This story is almost guaranteed to make you scratch your head.
Head lice, the scourge of many a parent during the school year, do not take the summer off.
Wherever children congregate – day care, summer camp or summer school – lice can spread.
And they are getting more difficult to kill.
Gene mutations are making lice resistant to common over-the-counter drugs that have been used for years to fight them. According to a 2016 study, it appears that lice in at least 42 states, including California, have developed resistance to the products, becoming what some now call “super lice.”
Gina Loretelli of Ripon said an over-the-counter insecticide product failed when her two children came down with head lice a few years ago. A doctor recommended she leave the treatment on her children’s heads for 20 minutes before rinsing it off, instead of the 10 minutes indicated on the label.
That didn’t work either and it possibly made her daughter sick, Loretelli said.
“The doctor said over the phone, ‘You have to keep trying things’,” Loretelli recalled. She kept calling around until finding a Santa Cruz woman who had a natural remedy that worked.
“It is just a nightmare,” said Loretelli, who offers her services as a “lice lady” to friends and relatives. “I have a friend who spent over $1,000 trying to get rid of lice.”
Before we talk about ways to fight drug-resistant lice with medications and professional nit pickers (nits are lice eggs), let’s dispel some myths.
Anyone can wake up with a head full of lice. But children ages 3 to 11 are prime targets. Each year an estimated six million to 12 million infestations occur in the United States among children in that age range.
▪ Lice can’t fly or hop. They’re not going to jump across a classroom from one child to another. They are spread through direct contact with the hair of an infected person. (Visualize kids sharing hair clips, scarves, hats, coats or teens shoving their heads together to take selfies.)
▪ They can’t be killed by chlorine in a swimming pool, but they’re unlikely to be spread in the water.
▪ Although a big nuisance, lice don’t spread diseases.
Doctors say the biggest misunderstanding – that lice like dirty hair and dirty homes or classrooms – is the toughest to fight. The cleanest of the clean can get lice. But the social stigma remains, clinging as tight as lice to hair shafts.
When the tell-tale itching begins, the lice have to go. But getting rid of them could require a trip to the doctor instead of the drugstore.
Over-the-counter drugs, those containing pyrethrins (pyrethroid extracts from the chysanthemum flower) and permethrins (synthetic pyrethroids), used to knock out lice in one or two treatments. But that’s less likely now.
“The lice medication that we have been using, which is the cheapest, was 95 percent efficacy and now the efficacy is down to 50 percent, “ said Dr. Razia Sheikh, a Fresno pediatrician.
Despite the decreasing effectiveness, Sheikh said over-the-counter products remain the first line of attack against lice for many of her patients. There are reasons for trying over-the-counter drugs before having a doctor write a prescription, she says. There’s always a chance the non-prescription drugs will work, especially if applied properly. And they’re cheaper, at less than $25 a bottle, than prescription medications.
Several medications, from a benzyl alcohol lotion to a topical suspension gleaned from soil bacteria, are available by prescription. Parents can learn more about them on the Centers for Disease Control and Prevention website.
Prescription drugs for head lice can cost from $60 to $300.
Dr. Anand Magoon, a family practice doctor for Sutter Gould Medical Foundation in Turlock, said he may prescribe permethrin for a family that’s trying to get rid of lice. The treatment is the same as the over-the-counter product Nix but it’s a stronger dose. The doctor said he supplies enough so that other people in the family can be treated.
But lice are hardy insects, and even some prescription products only kill the adults, leaving their nymphs and unhatched eggs to grow.
This is where nit picking is important.
Removing head lice and their eggs is a laborious process. Lice themselves are tiny, about the size of sesame seeds, and the nits are small and attached so close to the hair shaft that it’s easy to confuse them with dandruff.
But a thorough picking of lice and nits is key to stopping a lice re-infestation, doctors say.
Loretelli of Ripon said she uses a special comb to find any lice and clean nits from the hair. She said some nits are so tightly stuck to a hair shaft, she has to pick them with a fingernail and drag them out of the hair.
“You have to press on the scalp, because the baby bugs will hide under flakes of skin,” Loretelli said.
Nits are firmly cemented on the hair and don’t transfer from one head to another. Dead nits can be mistaken for live ones, and the American Academy of Pediatrics recommends that schools discontinue “no-nit” policies so children who have been treated for lice can go to school.
But picking the live lice and nits can make a parent feel like pulling their own hair out. Some turn to professionals to make sure all the crawling critters are caught.
When her children had lice a few years ago, Loretelli said, a woman in Santa Cruz sent her an olive-oil-based natural product, recommended a comb with little coils around the teeth and walked her through the process of combing out her children’s hair.
The natural treatment involves coating the child’s hair with olive oil and placing a shower cap over the head. Wait a couple of hours for the oil to smother the lice and then comb out the lice and nits. Loretelli said she braided her daughter’s hair after it was coated with olive oil and had her wear the shower cap overnight. She advises friends to repeat the process a week later.
Dr. Magoon said these types of remedies suffocate the lice but do not kill the nits.
Loretelli said it’s easy for parents to freak out when a child has head lice and run to the drugstore for the common treatment. “Every time we do that, it is just making those lice stronger,” she commented. “It is just building up their resistance to it.”
Ken Carlson: 209-578-2321, @KenCarlson16