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.
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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.”
“People come to us after they have used over-the-counter medications for several times, so that tells us there is resistance going on in the community,” says Dr. Prem Singh, a Fresno pediatrician.
But 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. Every year an estimated six 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. Case in point: No parent would be interviewed on-the-record for this story.
Getting rid of lice you won’t admit you have
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,” says Dr. Razia Sheikh, a Fresno pediatrician.
Despite the decreasing effectiveness, Sheikh says the 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.
People come to us after they have used over-the-counter medications for several times, so that tells us there is resistance going on in the community.
Dr. Prem Singh, Fresno pediatrician
Several medications, including 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 $60 to $300. Private insurance may cover the medications, but parents can have high-deductible health plans and high copays that leave them paying most of the drug bill. And Medi-Cal, the state-federal insurance for low-income children and families, pays for some but not all of the prescription drugs. For example, according to the California Department of Health Care Services, Medi-Cal covers Ovide, a malathion lotion, and Sklice, an ivermectin lotion, among others. Patients should check with their doctors and pharmacies to make sure medications are covered by Medi-Cal.
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.
“You need to comb through the hair to look for any lice or the eggs after you have treatment to make sure you have cleaned the hair,” Singh says.
If the eggs are more than an inch away from the hair line, they are usually dead, Singh says.
Nits are firmly cemented on the hair and don’t transfer from one head to another, Sheikh says. Dead nits can be mistaken for live ones, and she says the American Academy of Pediatrics recommends that schools discontinue “no-nit” policies so children who have been treated for lice can go to school. Fresno and Clovis school districts allow children with nits to return to class.
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.
At Dr. Nit Wit in north Fresno earlier this week, Brenna Navarro, a lice removal specialist, divided a teen’s hair and ran a nit comb through the strands to capture lice and eggs.
We’re usually the last resort.
Taylor Salinas, Dr. Nit Wit shop manager
The teen’s father, who swiveled in a chair next to his daughter, says the family needed an expert. His daughter had lice infestations twice before. They never saw any lice or nits after treatments, he says, but maybe they weren’t finding all of them.
But a professional lice/nit removal treatment is not cheap: $125 for the first three hours.
“We’re usually the last resort,” says Taylor Salinas, the Dr. Nit Wit shop manager.
The shop uses natural oils to treat the hair for lice, which some people prefer to chemicals. And specialists use a special fine-toothed comb to capture nits.
Four years on the job has taught Salinas how to spot lice and nits. She likes to tell people to “come in and let me show you how to do the combing process.” The shop does $25 head checks for people who have done the combing themselves but want assurance that all the lice and nits are gone.
People may be missing nits because they’re using flimsy combs to capture the eggs, Salinas says.
They also may be using over-the-counter products that are not killing the lice, she says. Many of the shop’s clients have tried products without success.
Lice have been exposed to the chemicals for a long time, Salinas says. “They’re not really super bugs, though. … They’re smarter bugs.”