Treating Head Lice

The tiny parasitic insects known as head lice can infest the head and neck area and attach their eggs to the base of the hair shaft. Head lice do not cause disease, but they can itch and irritate the scalp. And excessive scratching can cause bacterial infection. But a number of products are available to treat head lice, including a new drug approved in April 2009 by the Food and Drug Administration (FDA).

An estimated 6 to 12 million cases of head lice infestation occur each year in the United States in children 3 to 11 years of age, according to the Centers for Disease Control and Prevention. Head lice are most common among preschool children attending child care, elementary school children, and household members of children who have lice.

Head lice are spread mainly by direct head-to-head contact with a person who already has head lice. Lice don’t fly or jump; they move by crawling. But because children play so closely together and often in large groups, lice can easily travel from child to child.

Blood-Sucking Bugs

Head lice are blood-sucking insects about the size of a sesame seed and tan to grayish-white in color. They attach themselves to the skin on the head and lay eggs (nits) in the hair.

“Getting lice does not mean you are dirty—it only means that you’ve been around others with head lice,” says Susan Walker, M.D., director of FDA’s Division of Dermatology and Dental Products.

You can check for head lice or nits by parting the hair in several spots. Use a magnifying glass and a bright light to help spot them. Lice can move fast so it may be easier to spot the nits. Nits can look like dandruff, but you can identify them by picking up a strand of hair close to the scalp and pulling your fingernail across the area where you suspect a nit. Dandruff will come off easily, but nits will stay firmly attached to the hair.

FDA-Approved Treatments

FDA-approved treatments for head lice include both over-the-counter and prescription drugs in the form of shampoos, creams, and lotions. Many head lice products are not for use in children under the age of two, so read the label carefully before using a product to make sure it is safe to use on your child.

On April 9, 2009, FDA approved a new prescription medication for the treatment of head lice. Ulesfia (benzyl alcohol) Lotion, 5%, is approved for use in children 6 months of age and older. This new drug is the first FDA-approved head lice product with benzyl alcohol as the active ingredient.

The safety and effectiveness of Ulesfia Lotion, 5%, were shown in two studies of more than 600 people with active head lice infestation. The study participants received two, 10-minute treatments with either Ulesfia Lotion or a topical inactive substance (placebo), one week apart. More than 75 percent of the participants who received Ulesfia Lotion were lice-free 14 days after the final treatment, compared to 26 percent who received the placebo. The lotion kills lice but not nits, so the second treatment is needed to kill lice that have hatched since the first treatment.

“Benzyl alcohol lotion is considered to be a safe treatment for head lice,” says Walker. “However, it is not without risks.” Common side effects of the medication include irritation of the skin, scalp, and eyes, and numbness of the scalp where the product is applied. The product is not approved for use in children younger than 6 months, and premature infants could be at risk for developing serious side effects such as seizure, coma, and death.

Ulesfia Lotion, 5%, is distributed by Sciele Pharma Inc., a subsidiary of Atlanta-based Shionogi Company.

Steps for Safe Use

Follow these steps to use any head lice treatment safely and appropriately:

• After rinsing the product from the hair and scalp, use a fine-toothed comb or special “nit comb” to remove dead lice and nits.
• Apply the product only to the scalp and the hair attached to the scalp—not to other body hair.
• Before treating young children, talk with the child's doctor or your pharmacist for recommended treatments based on a child’s age and weight.
• Use medication exactly as directed on the label and never more often than directed unless advised by your health care professional.
• Use treatments on children only under the direct supervision of an adult.

Heading Off Head Lice

• Teach children to avoid head-to-head contact during play and other activities at home, school, and elsewhere (sports activities, playgrounds, slumber parties, and camps).
• Teach children not to share clothing and supplies, such as hats, scarves, helmets, sports uniforms, towels, combs, brushes, bandanas, hair ties, and headphones.
• Disinfest combs and brushes used by a person with head lice by soaking them in hot water (at least 130°F) for 5–10 minutes.
• Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with a person with head lice.
• Clean items that have been in contact with the head of a person with lice in the 48 hours before treatment. Machine wash and dry clothing, bed linens, and other items using hot water (130°F) and a high heat drying cycle. Clothing and items that are not washable can be dry-cleaned or sealed in a plastic bag and stored for two weeks.
• Vacuum the floor and furniture, particularly where the person with lice sat or lay. Head lice survive less than one or two days if they fall off the scalp and cannot feed.
• Do not use insecticide sprays or fogs; they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin.
• After finishing treatment with lice medication, check everyone in your family for lice after one week. If live lice are found, contact your health care professional.

   Heading Off Head Lice source: Centers for Disease Control and Prevention