Super Lice: What you need to know

You may have seen a lot of headlines recently about drug resistant super lice that is now spreading throughout the United States.

A whopping 42 out of 48 states tested are overrun by this so-called super lice, according to a study published in the Journal of Medical Entomology. The map of the United States below shows resistant lice in 100% of Texas samples. 

The problem is that the so-called "super lice" has mutated such that it is now resistant to most over the counter treatments.

The current recommendations from some health care professionals is that it is still reasonable to give over the counter treatments a couple tries separated by a week before needing to see a Doctor. 

The good news is that there are still prescription options that are effective even when the over the counter options fail.

If you need to see someone about lice I am happy to help or you can see your own PCP. 

The following general information about Lice is taken from an online physician resource.

HEAD LICE SYMPTOMS — Most people with head lice do not have any symptoms. Some people feel itching or skin irritation of the scalp, neck, and ears. This is caused by a reaction to lice saliva, which the lice inject into the skin during feeding.

HEAD LICE DIAGNOSIS — Head lice are diagnosed by examination of the scalp and hair. Special "nit combs" can be used to assist with the diagnosis.

●Before using the fine-toothed comb, use a regular brush or comb to remove tangles. This can be done while the hair is wet or dry. If the hair is wet, apply hair conditioner to make the hair easier to comb.
●Place the fine-toothed comb at the top of the head, touching the scalp. Pull the comb through the hair from roots to ends. After each stroke, carefully examine the comb for lice or eggs.
●Comb the entire head at least twice

Finding eggs (nits) without lice does not necessarily mean that there is an active infestation; nits can be found for months after lice are treated. Because lice lay eggs at the base of the hair shaft, the identification of nits within ¼ inch of the scalp suggests (but does not confirm) an active infestation [3].
Lice can be more difficult to see than nits since they can move and hide from view. A doctor or nurse can examine the head under a special lamp, which causes nits to glow a pale blue color. If you are unsure whether your child has lice, make an appointment for your child to be examined before you start treatment.

Finding head lice can be upsetting to children and parents, but it is important to keep the following in mind:
●Head lice are not a sign of being dirty or sick
●You can get rid of head lice with proper treatment
●There are no serious or long-term health problems associated with head lice

HEAD LICE TREATMENT — There are several options for getting rid of head lice, including creams and liquids, combing, and oral medicine (pills). It is important to follow directions carefully to be sure that the treatment works.
If you are sure that your child (over age two years) has head lice, you can use a nonprescription lice treatment. Examine family members and close contacts at the same time and treat them if needed. If your child is under age two years, contact the child's doctor or nurse for treatment advice.

Insecticides — A topical insecticide (pediculicide) is a substance, usually a lotion or gel, that is applied to the scalp to kill lice. Available insecticides include:
●Permethrin (Nix, Rid)
●Pyrethrin (A-200, Pronto, Tisit)
●Malathion (Ovide, prescription required in the United States)
●Benzyl alcohol (Ulesfia, prescription required)
●Spinosad (Natroba, prescription required)
●Topical ivermectin (Sklice, prescription required)

Follow the manufacturer's instructions for applying the insecticide carefully. Typically, you wash the hair with shampoo, rinse it, and towel-dry it. Apply the insecticide cream or gel liberally to the scalp and leave on for 10 minutes before rinsing with water. Malathion (Ovide) should be left on the scalp for 8 to 12 hours or overnight. Malathion has a bad smell, which can be hard for some people to tolerate. Malathion is also flammable and should never be applied in close proximity to fire or electric heat sources (such as a lit cigarette, curling iron, or hair dryer).

A second treatment is needed with permethrin, pyrethrin, and benzyl alcohol 7 to 10 days after the first treatment. This is because some lice are able to survive the first treatment. A single application of malathion often is sufficient. However, malathion should be reapplied if live lice are seen seven to nine days after treatment. Treatment with spinosad should be repeated if live lice remain after seven days. Topical ivermectin is given as a single treatment; patients should consult with a healthcare provider before repeating treatment.

Wet-combing — Wet-combing is a way to remove lice from the hair with careful and repeated combing. It is a good option for treating very young children or if you want to avoid using insecticides. However, wet-combing is time consuming and must be repeated multiple times over a period of a few weeks.
Wet the hair and add a lubricant, such as hair conditioner or cream rinse, vinegar, or olive oil. See above for a description of how to wet-comb. The combing session should take 15 to 30 minutes, depending how long and thick the hair is. Comb every three to four days for two weeks AFTER you find any large, adult lice.

Oral medicines — A medicine taken by mouth called ivermectin might be prescribed for people whose lice are resistant to topical insecticide treatment.

Other treatments — Studies have examined lotions and other materials (olive oil, butter, mayonnaise, petroleum jelly [Vaseline]) that are applied to the head, and then allowed to dry, with the goal of suffocating lice. However, lice are difficult to suffocate; wet-combing probably works as well and is less messy.
Lice treatments that use gasoline or kerosine are toxic and can lead to serious injury and should not be used.
We do not recommend any of these treatments.

PREVENTING HEAD LICE SPREAD — Adults and children who live with a person diagnosed with lice should be examined for lice and treated if needed. Anyone who sleeps in the same bed should be treated for lice, even if no lice or eggs are found.
School policies differ about who at a school, if anyone, needs to be informed when a child has lice. A confidential call or visit with the school nurse is a good place to start. Most experts believe that children with head lice do not need to be removed from school.
Clothing, bedding, and towels used within 48 hours before treatment should be washed in hot water and dried in an electric dryer on the hot setting. Dry cleaning is also effective. You can use a vacuum to clean furniture, carpet, and car seats. Items that cannot be washed or vacuumed can be sealed inside a plastic bag for two weeks. Items that the person used more than two days before treatment are not likely to be infested because head lice cannot survive off the body for more than 48 hours. You do not need to have your home sprayed for lice.


​