Excerpts from Dermatology Times 7/20/16
School will soon be back in session, and unfortunately, this usually means an uptick in the incidence of head-lice. Do you know what to do if your child comes home from school with lice?
Here are a few helpful tidbits about the world of lice: Head lice die in one to two days without feeding, and nits die within a week and cannot hatch if they are not near the scalp; Nits (lice eggs) alone do not indicate contagiousness; However, behaviors such as sharing brushes, combs or pillows could transfer nits or lice from person to person; Once hatched, lice move by crawling – they cannot hop or fly; Pets do not play a role in transmission of human lice.
What to Do
If lice are found on someone, machine wash and dry all clothing and bed linens worn or used in the two days before treatment. Items that can’t be washed should be placed in sealed plastic bags for two weeks. Soak combs and brushes in hot water (at least 130°F) for five minutes. And vacuum the floor and furniture around where the infested person sits or sleeps, then discard the vacuum contents in a sealed plastic bag. In addition to these actions, topical treatments may be used to kill the lice and nits on the persons scalp and hair.
According to Dr. Raegan Hunt, lice are becoming more immune to traditional over-the-counter treatments like Rid and Nix. Earlier this year, a study examined head lice in 48 states and found 98% had developed mutations. The good news: “There are several fairly recently FDA-approved topical lice treatments that can be used to combat the resistant ‘super lice,’” says Dr. Hunt, a pediatric dermatologist at Texas Children's Hospital:
Well-known treatments, such as Rid or Nix, are comprised of permethrin lotion 1%, and may not work due to the development of drug resistance.
Malathion lotion 0.5% (Ovide) works in a single application for most patients, but is limited to those 6 and older. Resistance has been reported in the United Kingdom.
Ivermectin lotion 0.5% (Sklice) got FDA approval in 2012. It kills baby lice (nymphs) and works as a single application on dry hair without nit combing. It’s approved for children 6 months and older.
Spinosad 0.9% topical suspension (Natroba) was approved by the FDA in 2011. It’s approved for children aged 4 and up, and is also effective as a single application on dry hair without nit combing. Retreatment is usually not needed.
Benzyl alcohol lotion 5% (Ulesfia) received FDA approval in 2009 and requires repeat treatment on the ninth day. It’s approved for ages 6 months to 60 years.
After treatment, if you see large, live lice, they may be a sign of a re-infestation. Also, according to Dr. Hunt, lice of different sizes can be a sign of possible resistance to treatment.