Friday, March 4, 2016

Super Lice

Please see the new and updated post September 2017

I recently saw the headline about super lice and shuddered. As if regular lice weren’t bad enough! Things have changed in the past several years since I wrote my old head lice post. The bad news is that lice are even more resistant to the over the counter medications. On the positive side, there are some more resources available to help you out than there were several years ago.

Diagnosis: Learning that your child has head lice can be incredibly aggravating. Trust me I know. You might be suspicious because your child is scratching their head or you may have gotten a call from school that your child was exposed. It is rare to actually see the live lice crawling around, although I was once measuring a child's height and there was actually a halo of lice crawling all over her head...ugh. Not everyone gets itchy, Your child might be crawling with them and never give a clue.

Once a person gets head lice, the mature or adult head lice can lay up to 10 eggs or nits each day. These nits, or lice eggs, hatch in about 7 to 12 days. Baby lice or nymphs are about the size of a pinhead when they hatch, and quickly mature into adult lice in about 9 to 12 days. Lice don't like light and they move very quickly, therefore the diagnosis is often made by finding the nits.  One site claims that the average speed of a louse is 3.75 inches per minute. This is equivalent to 18.75 feet in one hour, and approximately 450 feet per day. This is over the length of one football field!
The nits are small white, opaque or tan specks that adhere tightly to the hair shaft. If you flick something and it floats away, it may just be dandruff. The nits are usually close to the scalp. If they are further up the hair shaft, likely they have been around awhile undetected.

Check your child's head in a methodical manner, paying special attention to the areas behind the ears, the nape of the neck and the crown. Make sure you are in a well lit area. Remember that if one person in the family is infested, you should check everyone. You may actually be able to feel a nit on your own hair; it will feel like a tiny little knot.

If you have found some bug or nits, it is time to treat. You have several options

My old post had a several step protocol for using the over the counter medication.  It started by using a strong stripping shampoo such as Prell followed by a 30 minute application of Nix. Due to resistant bugs even then, we followed up several days later with cetaphil, olive oil or mayonnaise left on for several hours to suffocate them. The final step for kids who were old enough was to sizzle any survivors with a hair straightening flat iron. Poison, Suffocate, Sizzle.

If you are really pinching pennies, that method is still probably marginally cheaper than getting a prescription but not all that much. Although I would occasionally get calls asking for a prescription to be phoned in, my suggestions, if followed to the letter, seemed to work well. For historical purposes here is the link to my old post:

I had reasonably good success, but the lice have only gotten more and more resistant. It feels like a waste of time to even bother with the Nix
If you do opt to tackle the treatment yourself, I think that your easiest option is Sklice. Sklice is a lice treatment that has been on the market for several years. The key factor is that the super lice are NOT resistant to Sklice yet. This treatment is available only with a prescription. Sklice is fairly non-toxic. It is the only FDA approved drug that contains Ivermectin.  Ivermectin has  been used as an oral medication to treat river blindness in millions of patients. To treat lice, it is applied topically and left on for ten minutes. It is approved down to 6 months of age. The cost will vary depending on your insurance plan. As of March 2016 you can go to for a $10 copay coupon.
This website will give you all the directions that you need along with other useful lice info. With the copay assistance, your out of pocket price may not be more than $40.

Sklice directions claim that you don't need to do any nit combing after the treatment. One tube/one ten minute treatment. Even folks with lots of hair just need to use the one tube. I have asked the Noe Valley Walgreen's to keep it in stock. 450 Sutter Pharmacy also tries to always have it on hand and they deliver.

If you opt to hand off the responsibility and hassle and money is no object, there are companies that will do the treatment and the nit removal for you.

Hair Fairies has been taking care of head lice for nearly two decades. There are eight locations nationwide. We are lucky enough to have several in the Bay Area. Our closest location is probably the salon on Fillmore street here in the city:415-292-5900.

Folks who have used them have nothing but good things to report. The fee is based on the time it takes to pick all the nits. The cost can add up, but many parents are so happy to have someone else do this for them, that they feel it is a worthwhile expense.

Maria Botham, the president and CEO says:

"We’ve dedicated ourselves to understanding head lice and getting rid of them. We use that expert knowledge to develop safe, mild, clinically proven head lice removal products and techniques — and, ultimately, to bring confidence and peace of mind to families like yours. Each situation, each child and family is special, so we treat you that way. Our skilled technicians are professional and personable, our salons reassuring and fun. And, simply put, our products work! We use them in our salons every day. That’s why families, healthcare professionals, schools and camps around the country trust Hair Fairies to get rid of head lice. It’s a responsibility we take seriously. So many parents tell us they’ve spent hundreds of dollars and countless hours trying over-the-counter products that claim to get rid of head lice but don’t. All while their child is miserable. Hair Fairies is the better choice — economically and emotionally. If your family encounters head lice, take a deep breath. Stay calm. Hair Fairies is by your side."

Tell them that Nurse Judy sent you for a free head check.  If head lice or nits are found, the NURSE JUDY promo will get you 20% off your first treatment. For the record, I receive nothing in return for my recommendation of this or any other product that appears in my blog.

If you don’t want to leave home, Bug-A-Lugz is another great service. or call 415-574-8198. Sharon, the owner, founded the company in 2008. They use all natural and organic products. They service many of the local schools and preschools in the Bay Area. There is a $10 travel fee and a $35 cost for head checks. If lice are found, that $35 is applied to the treatment. Each treatment is $100/ person. They recommend two treatments. There is a 30 day guarantee.

Both Hair Fairies and Bug-A-Lugz will furnish you with a form to bring to your doctor for a signature. Some insurance may reimburse for these services.

Clean up: Sadly, getting rid of the bugs is probably the easiest step. It is essential to make sure you eliminate any lurking lice in your house (and car) that are waiting to crawl right back into your treated hair.

Wash sheets and pillow cases for the first two days after treatment. Wash towels, recently worn clothing and any hats or hoods that have been in contact with the lice. (Sometimes a trip to a Laundromat that has the big dryers and lots of machines can help you take care of the clean up more efficiently.) Items that can not be washed should be dry cleaned, put in a hot dryer for at least 30 minutes or placed in a ziplock bag in the freezer for 24 hours. Sealing items in an airtight bag for several weeks is also a common recommendation, but may not be reliable. Combs and brushes should be cleaned by soaking in hot water (about 130*F) for 10 minutes. All rooms and furniture, including car seat should be vacuumed. I have never been a fan of the pesticide sprays, but I am intrigued by the non toxic versions that are now on the market.

Hair Fairies has an all natural lice repellent spray that folks swear by for spritzing around all the areas that could have infested. This can help with all of your non-washables such as hats, carpets, couches and car seats. Maria the owner says that some folks even take the spray with them on airplanes (great idea!)

Prevention: Lice do not jump or fly. Since they travel by crawling, it is important that your children learn not to share brushes, hats, hair bows or headphones. Crowded coat racks are a good way to catch them. Teach them to hang their coats separately. If your child is in a class or daycare with a lice outbreak, talk about eliminating any dress up boxes. If you child has long hair, pull it back into ponytail or braids to minimize the risk. Although it is unproven, some people say that washing the hair on a routine basis with tea tree oil shampoo or vinegar rinses may act as a prevention.

Both Hair Fairies and Bug-A-Lugz have special shampoos that they sell as part of the practice that can be used preventatively.

Remember that lice do not care about family income, education, lifestyle or cleanliness. 10 million Americans are infested each year.

Pets do not transmit or carry human lice.


As icky as lice are, it is important to keep one’s sense of humor. There are worse things out there, really. Years ago I had come across an article equating the “stages” of dealing with lice to the Elizabeth Kubler Ross stages of grieving. Thanks to the wonders of the internet I was able to dig it out of cyberspace:

If this post made you itchy just reading it, trust me,  I have been scratching my head all week.