Being Nitpicky About Lice

In good times or bad, your family’s hygiene is a big factor with regards to their health. As Winter progresses, you’ll be spending more time inside, and close quarters means more risk of infections. It also means more risk of infestations, and lice are one of the most common you’ll see.
A common health problem pertaining to poor hygiene is the presence of lice, also known as “Pediculosis”. Lice (singular: louse) are wingless parasitic insects that feed on blood and are found on many species. On humans, there are three types:

• The Head Louse Pediculus humanus capitis
• The Body Louse Pediculus humanus corporis
• The Pubic Louse or “Crab” Pthirus pubis
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Body lice can act as a vector to transmit disease to human hosts. At present, there is no evidence that head or pubic lice do, but all lice cause irritation that can have major implications for the health of a survival group. Sometimes, irritation and itching caused by lice breaks the skin; this allows other infections to develop.

Lice are, generally speaking, species-specific: You cannot, as an example, get lice from your dog, like you could get fleas. You get them only from other humans. It’s interesting to note that human lice and chimpanzee lice diverged from each other, from an evolutionary standpoint, about 6 million years ago; this is almost exactly when their hosts went their separate ways.

Major risk factors for lice infestations include crowded, unsanitary conditions or situations where close personal contact is unavoidable. In normal times, these conditions most commonly occur in schools where ordinarily clean children come into contact with those who have lice.

The sharing of personal items can also lead to louse infestations. Clothing, combs, bedding, and towels that are used by multiple individuals are common ways that lice spread from person to person. These risks are even more pronounced in survival settings.

HEAD LICE

Head lice (Pediculus humanus capitis) are greyish-white as adults and can reach the size of a small sesame seed. Infestation with head lice can cause itching and, sometimes, a rash. However, this type of lice is not a carrier of any other disease. Head lice are relatively common, so much so that 6-12 million cases a year are reported in the United States (mostly among young children).

With their less developed immune systems, kids often don’t even realize they are infested with lice. Adults, however, are usually kept scratching and irritated unless treated. An interesting fact is that African-Americans are somewhat resistant to head lice, possibly due to the shape and width of the hair shaft.

The diagnosis is made by identifying the presence of the louse or its “nits” (eggs). Nits look like small bits of dandruff that are stuck to hairs. They are more easily seen when examined using a “black light”. This causes them to fluoresce as light blue “dots” attached to the hair shafts near the scalp.

As black lights will be rare commodities in a collapse, a fine-tooth comb run through the hair will also reveal the adult lice and nits. These special combs are used to remove as many lice as possible before treatment and to check for them afterwards. The diligence required to do this effectively led to the coining of the term “nitpicking”..

You will find the nits firmly attached to the hair shaft about ¼ inch from the scalp. Nits will generally appear as yellowish white and oval-shaped. The application of olive oil to the comb may make them easier to remove. Many prefer the metal nit combs sold at pet stores for animals to plastic ones sold at pharmacies for humans.
In normal times, wash and dry all clothes in hot temperatures or, alternatively, place in the freezer to kill the lice. If you are off grid, place clothing and personal items in a plastic bag for two weeks. Adult head lice usually only live a few days off the host.

BODY LICE

Body lice (Pediculus humanus corporis) are latecomers compared to head lice, probably first appearing when humans began to wear clothes about 170,000 years ago. As the concept of doing laundry occurred somewhat later than that, you can imagine that constant contact with dirty clothes caused frequent infestations.

Body lice, unlike head lice, have been linked to infectious diseases such as typhus, trench fever and epidemic relapsing fever. Continuous exposure to body lice may lead to areas on the skin that are hardened and deeply pigmented, a condition previously known as “vagabond’s disease”.

Infestations may be an issue common only with the homeless or in underdeveloped countries today; it will, however, likely be an epidemic in settings where regular bathing and washing of clothes isn’t possible.

Body lice are slightly larger than head lice; they also differ in that they live on dirty clothes (especially the seams), not on the body. They go to the human body only to feed. Also, they are sturdier than their cousins and can live without human contact for 30 days or so. Examination of clothes and bedding seams usually pinpoints the problem.

Destruction of the infested clothing, if possible, is the appropriate strategy here. Sometimes, using medication is unnecessary as the lice have left with the clothes (don’t bet on it, however). .

PUBIC LICE

Pubic infestations may be either caused by lice or mites. Pubic lice (Pthirus pubis), also known as “crabs”, usually start in the pubic region but may eventually extend anywhere there is hair. They are most commonly passed by sexual contact. Severe itching is the main symptom and can involve the axillary (armpit) hair or even the eyelashes.

Although they are sometimes seen in a patient that has other sexually transmitted diseases, pubic lice do not actually transmit other illnesses. It should be noted that pubic lice infestations are one of the few sexually transmitted diseases that is not prevented by the use of a condom.

SCABIES

Scabies is often confused with “crabs”, but is caused by another creature entirely: tiny eight-legged mites of the species Sarcoptes scabiei. Like pubic lice, scabies can be passed through sexual contact or other direct skin-to-skin contact with another human but not from animals.

Unlike lice, however, the mites do not live and reproduce on hair shafts but burrow through the skin forming small raised red bumps that may become “crusty”. These areas may hold hundreds of mite eggs. Itching is usually severe and most intense at night. It should be noted that Scabies can affect skin folds, even those with little hair such as the folds of the wrists, elbows, or between fingers and toes.

TREATMENT

Infestations with lice and mites can be treated with medications called “Pediculocides”. They include:

• Pyrethrins (brand name Rid shampoo, a natural product also found in chrysanthemum flowers)
• Permethrin 1% (brand name Nix lotion, a synthetic pyrethrin)
• Lindane Shampoo (prescription brand Kwell)
• Spinosad (brand name Natroba, a natural insecticide derived from soil bacteria – only for head lice in children 4 year or older(brand name)
• Ivermectin 0.5% (brand name Sklice, also from soil bacteria and only for head lice in children 6 months or older)

Nix lotion (permethrin) will kill both the lice and their eggs. Rid shampoo will kill the lice, but not their eggs; be certain to repeat the shampoo treatment 7 days later. This may not be a bad strategy with the other treatments as well. Thoroughly examine the area in question for persistent nits and adults.

You might ask your physician for a prescription for Kwell (lindane) shampoo to stockpile. It is a much stronger treatment for resistant cases. It may cause neurological side-effects in children, so avoid this medicine in pediatric cases. Here are general instructions for the above products:

• Start with dry hair. If you use hair conditioners, stop for a few days before using the medicine. This will allow the medicine to have the most effect on the hair shaft.

• Apply the medicine to the hair and scalp.

• Rinse off after 10 minutes or so.

• Check for lice and nits using a comb in 8 to 12 hours.

• Repeat the process in 7 days

Wash all linens that you don’t throw away in hot water (at least 120 degrees). Unwashable items, such as stuffed animals, that you cannot bring yourself to throw out should be placed in plastic bags for 2 weeks (for head lice) to 5 weeks (for body lice). The bags are then opened to air outside and shaken out.

Combs and brushes should be placed in alcohol or very hot water. Your patients should change clothes daily, although this may be problematic in austere settings. It would be wise for any item that might have been exposed to be treated, even if belonging to other family members. Have enough pediculocide product to treat the entire group.

Over time, commercial medications may run out, but natural remedies for lice have existed for thousands of years. Even commercial medications like Rid Shampoo use pyrethrin, a substance extracted from the chrysanthemum flower. Another favorite anti-lice product is Clearlice, a natural product containing peppermint, among other things.

A combination used for lice utilizes tea tree and neem oils. One topical therapy mixes a blend of vinegar, tea tree oil, and neem oil, which is applied daily for 21 days. A mixture of Witch Hazel and tea tree oil applied daily after showering for 21 days has also been reported as effective against hair lice.

A triple blend of tea tree, lavender, and Neem oil applied to the public region for 21 days may be effective in eliminating Scabies. All of these methods require diligent removal of nits and adult lice by combing beforehand.

Although I have seen recommendations to “suffocate” head lice with mayonnaise, lard, butter, or coconut/olive oil, there isn’t enough evidence to be certain that this method will work. Besides, you might just need those products for survival purposes. If you do use it, you would generously apply to the head, place a shower cap overnight, and rinse out in the morning.

In normal times and not-so-normal times, keeping an eye out for lice will give you a head start on staying healthy. Good hygiene is the key to success, even if everything else fails.

Joe Alton, MD