Lice patrol

Though I’ve got lice stories to tell of my own, I’ve been embargoed by the victims. So instead I’ll begin with my friend, Kate’s* daughter, who discovered the unwelcome visitors two days before her first day of high school – a school in a new town where she didn’t know a soul. As if walking into a new social situation wasn’t hard enough!

Although Kate makes a point to tread lightly on this earth, choosing natural to synthetic, and organic when possible, for her, this called for an exception.

“We went for the toxic stuff,” she said.

Why lice, so common these days, can still cause one to be ostracized I don’t know. There isn’t a school around that hasn’t reported a recent outbreak.

Growing up in the suburbs circa 1960s, lice was more of a joke than a problem. “You don’t have lice do you?” was a common refrain when offered a comb or brush for our preteen locks. No one ever thought their best friend would seriously be harboring the little critters.

So back in the mid-ninties when lice hit my daughter’s day care, I was appalled.

A few years later those lice had apparently moved on to my kids’ elementary school, where the motto “Caring is Sharing” apparently went a little too far (and yes embarrassingly enough, that was their motto - at least for a time.) Each year, as the dreaded “letter” indicating a new crop of lice arrived in the mail, we’d tentatively comb through our kids’ hair, thankful every time we found suspect nits to be nothing more than lint. Our school wasn’t alone. It is estimated that upwards of six to twelve million kids ages 3-12 are infested each year in the United States alone.

Humans have been battling lice since the earliest days of our existence. Archeological digs reveal lice or nits (the rice-like egg cases adult female lice affix to human hair shafts) on human hairs, old combs, mummies you name it. And, just to dispel any fears, the body lice associated with Typhus and other diseases are not the lice that infect our silken locks. In fact there are three types of lice, head lice, body lice and pubic lice. Curiously and thankfully they not only seem to know their place on our bodies, but can apparently distinguish us, their favored and only host, from our pet pooches and lap cats. And, head lice, unlike body lice, are seldom associated with disease other than excessive itching and an occasional infection as a result of said itching.

Given all these years living together, humans of course have developed a diverse arsenal from the lethal to the eccentric fight these beasties. A swig of shed snake skin tea anyone? Or perhaps a liniment of mercury and stavesacre - also known as lice-bane, or Delphinium staphisagria – a beautiful but highly toxic plant. In the 1920’s its topical use was apparently associated with the death of at least one child. And then there was, and according to some reports still is, kerosene. A treatment which brings me back to my tree-climbing days when my father used gasoline to remove sticky pine-sap from my hands. Clean of sap, but coated with a flammable solvent I’d walk to the shower afraid I might explode. Not a recommended practice – and something I’d thought was left behind with the generation for whom chemicals were life saving and life simplifying miracles – not for our generation who was left to clean up their mess. So I was surprised when, besides exhortations to avoid using kerosene, I came across a recent report from Harvard School of Public Health warning those seeking lice-treatments away from “…motor or machine oils, as these materials can be harmful.” Really? But then, we’ve used plenty of harmful treatments to remove the itchy pests over the years.

For decades the most effective treatment was DDT – credited with keeping lice out of our hair from the 1940s when it was first hailed as a wonder-pesticide through the 70s (the chemist Paul Muller snagged a Nobel Prize eight years after patenting this now notorious organochlorine chemical.) DDT’s widespread use has been credited with keeping me and my 1960s compatriots lice-free throughout our youth. But then DDT became the poster-chemical for all that was wrong with wonton use of industrial, persistent, bioaccumulative and toxic chemicals. Not only did it contribute to the demise of raptors and fish eating birds, but after only a little over twenty years of use, the wily little beasts began to develop resistance (as did other pests treated with DDT.) Not surprising for an insect that can eat and mate at the same time. Clearly lice are efficient when it comes to survival and reproduction.

More recently, lice have developed resistance to other standbys like Lindane, now banned in California and some European countries for a combination of reasons - including its toxicity. One wonders why it’s still available for use in the U.S. when according to the FDA “….serious side effects including seizures and deaths have been reported to the FDA in patients who use too much Lindane or after a second treatment with Lindane….Seizures can happen in some patients even if they use Lindane as directed; Certain people are at higher risk to develop seizures and death from Lindane. This includes: babies and children; elderly; people weighing less than 110 pounds (50 kg).”

If for some reason you are prescribed Lindane, I would suggest you check out FDA’s site and read carefully.

And then there are the commonly used and readily available over-the-counter formulations including RID, Pronto and licetrol, which rely upon an ancient remedy derived from chrysanthemums – pyrethrin. Unfortunately, today’s lice have developed resistance to both pyrethrins and their synthetic chemical cousin permethrin (found in NIX, another popular treatment.) According to one report, if lice are still hanging around after two courses of correctly applied treatments – your little guests are very likely resistant to eviction – at least by those chemicals.

And finally (for toxic stuff) there’s malathion – an FDA approved lice treatment for children greater than six years of age. Malathion not only is an irreversible neurotoxicant but also, in its commercial formulation, has the added risk of going up in flame. Because the treatment is so flammable, users are warned away from using hair dryers and curling irons (for the 8-12 hours required for treatment,) and while resistance has yet to be documented in the U.S. that’s not the case worldwide.

So, what’s a modern parent like Kate to do when faced with a head full of lice, and an impending social disaster for her child?

Enter the Medical Letter On Drugs and Therapeutics, an independent nonprofit organization dedicated to appraisals of new drugs, which just published a review of lice medications including FDA’s most recently approved treatment, a 5% benzyl alcohol lotion. According to Medical Letters, because it actively suffocates lice by opening and obstructing their airways – rather than working at a biochemical level (inhibiting certain enzymes, a mode of action to which insects may develop resistance) there’s some hope this treatment won’t contribute to development of “superlice.” Additionally studies suggest the required ten-minute treatment is not only effective but “well tolerated,” even by the very young. Though they note that “preterm neonates injected intravenously with products containing benzyl alcohol have developed a ‘gasping syndrome’ with CNS depression,….sometimes progressing to neurological deterioration and cardiovascular collapse,” lice treatments are topical and this one has been approved for infants six months of age and older.

There are also “smothering” treatments – like mayonnaise and olive oil – to which I can personally attest (though I won’t say how.) These treatments slow active lice down enough to easily remove, but be warned, at least one recipient of the treatment (which involves spending the night with hair dressed in mayonnaise) has sworn off the stuff for life.

Here again, one can find words of wisdom offered up by Harvard’s School of Public Health which cautions that “Olive oil (or any similar food-grade product) would seem intrinsically safe, but may have associated hazards nonetheless. Oil may cause accidents (slips), and would be difficult to remove from the hair and scalp.” Hmmmm, here's a thought - avoid swabbing your floors with the stuff, and you may be OK. Seriously though, their site is worth checking out for a review of lice treatments in general.

Another smothering agent is dimethicone, the “primary” and apparently active ingredient in another newish product, LiceMD (I say apparently because it is frustratingly difficult to find any information on how the product works other than it contains dimethicone.) Dimethicone is type of silicone oil. I can confirm the ease of combing one’s hair (my own) after use – silicone after all is an excellent lubricant for rusty chains and creaky doors too. So maybe we’re not too far from motor oil and other lubricants after all.

A more pleasant treatment might be a combination of essential oils including lavender, peppermint and eucalyptus dissolved in ethanol and isopropanol (another alcohol) – reported to work as well on active lice as some of the more traditional pesticides to which lice are resistant.

Lice shouldn’t be cause for social trauma, but they are. So when the bugs find their way to your home, be patient – and at least give the non-toxics a try - they might just do the trick. And, you never know, there may even be some unexpected benefits - there’s nothing like gently combing through and nitpicking your kids hair to (at least temporarily) strengthen family ties - not that I'd know.

*Not her real name.