Practical
information
The practical information given in the
websites listed on the links page may be an ideal start for individuals with head lice.
Arming yourself with information on lice and the options available to you is a good idea.
The additional information that findings by A. M. Bailey and P. Prociv can provide is that
a complete cure is achievable and more likely if the hairstyle allows direct access to the
lice.
Have you ever disturbed a spider only
to find a hundred tiny baby ones? If you are lucky you may only have picked up a couple of
stray lice. That would be simple. However, for many people, the lice you see, pick or comb
are only the tip of the iceberg.
Depending on hair type, hairstyle, eyesight
and experience, most people cannot see developing lice or comb them out immediately, even
with a fine toothed comb; they are too small and well-hidden. Missed lice could be
responsible for a relapse in one or two months down the track.
In longer hair you may not gain easy
mechanical access to all the lice. Therefore, the benefits of a trendy new hairstyle that
both shortens and thins the hair is that large sections of hair can be combed quickly and
directly from the scalp outwards.
Hair-shortening is no guarantee that
you will be cured. This is not an advice page. This is information based on research
findings. It is your decision, as is considering any information on head lice. Shortening
hair will help to make the task more comfortable and efficient.
Some who have shortened hair after weeks of
exhausting combing and hand-picking wished they had tried it earlier. It grows back and it
is safer than the dodgy chemical concoctions that people are trying out of desperation.
Even so, you may need someone with experience to check for missed eggs or lice even in
short hair.
What about egg-picking?
There has been a backlash
against the time-honoured manual method of attempting to remove all eggs. Although it is
known that the flakey flat whitish 'nits' on the outer hair are harmless long-ago hatched
eggs, it is the impression of the author that those people who take the time to attempt to
remove most eggs have also looked closely enough, and picked or combed frequently enough,
to reduce live lice numbers.
A recent study implied that 'nits' are not well linked with live lice infestations. However, most studies to date have failed to account
for underdiagnosis due to previously unmeasured lice sizes and their
escaping behaviour and hair factors [Bailey, Prociv 2002]. The finding of many nits should
serve as a provisional diagnosis until careful examination rules out
this red flag for a chronic live infestation.
In the case of initially heavy
infestations in very tangly hair, a reduction from hundreds of nits to only a couple of
dozen within, say, a week indicates that the person is making progress. When time is
short, all eggs laid closest to the scalp are usually the ones that most need removal, and
priority should be given to ensuring they are definitely removed.
Depending on climate, hair type and heaviness
of an infestation, there could be vital eggs further out. It should also be remembered
that removal of hidden lice is important; one louse left behind could lay another five
eggs every day.
Two schools of thought
Those dealing with head lice
infestation can be divided into two groups:
(A) those who are unaware of the difficulties faced by families; and
(B) those who see an urgent need for screening in schools.
Group (A) may include:
| (i) people who still believe that symptomless adults
or families cause the majority of children to simply bring lice to school, despite
evidence indicating that most people are louse free and only become infested when their
children first attend pre-school and school; (ii) lucky people who have never
experienced a full-on louse infestation and have never had to personally remove many
resistant lice from their own very young children;
(iii) those who have had a very
light infestation and/or easily combed hair, so that lice were cleared with little effort
and never returned;
(iv) those who had a heavy
infestation, recognised chemical failure and simply resorted to a head shave (usually
boys, or men who can present to their workplace with this '"hairstyle"). |
Group (B) may consist of:
| (i) adults who
themselves have had a heavy infestation, experienced chemical failures and spent hours
combing lice from their own head because they had no carer to remove lice for them; (ii) those who have had the sole responsibility
for removing resistant infestations -- louse by louse and egg by egg -- from several
members of their family, including children that cry throughout the entire process;
(iii) those who have attempted the
above, thought they were cured, found lice again, repeated the whole process month after
month, and then finally resorted to a short-hair cut to facilitate a cure;
(iv) those carers who have had to
attempt physical removal of resistant lice from disabled children or adults who resist, or
from very young children who have sensitive scalps;
(v) childcarers or teachers who, after
repeated requests to indifferent parents and for the lack of a school nurse with
appropriate authority, have felt compelled to treat neglected children in their care, in
order to alleviate weeping, crusted scalps -- the obvious result of neglected, visibly
crawling, head lice infestations;
(vi) anyone with hair that is fine and
easily pulled out, or thick and tangly, and which makes fine-toothed combing to check for,
or remove, lice much more difficult than another person with smooth or straight hair can
ever imagine;
(vii) those with more than one of the
above experiences. |
If one takes a moment to picture the
practicalities, head lice infestation can cause significant disruptions to work, home and
family time which could instead be spent preparing nutritious meals, for example, or
hugging, reading or exercising with children. In some state primary schools where
'nit-nurses' do not screen or check for completed treatment, as many as 20% of the school
population may be actively infested with lice at any one time. Add to that all the new
students going through each year and the families that become infested. Collectively the
cost to the community is enormous. Lice were not always so easily caught because control
programs used to be more rigorous.
A better understanding
If you identify with people in Group
(B) you might happily accept your lot and move on, as with many of life's challenges --
but what if you catch lice again and again? Some health departments have a policy on head
lice management which is based on the assumption that, with extra education, everyone will
accurately detect and cure lice. However, once caught, lice may hide very well in hair.
Without enforced check-ups and caring advice by examiners for those families who need
help, unknowing carriers could remain and thwart efforts to control lice in the community
overall.
You may be able to encourage
understanding in your local school and community groups by explaining this situation and
suggesting that screening for all will help to break the ongoing cycle of spreading lice.
Or you may want to write to your local representative and explain how head lice managment
for your family is difficult and compounded by unchecked carriers. Quoting evidence from
research may assist your efforts.
How to find out more about lice
research?
Your local school or health department may
have updated information on research or you may have already read health department and
local community publications on head lice.
It is easier to start with the simple before
going to the complex. You might be able to visit your local community library, or
university or hospital library, and read general textbooks on insects, dermatology or
general family medicine and look up the sections on ectoparasites, childhood infectious
diseases or pediculosis. Articles by Bailey & Prociv provide an overview of the
variable information on head lice.
If you are a new student you may
download articles from some online journals on some science library computers. If you are
not a student you may have a student friend or contact who attends or works at your local
university who may lend you photocopies of the research articles. You can find out more
about some research articles by looking them up on "PubMed" while other articles
are, admittedly, difficult to come by.
PubMed is a free website index of many
high-quality medical journals, and the titles of the articles within them, from around the
world. You can type in a subject, or the name of the author, and find many listed
articles, usually in chronological order from the most recent to older articles. Sometimes
abstracts (summaries of the findings) are given if you click further. You can even order
copies of some articles online if you are happy to pay the price and do transactions on
the net, but that must be an informed decision on your behalf.
For example, articles in the
Australasian Journal of Dermatology (abbreviated as Australas J Dermatol) are indexed by
PubMed, where you can read the summary for the article "Persistent head lice
following multiple treatments: evidence for insecticide resistance in Pediculus humanus
capitis."
The Australian Infection Control
Journal is listed on the Australian Medical Index and on CINAHL. CINAHL is a cumulative
index of nursing and allied health literature. It cannot be browsed without a
subscription, but if you are really keen, you may be able to look up the website and buy a
copy of a journal article from the section "CINAHL Express" if you have the
citation (as given under the "Sources of information" on the home page). Again,
that is your personal decision.
Some interesting articles on head lice
are published as full text on other websites, e.g., the article by W.S. Pray is available
(at the time of writing) to read on the NPA's website "headllice.org". R.
Speare's website links you to some text from work by the respected authors Buxton and
Nuttall. |