Head Lice 2017/updated treatment and referral options
I hope you don’t need to be reading this post except for a bit of Schadenfreude
Lice is a chronic problem that our patients deal with throughout the year. My original post about lice back in 2013 actually went viral. I learned to accept that my moments of fame are generally poop or vermin related. Lice have become more resistant and the treatment and services available have changed over the years, so it time to update the post.
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 as they stood tall against the wall there was actually a halo of lice scurrying 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 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 , 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 on a hair 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 and got farther away from the head as the hair grows.
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. I have had moms speculate that people with a Y chromosome don’t do too well at this task. If you don't have someone reliable to check your head, you may actually be able to feel a nit on your own hair; Run your fingers through your hair from scalp to the ends. A nit will feel like a tiny little knot. If you feel something, yank it out and take a look. A nit doesn't encircle the entire hair, but looks like a tiny sesame seed stuck on one side.
When my children were in elementary school we all got it. That was when I became an expert and spent weeks doing head checks on their entire school. My eyes aren’t as good as they used to be, but I can still consider myself a better than average ‘nitpicker’. Is that a good thing? I am not sure.
I thought I was done dealing with lice on a personal level, but when my daughter Alana was a SENIOR at Lowell, she and many of the peer helpers ended up with head lice. The culprit was an old couch in their break room that was infested. The reason that I share this is so that you know I have been there. I understand why some parents start insisting that they want to pour strong pesticides on their little darlings’ heads. Stop. Take a breath. There are other options.
If you have found some bug or nits, it is time to treat. You have several methods to consider.
Nurse Judy Original Method
My old post had a several step protocol for using the over the counter medication. It still may be the most cost effective way to treat and I have parents successfully get rid of lice if they do all of the steps. Poison, Suffocate, Sizzle.
If you see a lot of nits, you should start by loosening them up with either plain white vinegar or an “egg releaser” product such as Clearlice. Both of these work well but might neutralize the active ingredient in the Nix and should be used first and rinsed out thoroughly.
Next step is to wash the hair with a strong stripping shampoo such as Prell. This is a classic old shampoo that should be at a local, larger drugstore. You can certainly get it online. Experts say that this helps the Nix be much more effective because it strips the hair of any oil and makes it hard for the lice to hide. The next step is a 30 minute application of Nix. Ignore the package that tells you to leave it on for 10 minutes. This application is still way less toxic than the more concentrated version that is used to treat scabies and is left on the entire body for 24 hours.
One of the moms in my practice shares the tip that combing out the hair while it still has the conditioner in it stops the bugs from being able to move as you are combing it out. She found it much easier than working on the dry hair. (Thanks Alice.)
Alice's family also loved using this
There are resistant bugs out there, so Nix alone will not be enough. The media gave these guys the moniker Super Lice a few years ago. The stuff of nightmares. There is a new UltraNix on the market that claims to be more effective
You have killed the weaker ones with the Nix, but to get the stronger bugs, you need to follow up a day or two later with cetaphil or oil. Olive oil or coconut oil are probably the best oil choices, but it really doesn’t matter. What we are doing is suffocating any survivors. Slather the hair with the goop of your choice, put on a shower cap and leave it on for several hours. Some studies say that it takes 6 hours to do the job. Do NOT put your child to sleep wearing a plastic shower cap on their head. This should be done during waking hours. The Prell shampoo will come in handy once again to help you rinse out so that the hair doesn’t feel too oily.
The final step for kids who are old enough is to sizzle any survivors with a hair straightening flat iron. When you comb out, It is important to use a good metal flea comb. Having a good one makes a big difference. Do a daily thorough combing to make sure you aren't finding new nits.
If you have good insurance, there is a prescription medication called 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. 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 www.sklice.com 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.
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.
Lice Clinics of America – South San Francisco is a science-based lice removal company. This is a new service that was not included in the last post. They are the exclusive provider of the revolutionary AirAlléTM device, an FDA-cleared medical device that kills head lice and lice eggs using just heated air; this allows us to offer a single (~1 hour) treatment to get rid of 99.2% head lice and lice eggs. Their clinic is committed to treating every patient in a caring, clean and professional manner. Their core values lie in client centered, quality service. The results are guaranteed!
They are located at 1001 Sneath Lane, Suite 107, San Bruno, CA 94030. The clinic is open seven days per week by appointment only! 650-746-8788. The total cost is $185 per treatment. Some PPO insurances will cover part of the cost. If everyone in the family is treated they will give a 30 day guarantee. Tell them Nurse Judy sent you and get a 10% discount.
If you don’t want to leave home, There are a few companies that do home visits.
Go on line 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.
Nitcontrol.com I learned of this company from one of my patients who had a good experience with him. He comes out to your house and charges by the hour, 125/hr plus a small travel fee. He works all over the Bay Area. He managed to go through all three family members in just over an hour, much cheaper than Sklice for all.
8/2019 one of my patients informed me that they recently used Lice patrol and were very pleased with the service.
Here is their feed back.
Martina Mitchell of Lice Patrol had literally nothing but five-star reviews on Yelp. She was able to make a house call the next day for, get this: All of us including my mom (who chose an unfortunate time to visit from out of town and sleep on our couch), our nanny, our nanny share buddy, and his two parents. She was thorough, methodical, calming, and is coming back in five days to check again! It was $420 for three and half hours and eight people, and two combs to boot
800-261-9389 or 1800-224-2537
Their website is a wealth of good information.
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!)
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.
(As are old nasty couches in a Peer Helper break room.) 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 or costume boxes.
Are you at an event with a photo booth that has all of those creative hats to try on for the picture? Tag, you’re it.
If your 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:
And here is another post that a mom shared. This woman does a weekly parenting blog.
If this post made you itchy just reading it, trust me, I have been scratching my head all week.