Getting rid of head lice poses a problem for children, parents

By Donya Betancourt

SANUR, Bali (JP): It's not something that we may want to talk about, but lice are a problem for many parents and their children.

Human infestation with lice is usually limited to the head louse, body louse and crab louse. Body lice are found in clothing, bedding and on the body; crab lice, or "crabs", infest the pubic area and are common in sexually active adolescents and adults; and head lice are tiny insects that live primarily on the head and scalp.

Head lice infestation can occur at any age, but it is most common in school-aged children or younger children, such as those in child care centers. Lice are found only on humans. Infection can be spread by close personal contact, such as direct head to head contact, although sharing personal items such as hats, brushes and combs is also a factor in the spread of head lice.

A small, adult head louse may be seen with the naked eye; it is usually two millimeters to three millimeters long, gray in color and lives within one centimeter above the scalp. Lice move rapidly and only a few may be present; a magnifying glass may help to see them more easily. In severe infestations they will clump together and take on the appearance of freckles or age spots.

Head lice suck blood and create a rash which may be more noticeable than the lice. Head lice attach their eggs at the base of the hair shaft -- these eggs, or nits appear as tiny white or dark oval shapes and have a valve like shell which can be differentiated from hair casts and scale. Adult head lice cannot survive more than 48 hours away from the human host. Typical symptoms are scalp itch, or visible nits or lice on the scalp. Sometimes additional presentations are scalp pyoderma (abscesses) or lymph node enlargement at the back of the head. Itching is most intense especially at night and usually leads to loss of sleep. The diagnosis is identification of nits or lice.

Treatment

Several effective treatments are available. Children with head lice should be treated with a medicated shampoo, rinse or lotion developed specially for the head lice -- two treatments of "permetrin" cream rinse applied for 10 minutes after shampooing, or "malathion" lotion applied for eight hours to 12 hours is also effective in killing adult lice and requires only one application for effective treatment.

A word of warning: These treatments are powerful insecticides and may be toxic if not used only as recommended.

All family members should be treated, even if they have no symptoms. Because lice can survive off the host for two days, combs and brushes should be washed in hot soapy water and hats, sheets, pillowcases and towels should be washed, dry-cleaned or pressed with a hot iron to prevent reinfestation.

If effective treatment is used, residual nits more than 1 centimeter away from the scalp, are considered "not infectious". You can remove nits with a solution of vinegar and water mixed in 1:1 ratio and applied for 15 minutes before combing the hair with a fine-tooth comb. In extreme cases of infestation it may be necessary to shave the hair in conjunction with the insecticide bath.

To prevent the spread of head lice when a case occurs in a child care setting: * Temporarily remove the affected child from contact with others until 24 hours after treatment or the child is free of nits. The child should be checked for any evidence of new infection daily for 10 days after treatment. It may be necessary to repeat treatment in 7 to 10 days. * On the same day, screen all children in the classroom or group and any siblings in other classrooms for adult lice or nits. Simultaneous treatment is necessary to prevent spread back to previously treated child. * Educate parents regarding the importance of following through with the same recommendations at home and notifying the school if head lice have been found on any member of the household.

Pubic lice can also be found on the thighs, trunk and beard in adults -- infestation of the eyelash and periphery scalp may occur in children. Treatment is the same as head lice. Sexual partners and family members who share the same bed should be treated. Bedding, towels, underwear and clothing should be washed in hot water. Lice in the eyelash should be treated with pediculocides; petrolatum should be applied thickly twice daily to the lashes for eight days, and nits removed by hand.

Body lice reside in clothing and bedding, not on people. Intense itching due to the louse bites is present and the lesions often have a linear array, with many excoriations (visible marks). If you suspect infestation, examination of the clothing, particularly jeans, for nits or organisms is in order. Treatment is washing of the clothing and bedding in hot water. But it is important to understand that lice cross all social and economic boundaries and that there should be no shame associated with the infestation and treatment of lice.

The writer is a pediatrician, based in Sanur, Bali. If you have questions, please feel free to write to hear at drdonya@hotmail.com, or you can reach her at features@thejakartapost.com.