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LETTERS: Anthony Lwegaba Shaving can be safer head lice treatment than insecticides BMJ 2005; 330: 1510-c [Full text]

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Can shaving be a safe treatment strategy for head lice

Kosta Y. Mumcuoglu   (26 June 2005)

Educating the community is important

Dr.Satheesha Nayak   (27 June 2005)

Shaving for head lice is unnecessary and often distressing

Christine M Brenton   (29 June 2005)

Can shaving be a safe treatment strategy for head lice 26 June 2005
Kosta Y. Mumcuoglu, Senior Research Scientist Department of Parasitology, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel Send response to journal: Re: Can shaving be a safe treatment strategy for head lice	Dr. A. Lwegaba, while working with displaced and nomadic populations in Africa, observed that head lice were not a clinical problem because people shaved their heads. He also reports an example of poisoning and some deaths in an institution for mentally handicapped children in Uganda due to the fact than these children licked their hair after it had been treated with insecticide. The author mentions that his colleagues disagreed with him and he wonders why. Today, the prevalence of head lice infestation is either high or increasing in most countries where studies have been conducted. In most countries 5–20% of children, 4–12 years old are infested with head lice at any given moment.1 The psychological effects of a louse infestation often exceed the physical ones: in the majority of cases a mild pruritus is the only sign of a louse infestation.2 Parents, teachers, kindergarten staff, social workers and even nurses and physicians are distressed by the presence of lice. They often blame the child and make him/her feel responsible for the infestation3 while the only thing that the child had done was to be social and have contact with other children. Therefore becoming infested with lice is no more or less the child’s fault than getting flu or any other infectious disease. In desperate situations parents also use "alternative" methods for lice control such as gasoline, insecticides that should not be used for treating humans, and different food products such as margarine and mayonnaise. Shaving the head or even a short haircut for prevention or control of lice is not recommended due to the psychological damage the child might experience, especially girls, who have usually longer hair, are more conscious about their looks and are generally more often infested with head lice than boys. It should be stressed that by no means should the child be stigmatized or punished. In the majority of cases we are not dealing with sport stars, prisoners or soldiers but with 4–12 year old children; neither are we dealing with refugees or nomads, but children from all socio-economic levels. Millions of children are treated every year for lice, and the number of known cases with serious side effects reported is minimal, especially when approved pediculicides are used according to the instructions. References 1. Mumcuoglu, K. Y. 1999. Prevention and treatment of head lice in children. Paediatr Drugs 1: 211-218. 2. Mumcuoglu KY, Klaus S, Kafka D, Teiler M, Miller J. 1991. Clinical observations related to head lice infestation. J Am Acad Dermatol 25: 248- 251. 3. Mumcuoglu KY. 1991. Head lice in drawings of kindergarten children. Isr J Psychiatry Relat Sci 28: 25 32. Competing interests: None declared
Educating the community is important 27 June 2005
Dr.Satheesha Nayak, Selection Grade Lecturer in Anatomy, Manipal Academy of Higher Education Manipal, Udupi District, Karnataka State, INDIA. 576104 Send response to journal: Re: Educating the community is important	The head lice (Pediculosis capitis) is one of the community problems in rural India also. Lack of education, full of blind beliefs and poor hygiene are the main causes of this problem. In the villages, people do not wash the hair daily. They apply either coconut oil or any other vegetable oil to the hair and keep the hair tied. This forms the best breeding ground for the lice. Fungal attacks are also common in this kind of a situation. I have seen people going to the temples and offering various things to gods to get rid of the head lice. They also apply various toxic things to the scalp to get rid of the lice. I have seen application of kerosene oil, DDT (the popular pesticide) and so on. In children, they shave the head to get rid of the lice but in adults, especially females the shaving is rare. Educating the community regarding the hazards of use of pesticides and chemicals and about maintaining a good hygiene is very important in this regard. Competing interests: None declared
Shaving for head lice is unnecessary and often distressing 29 June 2005
Christine M Brenton, Public Health Nurse Department of Health, Western Australia, 6008 Send response to journal: Re: Shaving for head lice is unnecessary and often distressing	The Department of Health, Western Autralia (DOHWA) actively discourages shaving hair to remove head lice. It is unnecessary (effective treatments are available),it often distresses the child, and is usually the result of despairing parents not receiving accurate up-to-date advice on effective treatments (or sometimes, not following instructions correctly). One-off treatments are a short term solution only, and more substantial school community education on long-term systematic management programs is required. It is essential that out-of-date, unsubstantiated head lice treatment advice is NOT perpetuated. Rather, we must promote effective treatments based on current research-based information. Also, treating a child in isolation without sceening their contacts, may lead to persistent infestations circulating amonst the class. So, we also need to ensure that the parents of children in the same class are given detailed advice at the same time, to ensure their child is effectively screened. Many parents are unaware that "dry" head checks (checking dry hair with the hands) are often unreliable, however much time is devoted to doing it, due to the rapid speeed at which head lice move around. Parents are advised to use copious amounts of hair conditioner applied to dry hair to immobilise the lice for a short time, so that if present, they can be efficiently trapped in the nit comb. Of course, sometimes lice and eggs close to the scalp are highly visible and nothing else is needed to identify the infestation. In WA, we provide an internet resource for parents, schools and child carers at: www.health.wa.gov.au/headlice This focuses on: 1. providing school parents and staff, and anyone else concerned, with current research-based advice. DOHWA also distributes this advice to hairdressers, pharmacists, local goverment Council oficers, child care centres, parent associations, libraries, training institutions for hairdressers, child carers and teachers. Open, free education sessions are held each term by the Department to advise on establishing effective whole school head lice management programs. 2. ensuring the the parents of the whole class are given the same advice and assitance with options, at the same time - and not for example just a brief, unhelpful note home that says "check your child and treat if lice are found". 3. establishing is a systematic and consistent process for ensuring that parents can and do comply with school's requests to check and treat. 4. detailed multi-focussed education strategies. A set of class lesson plans is provided on the inetrnet site and a video / DVD is being produced for each school to lend to parents. The WA Department of Health's preferred treatment is the 10 Day Hair Conditioner Method -see internet site. Second daily combing is sufficient.( If parents prefer using insecticide, they can read correct instructions on this internet site. According to the Australian Therapeutic Goods Administration, labelling of insecticide products in Australia may be unclear, and so may lead to ineffecive treatment. Note: to make combing during the school week less time-consuming, it is suggested that combing be done on tuesday, thursday, sat & sunday x two weeks. This is a little over the essential 10 days, but helps to reduce the risk of re-infestation while the class cohort is being checked. Apologies for this extended posting - however, head lice seem to cause distress to all involved, out of all proportion to their actual significance. DOHWA is keen to promote a multifaceted, systematic and effective approach to reducing this. Competing interests: None declared