals and other items that cannot be washed should be placed in tightly sealed plastic bags for 10-14 days, and hairbrushes and other hair accessories should be boiled in hot water. Parents may also choose to apply a furniture/bedding spray designed specifically for head lice infestation of the home. This deep clean is tedious, but imperative in breaking the cycle of head lice; neglecting to complete just one-step of the process can lead to reinfestation.
Reinfestation, an infuriatingly common occurrence that is more often than not, completely out of your hands. The majority of parents will execute every step of the lice eradication process only to be bitterly disappointed when their child returns home with yet another infestation within a week. How did this happen? There are a number of ways in which reinfestation occurs (previously covered), but the most common is something that parents cannot avoid: other children, or rather, their parents. For instance, a letter is sent home to parents informing them of the presence of head lice in the classroom. Most parents will receive this letter and respond accordingly; complete a head check on their child, treat if head lice are present, clean the home, and so on. However, there are parents who do not treat their children or homes, and continue to send their child to school with a head full of lice. Some schools enforce a “no nit” policy; if lice or nits are present in a child’s hair, they will not be allowed back into the classroom until they have been treated and all lice and nits have been removed. However, many schools have done away with such policies due to increased missed days and falling behind in schoolwork, especially in those cases of recurring infestations. Unfortunately, diligent parents are at the mercy of school policies and other children’s parents. If a parent is unhappy with school policy, they can elect to voice their opinions with the school board, but the buck stops there as agencies like the Centers for Disease Control & Prevention (CDC) are not regulatory agencies. Each school district has the sole power to enforce the head lice policy they see fit.
So what is the answer to eliminating persistent head lice cases? It is simple, education. In the absence of information and proper education, the vicious cycle of lice and recurring infestations will continue. We must all do our part to ensure success of head lice treatments, and stop the cycle of persistent cases of head lice. Consumers must utilize their resources to complete a thorough process of due diligence when it comes to lice infestation, while medical professionals must continually seek to further their education on the matter to provide the best guidance possible.
1USA. Centers for Disease Control & Prevention. Parasites - Head Lice. CDC- Info., 01 Sept. 2015. Web. 3 May 2017. <https://www.cdc.gov/parasites/lice/head/gen_info/faqs.html>.
2J Med Entomol (2016) 53 (3): 653-659. DOI: https://doi.org/10.1093/jme/tjw023 Published: 31 March 2016.
3First Aid Treatments - Total US XAOC. Nielson Item Rank Report. 14th ed. Vol. January. N.p.: Nielson (US) LLC, 2017. Print. Ser. 2017.