The school year is upon us. Time to see old friends and meet new ones. New teachers, new rules, and new bugs? Or is that old bugs?

Probably the most dreaded of the school-acquired infection is lice. Just the mention of it makes people wince and scratch. It is likely that more elementary school children are affected by head lice more than any other communicable disease, other than the common cold¹.

But what are we really dealing with? The adult head louse, AKA Pediculosis humanus capitus, is the causative critter for this problem. The lice are transmitted by direct contact with a person with an infestation. The lice cannot jump or fly. They cannot be transmitted from pets.

Female adult lice attach to hairs and lay eggs (up to seven to 10 each day!) at the base of a host’s hair, over the course of a month (the louse’s life span). The eggs are called "nits" and hatch after about eight days, when they are often seen better because the eggs become more white. Symptoms, mainly itching, are caused by a reaction to louse saliva with the skin. Adults feed on the scalp and face and neck just next to the scalp. But sometimes children can have a significant infestation without any symptoms and may just appear with a rash, if the nits/eggs are not seen.

Diagnosis is made by seeing either the adult louse or nits. Usually nits are more readily seen. Running a fine-toothed comb through your hair to find the lice or nits helps. (Get out your magnifying glass!)

Historically topical insecticides, like permethrin, pyrethin and malathion, have been used to treat lice. But lice are becoming more resistant to these treatments.

Here is the protocol we use at PAMF for lice. Additional information can be found on Dr. Dale Perlman's "Nuvo^® Method for Treating Head Lice" Web site:

1. Apply Cetaphil^© body cleanser (not face cleanser) thoroughly. Wait two minutes.
   
2. Comb out all Cetaphil possible, first with coarse detangler comb, then with a fine comb. You may then finish combing with a nit removal comb (the LiceMeister comb is best). This part is optional, and only necessary if your child's school has a "no nits" policy. Otherwise, it adds a lot more work, and does not increase the cure rate.
   
3. Dry the hair with a handheld hair dryer.
   
4. After waiting eight hours or more, shampoo with your regular shampoo.
   Repeat this weekly, up to three treatments, or until no more nits or lice are found. Nits more than one-half inch from the scalp are empty egg cases and are not contagious.
   
5. Bedmates should be treated as well.
   
6. If you want to remove nits, wrap the hair in a towel soaked in white vinegar for 30 to 60 minutes to loosen nits. Then comb the hair with a nit comb.
   
7. To eliminate transmission in the home, wash all potentially contaminated items (bedding, clothes worn in the last three days, hats, towels, stuffed animals, etc.) in hot water (less than 120 degrees)> Alternately, dry clean the items or store them in sealed plastic bags for two weeks (the longest period nits can survive without contact to a person). Immerse combs and brushes in boiling water or soak in isopropyl (rubbing) alcohol.

Note: this is a suggested treatment and we cannot guarantee results. If there is a recurring rash, reappearance of nits or lice, or sores on the scalp or skin, see your doctor.

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1. Price, JH, Burkhart, CG, Islam R. "School nurses' perceptions of and experiences with head lice." J Sch Health 1999; 69: 153.
A modern scourge – parents scratch their heads over lice. Consumer Reports 1998; 63:62