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Heading Off Lice

"Getting rid of the itchiness"
By: Risa Caldoza-De Leon MD, FPAPSHPIHeading Off Lice

Lice infestation is widespread throughout the world. In the United States, the US Centers for Disease Control and Prevention reveal that up to 12 million kids aged 3-11 years old suffer from lice every year. In 2000, a whopping 9 million Filipino kids (84% of public school children) were found to have head lice. Students from Southern Tagalog and Western Visayas were found to have a larger share. The problem was alarming that the Department of Education (DepEd) launched a program that gave out anti-lice treatment.

A study made by the DepEd and University of the Philippines in 2012 found that lice infestation was the second highest medical problem among public school children, the first being tooth decay. Kids seven to 12 years of age are affected the most.

A lousy inheritance

The louse is a well-known antique. In fact, like the pinworm, it is one of the “heirloom species,” crawling around 33 million years ago, long before man roamed the earth. It is generally thought that human head lice (Pediculus humanus capitis) evolved from head lice on chimpanzees 5.5 million years ago.

In 8000 BC, an actual head lice nit was discovered in the hair of a mummy in Northeast Brazil. In 7000 BC, head lice were found on a hair on a skull in Negev in Northern Israel. Specimens from Israel dating back 2000 years were gleaned from hair combs. In Peruvian mummies dating around 1025 AD, one carried 407 lice on its head, while the other had 545. The lovely Cleopatra has been known to own very elaborate nit combs; told you lice knew no class barriers.

They suck!

The tiny, wingless parasitic insect make their home in the head, amidst the forest of the hair follicles and feed on tiny amounts of blood drawn from the scalp. Creepy!

Lice eggs, called nits, look like dandruff stuck close to the scalp, where they are kept warm until they hatch. To attach an egg, mommy louse secretes a glue from her reproductive organ. These tiny yellow, tan, or brown dots hatch within one to two weeks and become nymphs--a beautiful name for an ugly parasite. The empty white eggshell stays glued in place and becomes easy to spot in the hair shaft. A week or two, the nymphs become the whitish to grey-brown adult lice, which feed on blood several times a day. The head lice hold tightly to hair with hook-like claws at the end of each of their six legs. They will not let go even when submerged under water.

Mommy louse, now 2–3 mm long, will then lay her eggs (3-10 eggs/day) again, and the cycle continues. A single louse lives for just 30 days, from the moment the nit is laid until the adult louse dies. To break the cycle and stop them spreading, they need to be removed within nine days of hatching. These creatures can survive up to 2 days off the scalp. So, for a short time at least, lice left on the pillow can crawl to another person’s hair.

Preschool and middle school kids from 6th-8th grades are the likely targets. Lice spread easily in school because there are lots of opportunities for close contact among the students – playing together, sharing stuff like brushes and clips, and other physical activities. They spread by direct head-to-head contact, and not by jumping or flying as commonly thought. Their short stumpy legs make them incapable of jumping, or even walking on flat surfaces. We can blame science for the notion that lice can jump. When combing dry hair, a head louse caught on the teeth of a comb can be flicked off by static electricity.

An itchy scalp, neck or ears is a result of an allergic reaction from the critters saliva and usually start two to six weeks after infestation. The lice biting the scalp, a common misconception, don’t cause itching. Kids may sometimes complain of things tickling their heads (yup, they’re crawling around the girl’s ponytail) and are often irritated and have difficulty in sleeping. Excessively scratching an irritated scalp can lead to a bacterial infection.

Remember lola’s “suyod”? This fine-toothed comb is a reliable way to confirm an active infestation. The comb can trap even the smallest lice. Try it on wet hair, it works better!

Out of my head

Head lice can usually be effectively treated with topical insecticides called pediculicides (medicines that kill lice) that may (ovicides) or may not kill the eggs. They are usually in lotion or gel form and are applied to the scalp to kill lice. Available insecticides include Permethrin, Pyrethrin, Malathion, Benzyl alcohol and ivermectin.

According to the US Food and Drug Administration and US Environment Protection Agency, pyrethrin is considered the most effective yet least harmful insecticide to mammals and humans because it only affects the nervous system of insects. Pyrethrins, which come from the chrysanthemum flower, can kill live lice, but not nits. Permethrin lotion is similar to pyrethrin. These medications are approved for use on kids 2 years old and above.

According to the 2015 guidelines of the American Academy of Pediatrics, 1% permethrin or pyrethrins are the first choice of treatment for active lice infestations, followed by nit removal and wet combing. The treatment should be reapplied at day nine and, if needed, at day 18.

Wet combing is another way to remove lice from the hair with careful and repeated combing. Although time consuming, it is a good option especially when you’re dealing with very young children. It must be done repeatedly, over a period of a few weeks, about 15-30 minutes per session, sometimes longer when the hair is long and thick.

Sometimes, the lice become resistant to topical treatment, and your doctor will prescribe a medicine taken by mouth called ivermectin.

The US CDC recommends that all household members and other close contacts be checked and if need be, treated all at the same time. There are a number of treatments for head lice. Consult your family doctor or your skin care physician for the best treatment.

Teaching kids proper hygiene goes without saying. Regularly washing the hair with shampoo and conditioner is a given. Teach them that it’s okay not to share personal items with their friends and classmates. Washing clothes and linens in hot water and drying them in high heat will kill lice left on them.

Now, stop scratching your head!

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