Head lice are tiny grey/brown insects. They are about the size of a sesame seed (the seeds on burger buns). Head lice cling to hairs, but stay close to the scalp which they feed off. They lay eggs which hatch after 7-10 days. It takes about 10 days for a newly hatched louse to grow to an adult and start to lay eggs.
Nits are the empty white egg shells which are left when the lice hatch. Nits can look like dandruff, but stick strongly to hair. Unlike dandruff, you cannot easily brush out nits.

Who gets head lice?

Head lice are common in children, but can affect anyone at any age. They are not a sign of dirty hair or poor hygiene. Close 'hair to hair' contact is usually needed to pass lice on. Head lice cannot jump or fly, but walk from one head to another. They soon die when away from hair, and do not live in clothes, bedding, etc. Most head lice infections are caught from family or close friends who are not aware that they have head lice.

What are the problems with head lice?

Most people with head lice do not have any symptoms. An itchy scalp occurs in about 1 in 3 cases. This is due to an allergy to the lice, not due to them biting. It often takes about 3 months for itch to develop after you are infected. So, you may not notice that you have head lice for a while, and you may have passed them on to others for some time. Head lice and nits do not wash off with normal shampoo. Head lice do not cause any other medical problems. In most cases the head is not 'crawling with lice'. Commonly, there are less than 12 lice present.

How can you tell if you have head lice?

Head lice are difficult to find just by looking in the hair. If you suspect head lice, it is best to do 'detection combing' (described below). Some people advise that you do this to children's hair regularly, about once a week.

Wash the hair in the normal way with ordinary shampoo.
Rinse out the shampoo and put on lots of ordinary conditioner.
Comb the hair with a normal comb to get rid of tangles.
When the hair is untangled switch to a detection comb. This is a special fine toothed comb that you can buy at pharmacies. (The teeth of normal combs are too far apart.)
Slot the teeth of the detection comb into the hair at the roots so it is touching the scalp gently.
Draw the detection comb through to the tips of the hair.
Repeat this in all directions until you have combed all the hair.
Check the comb for lice after each stroke. A magnifying glass may help.
If you see any lice, clean the comb by wiping it on a tissue or rinse it before the next stroke.
Comb over a white surface such as white paper. This is so that any head lice that are flicked out by the comb are easy to see.
After the whole head has been combed, rinse out the conditioner.
While the hair is still wet, use an ordinary comb to get rid of tangles.
Repeat the detection combing in the rinsed hair to check for any lice that you might have missed the first time.
It takes about 10-15 minutes to do detection combing properly, depending on how thick the hair is.

What are the treatment options for head lice?

Treatment is needed only if you see one or more live moving lice. Nits (empty eggshells) do not always mean infection. Nits stick to hair even when lice are gone (after treatment).

Treatment with lotions or cream rinse
You can buy various lotions or a cream rinse which kills lice from pharmacies. The active ingredient is malathion, permethrin, or phenothrin. You can also get these on prescription. Head lice shampoo does not work very well and is not advised. Lotions come in water or alcohol bases. Alcohol based lotions work slightly better than water based lotions. But, do not use alcohol based lotions if you have asthma, eczema, or broken skin.

Note: Alcohol based lotions are flammable. So, do not use near naked lights, cigarettes, fires, or flames. Be careful with children near fires who have alcohol lotion in their hair.

Some tips include:

Follow the instructions on the packet carefully. This may include the following.

For lotions: apply to dry hair. Part the hair near the top and pour a few drops onto the scalp. Rub well into the hair. Part the hair again a little further down and repeat. Repeat this until the scalp and roots of the hair are saturated. Apply down to where a pony tail band would be. Leave on for 12 hours (overnight) and then wash off. Each person needs about 50ml of lotion, and up to 150ml if you have long thick hair.
For cream rinse: apply to damp hair so that the scalp and roots of the hair are saturated. One tube is usually enough. Leave on for 10 minutes and then rinse off.

Do not go swimming before applying a lotion. The chlorine from the swimming pool may stop it working.
Do not use a hairdryer to dry hair after applying treatment.
Re-apply the same treatment after 7 days. (Although lice are usually killed by one application, not all eggs may be. The second application makes sure that any lice that hatch from eggs which survived will be killed before they are old enough to lay further eggs.)
Inspect the hair by detection combing 2-3 days after the second application. If you find any live moving head lice, despite treatment, then see a doctor or nurse for advice.

Wet combing treatment using the 'bug busting' method
'Bug busting' is a way of removing head lice without having to use a lotion or cream rinse to kill them. The Bug Busting method in described in the section above 'How can you tell if you have head lice?' Do this on every member of the household who has head lice. (The detector comb removes the lice which cannot grip hair which is slippery with conditioner). You need to do the wet combing routine every 4 days for at least 4 sessions (2 weeks).

The first combing session should remove all hatched head lice, but does not remove eggs.
Any young lice that hatch from eggs after the first session are removed at the second, third and fourth sessions. This is why it is important to do the full 4 sessions.
If you see full-grown lice at the second, third, or fourth session, this means that some had been missed on the first session, or you have become re-infected from someone else. If this occurs, you should increase the number of sessions. In effect, following any session where you find adult head lice, you should do 3 further sessions at 4 day intervals where you do not see adult lice.

Fuller details of wet combing treatment ('Bug Busting') can be obtained from:
Community Hygiene Concern, Manor Gardens Centre, 6-9 Manor Gardens, London, N7 6LA
Tel: 020 7686 4321 Web: www.nits.net Do family and friends need treatment?

Only if they have lice. All people in the same home, and other close 'head to head' contacts of the previous 4-6 weeks should be contacted. Tell them to look for lice and treat if necessary. (It used to be advised to treat all close contacts even if they had no symptoms. This has changed to just treating people with definite head lice infection.) All people with head lice in the same home should be treated at the same time. This stops lice being passed around again.

What about school?

Children with head lice should carry on going to school. Contrary to popular belief, head lice do not spread quickly through schools. Alarming 'head lice letters' from schools are unhelpful. You need close head-to-head contact to pass lice on to others. Young children who are 'best friends' and play closely together may pass lice on. If your child has head lice, a common sense approach is to tell the parents of their close friends to look out for lice in their children.

Can head lice be prevented?

There is no good way of preventing head lice. Lice repellent sprays do not work very well. If you do detection combing of children's hair every week or so, you will detect lice infection early. So if an infection does occur, you can start treatment quickly and reduce the risk of passing them on to others.

Some other points about head lice

Use an anti-lice lotion or cream rinse only when you are sure that you or your child have head lice. Do not use them to prevent head lice, or 'just in case'. Frequent use may cause a build up of small amounts of the active medication in the body. The risk of harm from this is very small, but it is best to use these treatments only when infected.
A common reason for head lice to recur in one person is because close contacts (family and close friends) are not checked for head lice, and not treated if they are infected. The treated person is then likely to get head lice back again from untreated family or friends.
After treatment and the lice have gone, it may take 2-3 weeks for the itch to go fully.
Nits may remain after lice have gone. They are empty egg shells and stick strongly to hair. They will eventually fall out. If you prefer, a fine toothed 'nit comb' can remove them.

A final reminder - alcohol based lotions are flammable. Some children have been badly burnt as their hair caught fire whilst being treated. Keep children away from fires, cigarettes, flames, etc, whilst lotion is in their hair.

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