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Headlice Frequently Asked Questions

What are nits ... ?

They are the empty eggs found glued to the hair shaft. Usually white or cream in appearance,1/32inch long, oval in shape with a distinct cap

How could it happen to my child... ?

That's often a parents reaction when they find out their child is infected, A lot of people believe that head lice will only strike children with dirty hair, so many parents can feel embarrassed or ashamed. But this isn't the case, in fact headlice eggs attach more effectively to hair when it is not so greasy. Head lice are spread by sustained direct head to head contact so children are the most susceptible.Peak incidence occurs among six to seven year olds with numbers tailing off on either side

Where are nits found... ?

The female head louse glues its eggs to the hair shaft, laying 5 to 6 eggs near the scalp each day. It takes between 7 and 10 days for the eggs to hatch. The distance the nit appears on the hair as it grows away from the scalp is a good indicator of the length of time the lice have been on the hair. (Hair growth normally at 1cm per month) Nits can only be removed by fine tooth (nit) combs preferably metal

more on life cycle at nitnurse.co.uk

How does someone get headlice ... ?

Headlice don't like to move away from the warmth, moisture, security and comfort of the scalp and therefore are usually passed onto someone else's hair by prolonged close contact. Therefore it is commonly spread between people who know each other well. Lice seen on pillows, hats and chairs are often elderly, dead or dying or are cast skins of lice which cannot infect a person. Rarely some lice have been known to survive up to a few hours off the head and thus may be able to infest other heads through sharing of hats, hairbrushes etc. Head lice are more easily contracted by young schoolgirls aged between three to ten years of age who by the nature of their play have heads in close contact for long periods of time. Also they are passed between members of a family e.g. parents and grandparents cuddling their children. They often do not realise they have headlice because they have built up resistance and immunity to the itch from saliva of lice feeding on the scalp and are asymptomatic

How do you know you have headlice ... ?

Headlice are aprox the length of a grain of rice and difficult to see. They tend to congregate around the back of the ears and the nape of the neck. The best way of detection is using a fine tooth comb on wet hair. Signs of a headlice infection include an itchy scalp or ' feeling lousy' .Itching can be caused by an allergic reaction to the lice bites-although lice may be present for weeks or months without causing any itch. Rarely sores from scratching appear on the head due to scratching and sometimes a re infected. Also little black specs (pepper dust) are often found on the pillow which is dried blood from the feeding of the louse. Sometimes dandruff ,particles of styling products, dirt or aphids blown onto the hair with the wind may be mistaken for headlice. dandruff is easily distinguished from nits since it is easily removed from the hair whereas the latter is not. It is important to remember that once live headlice have been detected all members of the family are checked

Are headlice harmful ... ?

Headlice are harmless although unpleasant to have. They cause itching of the scalp which can be quite severe in susceptible individuals. A heavy infection can lead to a general feeling of ill health, hence the term 'feeling lousy' feel lousy

How should I treat a headlice infection ... ?

It is essential to inform contacts such as nurseries, schools, relatives or friends if you discover headlice so they too can look for their presence and treat early if necessary.

The four main groups of Treatments are:

  1. chemical type insecticides ,
  2. The newer non incecticdal Cyclomethicone types
  3. 'natural remedies'
  4. combing or 'bug busting' techniques

1)Research into the most effective treatment often give conflicting and confusing results .For instance reports published in the Lancet show that chemicals are much more effective than bug busting. They found than in a trial the cure rate was 38% for families using the bug-busting technique compared to 78% for those who used Malathion(Derbac,Prioderm,Quellada). Whereas a Wales study found Bug Busting 2% more effective than malathion (see Community Hygiene Concern ). A new study has looked at permethrin creme rinse with and without combing and found that permethrin without combing was only marginally better. J Pediatric 2002 Nov;141: 665-70.A systematic review by Bandolier showed that the treatment of choice should be permethrin at 1% strength.

The chemical treatments such as (phenothrin) , Derbac (malathion ) ,Lyclear(premethrin) , Prioderm (malathion)(available over the counter) and Carylderm(cabaryl) (Prescription only) should never be used 'just in case' but only when a living louse is detected by wet combing. This is because of concerns of insecticide absorption through the skin, irritation of the scalp and lice resistance. Also these products tend to be expensive and once rinsed out of the hair offer no residual protection.. Shampoos are less effective than lotions since they are diluted when water is added and have a short contact time with the hair leading to headlice not being killed off outright, treatment failure and resistance. Alcoholic lotions can cause stinging and exacerbate eczema and asthma. The BNF advocate the use of aqueous formulas e.g. Derbac M for people with these conditions or for treating very young children.

Alcoholic lotions are preferable, except in severe eczema, asthmatics and small children. Lotions and liquids (malathion and phenothrin) should be applied to dry hair with a contact time of 12 hours. Foam application (phenothrin) should be applied to dry hair with a contact time of 30 minutes. Cream rinse (premethrin) should be applied to damp hair with a contact time of 10 minutes.

2)Two products containing cyclomethicone (Hedrin and Full marks Solution)work by effectively drowning the live lice and because they are non insecticidal no special precautions are needed .Advantages are:-

-Skin friendly
-Easy to apply
-For use in adults and children aged 6 months and over
-No organo-phosphates

3)Wet combing twice weekly for 20 minutes can eliminate lice in two weeks, but requires commitment, time and patience. bugbusting. The treatment usually is

Wash the hair as normal.
Apply conditioner or oil liberally, including the full length of long hair.
Lay out white paper, tissues or a bowl of water on a table over which you will comb the hair. These can be easily checked for lice after combing
Comb the hair through with a normal comb first, to get rid of any knots.
With a fine tooth comb ("nit comb"), starting from the roots of the hairs, comb out along the complete length of the hair. After each stroke check the comb for lice and wipe it clean. Work systematically around the whole head of hair. Continue for at least 20 minutes.
Rinse out conditioner or shampoo out oil from the hair as normal
A "bug-busting" kit is produced by the Community Hygiene Concern charity and contains four specially designed combs and detailed instructions.

4)Natural remedies such as Neem and tea tree oil may be a useful alternative to chemical treatments. They have little scientific evidence and are probably less effective and should be used alongside thorough combing. Advantages are they usually have less side effects.

The use of louse repellents such as repell is not recommended. The best way to prevent head lice spreading is to check the hair regularly and treat as soon as live head lice are found. Remember "Contact tracing" is essential so that reinfestation can be avoided.

Click here to purchase head lice treatments

Are there different kinds of human lice ... ?

Yes ,1)body lice are closely related to head lice but less common. They usually feed on the body but have been known to stray onto the scalp or facial hair. They are usually occur in people who infrequently wash or change their clothes and are spread as head lice by direct contact. Body lice usually remain on clothing near the skin and lay their eggs on or near seams of garments.2) Pubic or crab lice because of their short crab like bodies. Usually occur in the pubic area and spread mainly through sexual contact.

How long do headlice live ... ?

Headlice live for aprox 30 days but do not usually survive very long away from the warmth and food source provided by the human scalp. A mature female louse may lay up to a hundred eggs during her lifetime.

Can head lice survive on pets... ?

Human lice cannot infest pets or other animals

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