Saturday, April 23, 2011

Nitpicking the facts rotten on the head lice - Huffington Post (blog)

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Glenn D. Braunstein, M.D.
Glenn D. Braunstein, M.D.Chairman of the Department of Medicine, Cedars-Sinai

GET UPDATES FROM Glenn D. Braunstein, M.D. Like2Nitpicking the Lousy Facts on Head LicePosted: 04/11/11 06:15 PM ET React Amazing
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Here's a head-scratcher: how can something so tiny create such massive misery? Minuscule though they are, head lice still can wreak months of havoc on a household. My own grandchildren have played host to these persistent parasites -- which have a way of withstanding repeated comb-outs and drenchings with powerful insect-killing shampoos.

While lice have a high ick factor -- bet your own scalp itches as you read this post -- the bugs themselves are fairly harmless. They don't carry diseases. They just really gross most of us out.

Lice have annoyed and fed on us since antiquity. The Centers for Disease Control estimate that among 3- to 11-year-olds alone, there are 6 million to 12 million infestations a year. While there are plenty of products to combat lice, these frustrating critters have grown increasingly resistant to common remedies, necessitating repeat treatments.

Itching and Scratching as Signs of Lice

For grown-ups, the first heads up of lice woes likely will be a child's persistent itching or frequent scratching. That lice-related kid clawing can be traced to an allergic reaction to the bite of these bugs, which thrive on human blood. While the bites themselves don't cause disease, the scratching can lead to irritation and infection.

The gold standard for identifying a head lice infestation is to spot an actual, live louse or a nymph -- a newly hatched louse. This is tougher than it sounds.

Full-grown lice roughly are the size and shape of a sesame seed, white to reddish-brown in color and have claws designed to let them cling to and rapidly navigate the hair.

This is why lice detectives, in general, rely most on the second-best infestation evidence: nits or louse eggs. These easily can be confused with dandruff or specks of dried hairspray. But unlike those common scalp debris, these tiny white blobs won't easily fly away when flicked. Nits a quarter-inch or so down the hair shaft may indicate an infestation. Nits tend to be found clustered by the hairline at the neck's nape or behind the ears.

Once you've confirmed head lice as culprits, the battle just begins. A number of over-the-counter treatments are available for exterminating lice, though there is a growing concern that the creatures are becoming resistant to common remedies like permethrins (which are in the product Nix) and pyrethrins (carried in R&C and Rid).

It's unclear just how prevalent is the lousy resistance to specific products; it's often regional. Because over-the-counter pediculicides have been proven in studies to be safe, and they usually are effective, they're still a good first-strike medication against the pests.


After De-lousing, Follow Up

While the products kill lice and nymphs, none can kill 100 percent of the eggs. If those survive and hatch, the infestation begins anew. So it's important to keep checking for live lice after the initial treatment. Repeat treatments often are recommended a week to 10 days after that first go. In persistent cases, pediatricians can recommend prescription-strength medications such as malathion lotion (trade name Ovide), benzyl alcohol lotion (Ulesfia) or lindane shampoo (Kwell).

After killing lice, adults should comb youngsters' hair carefully to remove vermin and eggs. All family members should be checked and treated if necessary. Eradication can be laborious: Once a family is de-loused, their environs must be treated, too. Wash or dry clean all clothes and bed linens. Storing stuffed animals and comforters in a plastic bag should kill both lice -- which die within a couple days without human blood -- and eggs. Vacuum the floors and furniture. Combs and brushes should be sterilized or replaced.

It's an unpleasant way to have to spend a beautiful weekend -- but if all these little nuisances get nabbed the first time around, you may be spared repeating the process.

There's another treatment option: a machine called a LouseBuster. Its single, 30-minute application of hot air has been shown effective in killing all eggs and 80 percent of hatched lice in test infestations. The device is pricey and requires a trained operator. Don't think your regular hair blow-dryer will work in similar fashion -- not only won't it kill your lice, it will jet them into the air, all the easier to spread.

Besides causing excruciating itching for infested youngsters, lice also can be blamed for chagrin and high anxiety among parents of many kids in elementary schools across the country. Let me assure you embarrassed moms and dads who have kids with lice -- no, the infestation isn't a reflection on your home's cleanliness or grooming, nor your parent skills. It's not the dog's or cat's fault, either -- pets play no role in spreading lice. These critters just happen to be incredibly common and they spread easily -- by head-to-head contact and sharing of clothing, hair-grooming items, blankets or even furniture.

Best Practices for Schools
The annoyance and concern over lice, however, has gotten so intense that many schools have adopted "no-nit" policies. The Los Angeles Unified School District scrapped its version of this, in favor of a "no-lice" policy. This means that children with a confirmed infestation shouldn't come to school until it has been treated -- but the presence of nits alone isn't reason enough for youngsters to miss valuable school time.

That's in keeping with the American Academy of Pediatrics' views. In a report published last year, the academy noted that screening for nits didn't have a big effect on the number of infestations. A study of more than 1,700 children screened for lice found that only a third of those with nits carried live lice on their heads. Of kids with nits, just 18 percent developed a full infestation during two weeks of observation. Based on this and other data that show youngsters will miss important education time just because of too-rigorous and wrong-headed policies that penalize them for signs of lice and not full-blown lice infestations, the pediatrics academy and the National Association of School Nurses both oppose "no-nit" policies. Experts do recommend nit removal, as it can decrease the need for re-treatment and the risk of self-re-infestation.

Lice happen. So teach your kids smart behaviors -- avoid head-to-head contact while playing and don't share clothing, brushes, combs, towels, hair ribbons or barrettes. When you get the dreaded note from school or daycare, or see the telltale scratching, don't panic. If it's any consolation, lice actually prefer clean heads and hair.

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Follow Glenn D. Braunstein, M.D. on Twitter:www.twitter.com/CedarsSinai

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Post to Facebook.Post to Blogger.Post to Twitter.Post to WordPress.Post to TypePad.Post to Tumblr.Post to Yahoo! View All Recency ?|? Popularity Milrepa ? 09:58 AM on 4/13/2011 62 Fans I find it illogical to say that pets "don't spread lice". All that thick hair? Come on. The doctor should also remind us that people NEVER tell their kids' friends' parents about a lice problem, and then it really spreads. It's hell to get rid of. Milrepa: I find it illogical to say that pets "don't spread http://www.huffingtonpost.com/social/Milrepa/lice-infestation-treatments_b_847538_84290395.htmlHistory?| Permalink ?| Share it Richard Pollack ? 10:38 AM on 4/13/2011 0 Fans Lice are species specific. Human lice solely infest human beings. Dog lice only dogs. Bird lice just birds. Human head lice would starve before they'd feed on a dog, cat, hamster or other non-human animal.
Head lice are not nearly as transmissi-ble as are rumors about their spread. Broadcasti-ng informatio-n about lice on one's child really serves no useful purpose.
Finally, it sometimes can be difficult to eliminate head lice, but it should never be a hellish challenge.-.. unless one is pursuing the wrong strategies-. Richard_Pollack: Lice are species specific. Human lice solely infest human beings. http://www.huffingtonpost.com/social/Richard_Pollack/lice-infestation-treatments_b_847538_84294763.htmlHistory?| Permalink ?| Share it photo Jamie Lynn ? 09:51 AM on 4/12/2011 0 Fans I too had an awful experience when dealing with head lice infestatio-n in my home. It took months of trying expensive over the counter treatmetns that did not work. I was told by a friend to try using Lice Goodbye made from Fairy Tales Hair Care and this stuff actually worked. I now use their Rosemary Repel products that are safe to use everyday and they repel head lice. So far so good..no lice! www.fairyt-aleshairca-re.com Jamie_Lynn: I too had an awful experience when dealing with head http://www.huffingtonpost.com/social/Jamie_Lynn/lice-infestation-treatments_b_847538_84155374.htmlHistory?| Permalink ?| Share it lice student ? 04:34 AM on 4/13/2011 0 Fans what "scientifi-c" evidence is there for their repelent products? How can you prove that the product is activly repelling the lice from one head!!! lice_student: what "scientific" evidence is there for their repelent products? How http://www.huffingtonpost.com/social/lice_student/lice-infestation-treatments_b_847538_84277360.htmlHistory?| Permalink ?| Share it Family Physician ? 09:18 AM on 4/12/2011 0 Fans The statement made by Richard P. "Only some 'experts' suggest that nit removal is important, though they can't justify this with objective data." Is clearly a opinion. Up to date Clinical Research shows all OTC and prescribed pharmaceut-ical are not 100% effective against this communicab-le disease. In today's patient care; utilizing the EHR shows true data in the necessary need for removing viable nits to prevent an ongoing parasitic infestatio-n as-well secondary infections from scratching scalp sores. Family_Physician: The statement made by Richard P. "Only some 'experts' suggest http://www.huffingtonpost.com/social/Family_Physician/lice-infestation-treatments_b_847538_84151965.htmlHistory?| Permalink ?| Share it Richard Pollack ? 12:36 PM on 4/12/2011 0 Fans "Family Physician"-: I suspect you'd have a difficult time finding any drug that is 100% efficaciou-s for any condition. Whereas nit removal may sometimes offer some limited value, it is not medically necessary to eliminate an infestatio-n of head lice. Where's the 'true data' to which you refer? Richard_Pollack: "Family Physician": I suspect you'd have a difficult time finding http://www.huffingtonpost.com/social/Richard_Pollack/lice-infestation-treatments_b_847538_84177265.htmlHistory?| Permalink ?| Share it lice student ? 04:39 AM on 4/12/2011 0 Fans In the above article you mention that people should "Vacuum the floors and furniture" and "...they [lice] spread easily -- by head-to-he-ad contact and sharing of clothing, hair-groom-ing items, blankets or even furniture.-"

A trial conducted in a school, looking to see if head lice could be spread by floors or furniture, failed to find a single head louse (thats right not a single one) however there was something like a couple of thousand lice found on the heads of students using the classrooms-. There is no scientific basis for extensive environmen-tal cleaning to treat a head lice infection. In another article it was found that only approximat-ely 0.11% of a lice population would be found on a pillow after a nights sleep. Why spend all this time doing extensive cleaning when it isn't actually going to help and make a difference-. Spend your time and attention using scientific-ally proven remedies. lice_student: In the above article you mention that people should "Vacuum http://www.huffingtonpost.com/social/lice_student/lice-infestation-treatments_b_847538_84140268.htmlHistory?| Permalink ?| Share it photo misterPink ? 12:19 AM on 4/12/2011 5 Fans Just give it up. They don't hurt anything. Excruciati-ng itching? That's new to me.... misterPink: Just give it up. They don't hurt anything. Excruciating itching? http://www.huffingtonpost.com/social/misterPink/lice-infestation-treatments_b_847538_84128189.htmlHistory?| Permalink ?| Share it Richard Pollack ? 07:53 PM on 4/11/2011 0 Fans Good review. I'll offer just a few comments & clarificat-ions. Cases of head lice are incredibly overdiagno-sed; indeed, most are not. Head lice are not nearly as common as most believe. Prevalence is just about 1% in K-4th grade levels, and much less at all other ages. The '6-12 million' number is based on poor extrapolat-ions of flawed marketing data. Of bona fide cases of head lice, most are asymptomat-ic, so don't necessaril-y expect itching. There's really no need to vacuum or sterilize anything, as lice and eggs removed from a scalp will quickly perish, most within a day. Treatment is warranted solely if live (crawling) lice are present, NOT if only nits are found. Only some 'experts' suggest that nit removal is important, though they can't justify this with objective data. Finally, non-commer-cial educationa-l informatio-n I formerly hosted at the Harvard School of Public Health is now available at: https://id-entify.us.-com. On this site I provide links to the reports by the American Academy of Pediatrics-, National Associatio-n of School Nurses, & CDC, and offer evidence-b-ased guidance for parents and school personnel. Richard_Pollack: Good review. I'll offer just a few comments & clarifications. http://www.huffingtonpost.com/social/Richard_Pollack/lice-infestation-treatments_b_847538_84093691.htmlHistory?| Permalink ?| Share it ? ? new comment(s) on this entry — Click to refreshspinnerLoading comments… PHOTO GALLERIES How To Bike From Echo Park To Venice Beach Without Dying PHOTOS: Frank Gehry's Schnabel House For $13 Million PHOTOS: Protestors Greet Obama At Sony Studios PHOTOS: Vivi Nevo's Brentwood Modern For $4.79 Million FOLLOW US Facebook Twitter Apple Android Blackberry Email Rss Connect with your friends Check out stories you might like,
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