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Head Lice is not Nice

By: Risa Caldoza-De Leon MD, FPAPSHPIHead Lice is not Nice

Bing came to me for consultation, with her angelic, all-girls-school-taught daughter in tow. Briefly, she tells me about the problem in a very low, soft but horrified voice: “My daughter has lice!” So I smiled and replied, in the same manner: “Welcome to the club!”

According to the Centers of Disease Control and Prevention (CDC), up to 12 million kids today between 3 to 12 years of age get head lice each year. A study also revealed that 6 out of 10 students infested with head lice are unaware of it and 30% of them don’t really care. One of 10 parents simply ignores the problem.

Closer to home, the Department of Education and the University of the Philippines said that pediculosis (louse infestation) is the second most common problem among students, bested only by tooth decay. In 2000, 8 of 10 public school children, mostly girls in Metro Manila and some provinces, had head lice. A more recent study showed that 4 of 10 public school children in Muntinlupa City were infected. Five predictors were found: gender, age, use of own comb, infested siblings, and current intervention or treatment given.

Adults get infected too - just ask Robert Pattinson, Shakira, Jennifer Garner, Madonna, and Britney Spears. Yes, it happens to everyone.

The mere word can literally make you scratch your head. Louse (plural: lice) or kuto in the vernacular is that tiny 6-legged ectoparasite busy crawling around on your crowning glory, amidst the garden of hair follicles, creepily sucking blood and laying eggs to ensure that you have more of them. If you want to get technical, these minute critters are called Pediculus humanus capitus. They’ve also been here before you and I were.

A long time ago in 3100 to 322 BC, in the land of Cleopatra, head lice were already around and Egyptians would shave their entire body to ensure that the reviled creatures had nowhere to live. Their flawless, mummified corpses can attest to that! But the world’s oldest head lice trophy belongs to a human head dug up in northeast Brazil about 10,000 years ago!

Head to head

Pediculosis or louse infestation happens when a lot of these parasites inhabit and multiply on a person. Their saliva causes an allergic reaction that makes a person itch. Lice inject their anticoagulant saliva into the scalp to suck up blood up to five times a day. Scratching may lead to secondary bacterial infections. The itching may not start right away and may sometimes take weeks before the kids start to scratch. Data suggest that about half of the people who have lice do not itch.  Some kids just complain of tickling sensation on their heads.

Head lice live for about 30 days but can lay up to a whopping 100 eggs, at a rate of 3-6 per day during their entire life. These insects, which are about the size of a sesame seed, can be white, brown or dark gray. They avoid light and prefer to remain inside the hair close to the scalp. They have a single hook-like claw at the end of each leg that is specially engineered for the size and texture of a human hair strand.  These allow them to move easily between hairs, at a rate of nine inches per minute.

Their eggs are small, round or oval and are glued near the scalp. They also camouflage with natural hair pigments to match one’s hair color. After 10 days, depending on the temperature, the eggs hatch and go through three nymphal stages before becoming an adult. The empty egg casing is called a nit, but others call the eggs nits too. So if someone calls you a nitwit, you know what that is!

The most common way to get head lice is through head-to-head contact with a person who already has them. This is why kids at school can get lice easily. Very rarely, they may get it through wearing clothing, such as hats or scarves, using infested combs and towels, and lying on a bed or pillow that has recently been in contact with an infected person. Lice can survive for short periods of time on hats, combs, pillows, and towels but will die within 48 hours without the human host. Lice know no season; it is present throughout the year.

Lice knowing you

The American Academy of Pediatrics reminds us that the ideal treatment of lice should be safe, free of toxic chemicals, readily available, easy to use, effective, and inexpensive. Over-the-counter medicine for head or pubic lice include Permethrin creme rinse and shampoos that have pyrethrins and piperonyl butoxide. Other medicated shampoos, such as Benzyl alcohol 5%, malathion lotion, spinosad, and ivermectin need a doctor’s prescription. A physician should evaluate kids before beginning medications. You shouldn’t use medicated lice treatments on children younger than two months. Most treatments are done twice, 7 to 10 days apart. Remember to do a head check - everyone in the infected person’s household should be screened for signs of lice. These vermin are also getting tougher to kill to the point that they have become super lice. They have smartly evolved to resist our arsenal of strong chemicals. A report in 2016 found that most super lice in the United States are resistant to pyrethroids.

Nits like to cling to the hair shaft and can only be removed by using a special fine-toothed comb with teeth about 0.1 mm apart. Remember that red suyod your grandmother used to brandish around? It’s also better to lubricant with hair conditioner before you go through the entire head. Keep a paper towel handy to wipe the comb in between passings. When finished, wash or rinse the hair. Repeat this every day until no live lice or eggs are found. A study in 2005 noted that combing out the hair with a fine-toothed comb immediately after using conditioner worked better than a single treatment of an over-the-counter insecticide. The term ‘nitpicking’ came from the painstaking process one goes through to get rid of these pesky pests.

So I tell Bing, the mother of my patient, that although the stigma of having head lice is real, it is not disgraceful. It also has nothing to do with poverty or poor hygiene. Her posh child is safe from being ostracized. Why? Because she probably got it from her classmates and I bet they have it too!

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