These Lice Ain't Nice; Are 'Super-Lice/Mutant Lice' a Real Threat?

Will treatment-resistant lice make their way to our children's scalps this year? Though new and alarming research on lice is now out, if you are vigilant, these nits probably won't pose a risk to your family.

On August 18th, researcher Kyong Yoon, Ph.D. from Southern Illinois University presented data at the American Chemical Society meeting in Boston showing that 25 states have reported lice that are resistant to common over-the counter (OTC) products. New York, specifically (as well as New Jersey) reported up to three gene mutations. The media picked up on this finding and ran with it publishing titles such as "Super-Lice Strike!" and "Mutant Lice Invade!" as well as "Untreatable Lice." Did just reading that make you itchy?

Are lice really becoming untreatable and is this truly a risk for kids here in Scarsdale? According to the CDC, the answer is basically no. Lice can be resistant to pyrethroid products marketed under the names Nix, Pronto, A-200, R&C, Rid, and Triple X, but it is far from untreatable. Whereas Dr. Yoon recommends that companies develop additional treatments for lice to decrease current and future resistance, there are several other products on the market that one can use (including prescription-only shampoos). In fact, live lice and their nits (eggs) can be picked out of hair without additional treatment but it is time consuming. Furthermore, Yoon readily notes that lice have shown resistance to these products for more than two decades yet they still work the majority of the time. Other sources pointed out that the study was funded by pharmaceutical companies that manufacture prescription-only shampoos.

Here's what you need to know about lice:

• Nits are head lice eggs. They are often confused with dandruff. They are not generally viable if they are more than 1/4" from the hair shaft and therefore don't pose a risk of infestation in and of themselves.
• Nymphs are just-hatched lice. In 7 days they become adults.
• Adult lice are the size of a sesame seed and are tan, grayish, or brown. They can lay 8 nits a day and can live for 30 days. They require human blood (as do nymphs) to survive. Lice cannot live on pets.
• Lice do not prefer dirty hair.
• It may take 4-6 weeks for itching to begin the first time a person has lice. Therefore, a child may be infested with lice for a month before it is diagnosed.
• Lice do not fly or jump. They can only crawl.
• There are 6-12 million lice infestations each year among children ages 3-11.
• Lice do not transmit disease. They need to eat frequently (blood is their food source) so they are usually transmitted from person-to-person directly.
• The Scarsdale PTA does lice screening at the schools although it has not been shown to reduce the incidence of active infestations or to be cost effective according to the American Academy of Pediatrics (AAP).

A July 2010 publication in Pediatrics (five years before the recent alarming headlines about resistance) emphasized that resistance to treatment for lice is often confused with other reasons that a treatment may not work including misdiagnosis, lack of adherence, or inadequate treatment. The CDC and the AAP both recommend that treatment for lice only be initiated if live lice are found on the head and/or nits are found less than ¼" inch (1 cm.) from the hair shaft. Nits may be removed for aesthetic purposes but they, in and of themselves, are not indicative of a lice infestation. Therefore, children found to have nits do not need to be kept home from school or treated with insecticides. In studies, a "no nit policy" (such as New Rochelle's) has not been found to be effective at reducing head lice and both the AAP and the National Association of School Nurses decry the policy as unjust and lacking scientific justification. Diagnosis of lice is usually made by a parent who sees the crawling creatures. Sometimes a parent will notice the child itching his or her head and it is common to see small red bite marks around the nape of the neck and the ears in a child infested with lice.

Treatment of lice is generally effective. All household members should be checked. Clothing, accessories, and bedding of the infested person should be washed and dried on the hottest temperature possible or dry-cleaned, and the carpet and furniture should be vacuumed. Conditioner should not be used before using an insecticide shampoo and the hair should not be washed with a regular shampoo for a couple of days after treatment. Check with your pediatrician for the safest and most effective lice treatment. There's a service for almost everything in Westchester, so of course there are delousing services. They'll come to your house or you can go to a salon to have the lice and nits removed. Some companies call over-the-counter products poison and tout their own products as safe, effective, natural, and FDA-registered, but don't get confused by FDA-registered versus FDA- approved. FDA approved products undergo a safety and efficacy review by a neutral panel of reviewers versus FDA registered products that are not reviewed nor condoned by the FDA.

One mom I spoke with that recently had a child with a lice infestation said that she called a delousing company because it was her first experience with lice and she had no idea how to treat it. "Honestly, I panicked," she said. "I would try to self treat it next time because the woman from the delousing service was very knowledgeable and empowered me to understand the lifecycle, how the treatment worked, and why I should stay calm and not panic." She doesn't regret using the service that used an all-natural, enzyme-based, non-toxic foam, but she was still finding nymphs in her child two weeks later. She eventually called her pediatrician and went the insecticide route. "I really think combing the hair thoroughly and rechecking every couple of days is necessary," she said. "I could definitely handle it if it happened again and I wouldn't freak out."

The Scarsdale Schools policy reads as follows: "The CDC and AAP recommendation is that students not be excluded from school because of lice. Pediculosis [lice infestation] is considered a nuisance but has not been shown to spread disease. In Scarsdale, our practice is that only students with live bugs be sent home to start treatment. This is in part to protect confidentiality (younger students may march in to class and announce proudly, "I have lice") and to allow parents to get a jump start on treatment, which can be time consuming. Students with nits (egg casings) are encouraged to go home to start treatment as well, but may remain in school until the end of the day."

At the end of the day, lice are a part of growing up and raising kids. Though they cause widespread disgust, Scarsdale has yet to see an army of mutant lice marching through our schools.