Head lice - treating them

head; lice; headlice; nits; louse; fleas; egg; hair; insect; bite; itch; itchy; treatment; chemicals; wet combing; combing; scalp;

Contents

• Chemical treatments
• Things to be careful about
• Wet combing
• When treatment does not work
• Managing head lice
• Getting rid of nits
• Alternative treatments
• Resources

Help! You have read the topic Head lice - all about them, or someone has checked your hair, and YOU HAVE HEAD LICE! What on earth do you do????

Head lice do not spread dreadful diseases, but you do need to have them treated. You can't treat them by yourself, so you need to tell someone who can help you.

The Department of Health in South Australia recommends using a combination of chemicals to kill the lice, and a comb to remove lice and nits (the 'wet combing' method described below is probably the easiest).

Chemical treatments

There are several different types of chemicals that kill head lice, and they need to be used in different ways. They should be used exactly as described on the labels.

• You can get advice about which treatments to use from your chemist or family doctor, but check the costs, as some cost a lot more than others that work just as well.
• You can get lotions, foams or shampoos.
• Some may need to be on the hair for at least 8 hours, while some need only a few minutes.
• Heat can stop the treatment from working as well - so do not use a hair dryer on the hair after you have treated the lice.
• Leave at least 24 hours between using hair conditioner and using head lice treatment, because chemicals in the conditioner may stop the treatment working well.
• Treatments may be available from schools, at a reduced cost, or sometimes free for school-card holders.

Always treat your head again 7-10 days after the first treatment to kill any lice that hatched after the first treatment. Not all unhatched eggs will be killed by the treatment. Repeating the treatment kills the newly hatched lice before they start laying eggs.

• Check everyone who has been close to the person with the head lice, especially family members, including adults. Treat them if there are signs of lice. People can get used to head lice and not know they have them, so they keep re-infecting others. Do not treat people who do not have lice.
• Check eyebrows and eyelashes as well as hair.
• Treatments for head lice include maldison, pyrethrins and permethrin.

Note: Effective treatment for head lice is a legal requirement under the South Australian Public and Environmental Health Act 1987. A child's parent or guardian is responsible for checking and effectively treating children for head lice.

Things to be careful about

• Keep the chemical away from your eyes, mouth and nose.
• Only use head lice treatments if there are live eggs or lice. Don't use them to try to prevent lice.
• People giving the treatment should wear plastic gloves so they touch the treatment as little as possible.
• Don't use conditioners for a day before or a day after using the chemicals. Do not use hair driers after using the chemicals.
• Wet combing may be a better choice if you are concerned about using chemical treatments.

Wet Combing

• If wet combing is the only treatment that is being used it must be done on 2 or 3 times a week for at least 3 weeks, until there have been no live lice found for two times.
  • It needs to be repeated many times because it does not kill the eggs. Each lot of newly hatched lice need to be removed before they can lay more eggs.
• The idea is to quickly smother the lice by using hair conditioner to prevent them from moving and then to remove them by hand before they can mature and lay more eggs.
• Wait for at least 24 hours after using a chemical treatment before using conditioner on the hair, because the conditioner can stop the chemical treatment from working well.

1. Apply a large amount of hair conditioner to the hair. A cheap one is OK.
2. With the conditioner still on the hair, use an ordinary comb to comb the hair and get rid of tangles.
3. Carefully comb every part of the hair with a fine tooth head lice comb. (You can get this from a chemist shop). Place the comb flat against the scalp and comb from the scalp towards the tips of the hair.
4. After each stroke of the head lice comb, wipe the comb with a tissue or kitchen paper towel and look for lice on the tissue.
5. Comb each section of the hair 4 times. Use more conditioner when the hair starts to become dry and hard to comb.
6. Keep doing this until all the hair has been combed with the head lice comb.
7. Wash the conditioner out of the hair (having a shower may be an easy way to do this).
8. Wash combs in hot water.

When treatment does not work

• This can be caused by:
  • not using the treatment exactly as the directions say
  • not repeating the treatment 7-10 days after the first treatment
  • catching head lice again from someone else (treatment does not prevent getting lice, it only treats what is there)
  • the head lice becoming resistant to the chemical used.
• Check all family members - you might have caught the lice back from them. They may have lice without itching.
• Do other things which may stop you catching them again from others, like plaiting long hair or tying it back tightly, and making sure you do not share hats, helmets and brushes.
• If it seems that the treatment has not worked, try a different one.
  • Sometimes head lice become resistant to one treatment.
  • Treatments are sold by several different companies. Check whether a different treatment has a different chemical. It could be the same chemical with a different brand name.
• The places that have been bitten can go on itching for several days after the lice have been killed. Check whether live lice and eggs are still there and it is not just the itching.
• See your doctor if the head lice are still there after you have used two treatments.

Even if you are having trouble getting rid of head lice, do not use chemicals or other products that are not meant to be put on the hair or skin. Some of these can cause serious harm.

Managing head lice

While the head lice may be adequately killed by the chemical treatment, some people want to be very sure that their family, or others, cannot catch the lice from bedding, towels, clothes, toys, furniture or carpets.

• Any live lice will be killed by heat. Washing in hot water (over 60ºC), or putting bedding into a hot tumble dryer, or ironing clothing or bedding will all kill lice.
• Use of pesticide bombs or steam cleaning carpets is not needed. Vacuuming is sufficient.
• You could put other items that cannot be washed or ironed into a plastic bag, and leave them in the sunshine for 2 or 3 days.

Getting rid of nits

While dead nits do not need to be removed to stop the head lice spreading, most people think they should be removed (eg. schools may want you to do this).

• It is difficult to remove nits, as they are strongly glued to the hair.
• Use a fine toothed comb. Metal is probably better because it can cut the individual hair at the point where the nit is attached rather than trying to unglue the nit. Nits can also be picked out by hand.
• Warm vinegar dabbed onto the hair before combing may help unstick the nits from the hair.

Alternative treatments

Many people do not want to use chemical treatments, even when they are thought to be safe.

• Many 'natural' head lice treatments have chemicals in them that are the same as the treatments recommended above (many have pyrethrins).
• Other 'natural' treatments have chemicals which have not been proven to be safe, but some may be both safe and effective.
• We are not in a position to recommend or criticise these treatments.

There are several ways of removing lice without using chemicals, and they might be effective for some people.

Hair Gel

• This has been found to work for some people, presumably by interfering with how the lice move, perhaps preventing mating or laying eggs.

Robi Comb**

• This is a battery-operated comb that is used on dry hair and kills or knocks out the lice with small amounts of electricity. The comb then removes the lice from the hair.
• To use it successfully, you need to use it often - 10 to 15 minutes every day for 2 weeks to break the breeding cycle of the lice. It also needs to be carefully maintained to work well.
• The Robi comb does not kill the nits.

Nitpickers Comb**

• Some people who have used this say that it works well and saves time. The comb has rounded teeth so it does not tear the hair. The Nitpickers comb is available at a growing number of chemists and pharmacies and local councils.

Hair cutting

• Short hair is easier to treat and comb, but shaving the head and cutting long hair is not necessary. In some communities, shaving the head is acceptable. This does protect a person from getting head lice.

** Any products referred to in our health topics are usually well-known brands readily available in Australia. The brand names are given as examples only, and do not necessarily represent the best products, nor the full range of effective products on the market.

Have a look at the topic Head lice - all about them for more information.

Resources

• There is a lot of excellent information for students, parents, schools and health professionals on the South Australian Public and Environmental Health site. This includes printable pamphlets, posters, policy drafts and where to get access to videos, teaching material, and information in many different languages.
  http://www.dh.sa.gov.au/pehs/branches/headlice/headlice-index.htm

The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Youth Healthline on 1300 13 17 19 (local call cost from anywhere in South Australia).