Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Surviving Head Lice
- Robyn N Wood (21 May 2002)
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Community based managed care programme for for head lice is successful
- Surinder S Bakhshi (22 May 2002)
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Deliberate passing on of lice
- Sarah Beswick (24 May 2002)
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Treating lice with "lousy" products
- Sheila A Skeaff (22 October 2002)
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Beware the Lindane Nurse
- Phillip J. Colquitt (24 October 2002)
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Robyn N Wood, Senior Scientist, Immunology Dept Queensland Medical Laboratory 4014
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i felt, from reading Ms Crossans review, that the answer to this universal problem, is based on what is practical to the encumbered family. My own personal experience has been multifactorial. i have tried many commercial shampoos, most which have left my wallet empty, the children crying from the fumes exuding from their head for the next number of days, and the lice laughing at my pitifull attempts to find a shampoo that they are not resistant to. My neighbours and I then decided a networking approach may be more effective, as that was probably the way the little varments had first established themselves. So between the 2 families we purchased a Robicomb, to be our first line of attack (if we can find which family has placed it in a safe place in readiness for such an event). The Robicomb may catch a number of other nonidentified objects, but it does give parents extreme pleasure to think of the end suffered by the lice if they are slow enough to be caught. This is some small reward for the hours of frustration that it has caused. We then go on the attack between combs with the conditioner treatment. This is always most effective if the conditioner is the cheapeest one can find. At least the little beggars have not driven us to apply for another bank loan for this purpose. If in a few days or weeks (time permitting) this has not suceeded, then we also apply 1/2 doses of a tea tree (commercial-give me strength) egg killing shampoo. By this stage, if they haven't all gone, at least the kids are so used to the problem that they have stopped scratching incessantly (a dead giveaway at school)and either the problem has become so entrenched that everyone is relaxed about it, or you change schools. Simple really, isn't it? Robyn Wood
competing interests
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Surinder S Bakhshi, Consultant in Communicable Disease Control 213 Hagley Road, B13 9RG
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Liz Crossans in her gloomy review of head lice treatment concludes that not much has changed since the shaved heads, shame and nit picking of around hundred years ago (1). Not so. There is an alternative solution from focus on treatment of an individual head to a community based managed care of headlice. It presumes that head lice infestation is a transitory problem of primary school age children. There is no practical solution, either medical or non-medical, to clear satisfactorily a head of its lice and then keep it that way at that age. Reinfestation rapidly occurs It further presumes that head lice do not damage a child’s health and are only a social irritant. The answer is to accept its inevitability and adopt a policy of managed control than eradication in its period of infestation in the 3-4 years of primary school age. No nasty medical or alternative therapy; no buying of special combs, oils and shampoos; no shaving heads or exclusion of children from school. It then becomes a community issue rather than a medical concern. Birmingham Education Department (2) has taken a lead, in co-operation with the local public and community child health services, to emphasise the intrusive but harmless nature of the infestation and ask parents through their extensive network of school governing bodies, teacher-parent associations and direct dialogue with parents of accepting the inevitable. Parents are advised to pay additional attention to the head of their primary age school children, washing and grooming their hair regularly using an ordinary fine-toothed comb. Parents are asked to use the ‘wet’ comb method if they suspect head lice and continue ‘wet’ combing if necessary. The objective is to reduce the head lice load to an 'invisible' level. An attractive handbook (2) is available to teachers, school governors and nurses to accept the limitation of a managed care solution but pointing to the discredited alternatives. Number of complaints received by schools has declined dramatically. Not all parents are satisfied with this policy but hold their peace as they now accept making a drama of head lice infestation leads nowhere. Better to accept an orderly limited solution than drown in confusion and conflict. 1. Crossan L. experienced based treatment of head lice. BMJ 2002; 324:1220 (18 May) 2 Birmingham city council Education Department. Headlice guidance for educational establishments. Birmingham Health Education Unit. November 2000. |
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Sarah Beswick, Housewife
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I was told by a cute Brownie how headlice are really spread from child to child, not by head contact,prolonged or otherwise. Malice! So next time someone annoys you, take a louse from your own scalp and quietly put it on their hair. I have it on good authority that this is most satisfying and very effective. |
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Sheila A Skeaff, Lecturer Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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I was reassured to read Liz Crossan's article suggesting that wet combing is an effective means to combat lice. As a scientist and mother of three girls I have been both fascinated and frustrated with these little creatures. Over the last two years, through a series of simple experiments (granted with small sample sizes) I came to the same conclusion myself. I have used several different chemical treatments, believing both the pharmacists and the manufacturers claims that such treatments were effective. After the treatment I extracted "dead" lice from hair and placed them in glass jars only to see the lice "up and about" an hour later. I also spent 6 months using an expensive yet poorly designed lice comb that was basically useless. I have had pharmacists and our local GP, who after looking carefully in her hair, prescribe steriodal scalp lotions for a daughter who had an itchy scalp; the next day I found lice! Wet combing with a good lice comb every 2-3 days for at least two weeks has been the only successful method I have found to combat these resilient little bugs. There is a considerable lack of knowledge about lice and the treatment of lice in the community, amongst teachers, parents, doctors and pharmacists. In particular, pharmacists need to take more responsibility by ensuring that they sell effective lice combs and that they warn parents that many lice are becoming resistant to the chemicals in lice products. Busy parents today rely heavily on technology to "solve the problem"; if the technology is not keeping up, then people need to be informed by those who are producing and promoting the technology. Although I agree with the comments of Surinder Bakhshi and the Birmington Education Department that there is no need to be revulsed by lice in children's hair and that lice is now rampant in schools around the world, I do think that there are some simple things we can do. Fifty years ago girls were not allowed to attend school unless their hair was tied back; many girls now have the freedom to make their own choice about hairstyle, unfortunately loose hair inevitably means that lice can jump more easily from head to head. Fifty years ago boys had short hair, today many boys have long hair and others might have dreadlocks ("lice farms"). No doubt there are other societal factors that may also account for the rising numbers of children with lice. Personally I think more studies need to be done. Sure lice are pretty harmless in the grand scheme of things, but it's no fun having bugs and an itchy head. |
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Phillip J. Colquitt, Independent
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Editor, As will happen, the site I mentioned[1] and which you kindly passed on to readers[2], which site advocates treating lice by applying hair conditioner to dry hair, has now moved. The old address was (www.health.qld.gov.au/phs/shpu/9169_doc.pdf). The new address is (http://www.health.qld.gov.au/phs/Documents/cdu/13368.pdf). Based on my 24 continuous years involvement in nursing, Lorexane(Lindane 1-2%) is used almost as a reflex by many inexperienced nurses, at such times as there are isolated cases of head lice in hospital patients. Particularly worrying, is the nurse who demands a “free” bottle of Lorexane, and pressures doctors into agreeing. Then, becoming expansive and power crazed, nurse demands that all staff in the ward be treated, because she’s “got a wedding to go to this weekend”, and doesn’t want it ruined by having to touch anyone infected. Lindane is a dangerous agricultural chemical, and repeated undocumented applications to symptomless individuals have occupational health consequences beyond the understanding of those often advocating its use. [1] Conditioner should be applied to dry hair Phillip J Colquitt BMJ Rapid Responses (17 November 2001). [2] Letters. Experience based treatment of head lice. Liz Crossan. BMJ 2002; 324: 1220. |
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