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You pick up your child from school and notice something crawling on top of his or her head. The hairs on the back of your neck stand up, your heart starts beating fast, and you feel slightly itchy. Meet lice. These wingless parasites do not care who you are, what you do, and contrary to popular myth, how dirty your head is.

If you don’t see active crawling lice but have suspicions, examine the scalp closely with a bright light. Lice eggs or nits show up as a light yellow colored sphere (careful not to confuse with dandruff) attached at the base of the hair in areas behind the ears or at the base of the scalp. They will need to be removed to eliminate the presence of these creepy crawlers.

Should my child be taken out of school if he/she has active lice?

Affected children may return to school once treatment is initiated. However, it is a good idea to remind them to avoid direct head contact with others, which is the primary route of transmission.

What about swimming?

Lice can survive for hours underwater but cling tightly to the hair they call home, so risk for transmission in pools is low. As for the rest of the household during an infestation, wash and dry clothing and linens in hot water and high heat. Don’t forget to vacuum furniture and carpeting.

Treatment

First-line medical treatment is topical Pyrethrins and Permethrin-containing shampoos, which can be purchased over the counter. In the case of resistant lice, stronger prescription shampoos containing Ivermectin can be used. These shampoos are generally safe and effective and at most cause a very mild itching or burning sensation in those with hypersensitivity. Of course, run any questions or concerns by your doctor in the event of reaction. Although a one-time treatment of the hair and scalp for 10 minutes is usually sufficient, the Center for Disease Control recommends repeating treatment after 7 days to ensure eradication. Removal of lice eggs can be performed at home with a fine-tooth comb or “lice comb” following treatment.

I recently learned of a more old-fashioned treatment that involves saturating the scalp and hair with olive oil for six to eight hours to suffocate the lice. A lice comb is then run throughout the hair and wiped off with a paper towel to extract lice and nits and repeated until no more appear on the comb. While this technique avoids a possible drug reaction, it is more time-consuming and can take about a week to fully complete.

Whatever method you use, do not be shy to talk to a trusted doctor, especially if initial treatment fails. Lice are built to weather tough storms (this can be taken literally), yet the good news is that treatment is relatively easy and inexpensive. With knowing what to do and enlisting the proper tools, you’ll be able to keep that stress at least out of your hair.

Ariana Abid, MD
A native of Sarasota, Dr. Abid is a third-year resident in the Halifax Health Family Medicine Residency Program.

Ariana Abid, MD