Infestation of humans with Pediculus humanus capitus, the human head louse, is a phenomenon that was described as early as 1500 bc, in ancient Egyptian writings. As opposed to the body louse, which is a well-known vector of disease, head lice are not known to transmit disease.

Each year thousands of children are treated for head lice infestation with drugs that are acknowledged toxins as well as with home remedies that are similarly toxic and often very dangerous. There remains a significant negative stigma attached to head lice infestation and because of this, children are often subjected to treatments that do not make sense given the fact that head lice do not cause disease.

Head lice are not related to hygiene or socioeconomic status. Six to twelve million people in the U.S. are diagnosed with head lice each year, mostly children aged 3-12 years. It is passed amongst children by head to head contact, and lice that go more than a day without human contact cannot survive. Although head lice do not cause disease, they can cause itching which can lead to bacterial scalp infections.

Head lice are small, approximately 2 - 3mm long – about the size of a sesame seed. They feed multiple times per day and live for 23 - 30 days. Eggs are layed within 6mm of the scalp and are cemented to the hair shaft. The eggs hatch in approximately 1 week.

Diagnosis of head lice is best done by wet combing of the hair. Misdiagnosis is common. In one study when people diagnosed with lice were re-examined, only 58% had either lice or eggs, and only half of these had an active infestation.

Treatment of head lice is complicated by issues of toxicity with the treatment agents and by resistance to these agents. Again, toxicity is unacceptable for an infestation that does not cause disease.

Pyrethroids are the most commonly used agents to treat head lice. These are insecticides derived from chrysanthemum flowers. A commonly used pyrethroid is Rid which is a pyrethroid plus piperonyl butoxide.  Synthetic pyrethroids, such as Nix are the current “drugs of choice”. These are agricultural pesticides and there is significant concern about these agents being absorbed through the skin of children who are treated with them. Malathion or ovide is an organophosphate with well-documented human toxicity; it is extremely dangerous if swallowed. Lindane, or Kwell, has now been banned in several states. It has significant human toxicity when absorbed through the skin, and seizures and deaths have been associated with its use. Lindane is bioaccumulative in the environment – a single treatment with lindane pollutes 6 million gallons of water – and there is significant concern about its carcinogenic properties.

Combing out lice and nits (“bug busting”) is time consuming, uncomfortable and numerous studies have documented a lack of clinical effectiveness. Clearly, it is the safest method – but it is often not practical or effective.

Other methods that have been tried include vinegar, acetone, bleach, vodka, WD-40, kerosene, petroleum jelly, olive oil, mayonnaise and dog shampoos. Most of these are ineffective and many are extremely dangerous to the child. Oral therapies with trimethoprin-sulfa (an antibiotic) and ivermectin (an anti-parasitic agent) have side effects and there is concern about microbial resistance with widespread use of these agents for this indication.

A recent study with a novel agent called “Nuvo” (later revealed to be the skin cleanser Cetaphil) was shown to be effective in suffocating the head lice. There is also interest in a treatment called Hair Clean 1-2-3 which is a combination of essential oils such as coconut, anise and ylang-ylang. Studies in Israel have shown it to be effective. It is thought to be much less toxic that the more commonly used pyrethroids. Further studies are planned with Hair Clean 1-2-3.

One of the significant emerging problems with head lice is the rising incidence of resistance to treatment agents. Treatment failures have frequently led to the use of more toxic and dangerous agents in children.

In the end, we must not lose sight of the fact that head lice are unpleasant and socially unacceptable, but not dangerous. We cannot allow children to miss large amounts of school and to be exposed to agents with long-term toxicities because of head lice. We need to find less toxic, safer treatments. There must be a better way!

About Jeffrey R. Boscamp, M.D.

Dr. Boscamp received his M.D. from New York Medical College.  He was a Research Associate at Harvard Medical School and did his pediatric residency at Babies Hospital, Columbia Presbyterian Medical Center, NYC.  He was then a resident in internal medicine at Yale University School of Medicine, Greenwich Hospital.  He subsequently completed a fellowship in adult and pediatric infectious diseases at the Albert Einstein College of Medicine.

Dr. Boscamp is Chairman of the NJ Chapter, American Academy of Pediatrics (AAP), Committee on Infectious Diseases and a member of the NJ AAP executive committee.  Dr. Boscamp is also a member of the NJ Pediatric Leadership Council, and of the Catastrophic Illness in Children Relief Fund Commission.  He is a fellow of the AAP and the Pediatric Infectious Diseases Society.  Dr. Boscamp is board-certified in Pediatric Infectious Diseases, is a member of Alpha Omega Alpha, and was the recipient of the Lawrence B. Slobody Prize in Pediatrics at New York Medical College.  In 1993, he received the Outstanding Teacher Award in Pediatrics at Morristown Memorial Hospital, and in 1998 was recognized with the Attending of the Year Award in the Department of Pediatrics at the UMDNJ-New Jersey Medical School.  Dr. Boscamp is the author of numerous articles and book chapters and has been a speaker at continuing education programs and national conferences.