head lice

Head lice: short overview

• Appearance: up to 3 millimeters in size, flat, color translucent-whitish, gray or brownish; the eggs (nits) are up to 0.8 millimeters in size, oval, initially translucent, later white
• Transmission: usually directly from person to person with close physical contact; less often indirectly via objects such as hairbrushes or caps; NO transmission by pets!
• symptoms: severe itching on the head (often restless sleep), possibly bright red papules at stinging points; By scratching the scalp skin inflammation, eczema rashes and an additional bacterial infection are possible
• Preferred locations: on the head in the temple area, behind the ears, on the neck and on the back of the head
• Treatment: Best combination therapy of wet combing (with lice comb and possibly magnifying glass) and insecticide application

So you can recognize head lice

A full-grown head louse is about two to three millimeters in size, flat and translucent from whitish to gray or brownish in color. Because head lice adjust their color to the hair color of the host in the long term, populations with darker hair color mainly have brown head lice and in people with blond hair often see transparent or whitish parasites. However, if a head louse has sucked blood, it appears reddish because the blood shimmers through its chitin shell.

The eggs are oval, about 0.8 millimeters long and protected by a chitin shell (Nisse). Initially, the nits are translucent, later (when the larva hatched) white. They stick to the hair near the scalp.

Often a head lice infestation is discovered by chance, for example, when a few of the parasites fall out of their hair while combing. The diagnosis is therefore very rarely made by the doctor, but mostly by the parents or occasionally also by educators / teachers.

Remedy: magnifying glass and lice comb

Often there is already a suspicion that someone has head lice – either because of the symptoms or because there are already known cases of lice infestation in the immediate vicinity. Then the head can be systematically searched for the animals. For this it is advisable to use aids such as a magnifying glass and a lice comb.

But first you should Moisten hair, You may also be able to treat them with a conditioner to make them easier to comb. It also makes it easier to see where you already combed. The Pruning the hair with a normal comb or a brush also facilitates the work.

Then you should carefully use all the hair with the lice comb comb through, with its tines should touch the scalp at each stroke. The head lice and their eggs (nits), which stick to the hair close to the scalp, hang between the very narrow teeth (distance: 0.2 to 0.3 mm). This way, they can be combed out and identified more easily. For this purpose, the comb is best stripped off after each stroke on a piece of kitchen or toilet paper.

By the way: The nits are easiest to find behind the ears and neck.

With a magnifying glass It is particularly good to recognize young head lice that are still in the nymph stage. They are easily overlooked by the naked eye. In addition, the magnifying glass helps to distinguish head lice and their eggs (nits) from dandruff.

Head lice: treatment

“The child has head lice – what to do?” Many parents ask themselves this question and unfortunately the therapy options for laymen are often a bit confusing. In principle, however, one can distinguish three different approaches to head lice treatment.

Wet combing

The lice comb is not only for diagnostic purposes, it can also be used to combat head lice. In addition, the hair is made wet and possibly treated with a hair conditioner to make it easier to comb. Then you comb them out thoroughly and strand after strand with the lice comb. The whole thing should be repeated several times. In one study, “Wet combing” on days 1, 5, 9 and 13 in about 57 percent of participating children could eliminate the head lice. On day 17 should be checked whether the parasites really got rid of.

This method of treating head lice is laborious and requires a lot of patience from the patient and the “practitioner”. But especially with children, this is often difficult. In addition, the head lice can often not be completely eliminated by combing out. Therefore, it is better to combine mechanical therapy with topical lice treatment.

Remedy for head lice: insecticides

There are various agents for treating head lice based on insecticides or silicone (Dimeticon) or containing vegetable oils. They are available as tincture, spray or shampoo.

To the applied in Germany Insecticides against head lice include the synthetically produced active ingredients allethrin and permethrin as well as the active ingredient pyrethrum, which is obtained from certain chrysanthemum species. They damage the parasite’s nervous system and kill it. Insecticides have been used for decades against head lice, even in other European countries. As a result, head lice in some countries have developed resistance to the insecticides. Whether this is also the case in Germany has not been checked so far.

The insecticides against head lice must be used several times to bring success. The exact application depends on the respective product. Read the instructions for use before starting treatment, especially when it comes to the duration and duration of use. Otherwise, it may happen that some head lice or larvae and eggs survive.

In pregnancy and lactation, in MCS syndrome (multiple hypersensitivity to chemical substances) and in allergy to chrysanthemums insecticides are not suitable for head lice. Here, the head lice treatment should only be done by wet combing out.

For several years now Head lice remedy with dimethicone, a silicone oil, available. They are applied to the dry hair and scalp and distributed well. The oil layer also covers the head lice and nits, causing them to suffocate. Sometimes you have to leave it on overnight, sometimes only ten minutes. The exact application depends on the product and can be found in the instructions for use.

You should also pay particular attention to the warnings: silicone-containing agents are easily flammable. Therefore, after application, the child should not be near flames or use a hair dryer!

By the way: Dimeticon is considered non-toxic and is not absorbed into the body via the skin.

Herbal remedies for head lice included vegetable oils like coconut oil, aniseed oil or neem oil (neem tree oil). The application varies from product to product – as well as the mechanism of action. Some vegetable oils are said to choke the lice, others to kill the parasites much like a neurotoxin.

For all means applies:

• None of the head lice remedies works 100 percent. Each must therefore be used several times.
• The remedies may temporarily irritate the skin and cause itching.
• Means in spray form could be inhaled and then possibly cause allergic reactions. They are therefore not suitable for children with respiratory diseases such as asthma (solutions or gels against head lice should be preferred).

Recommended: comb out and combine insecticide remedies!

Experts recommend combining combing with the use of an insecticide against head lice. This should show the best success rate in head lice treatment. The prerequisite for this is that the insecticide is used correctly in accordance with the instructions for use and the lice comb. Those who are uncertain can best be advised in the pharmacy or by the doctor.

The following treatment scheme is recommended:

Day	activities
day 1	Treat the hair with an insecticide and then comb it out wet.
Day 5	Comb wet hair to remove early hatched larvae.
Day 8, 9 or 10	Treat the hair again with an insecticide to kill late-hatched larvae.
Day 13	Check by wet combing.
Day 17	Eventual final check-up by wet combing.

Home remedies for head lice

Anyone worried about the possible side effects of insecticides or silicone oil, likes to resort to alternative treatments for head lice. Home remedies such as essential oils (for example tea tree oil or lavender oil) as well as vinegar should be able to effectively combat the parasites.

The essential oils in the lice may block an important enzyme in the metabolism, although the exact mechanism is not yet known. Also, the effectiveness of such head lice home remedies, there are only a few studies.

Even with vinegar, the effectiveness against head lice is unsecured. In any case, it is recommended to let the vinegar work on the hair for half an hour after application and then wash it out.

Other home remedies for head lice include alcohol, aloe vera and Kaisernatron. Again, the effectiveness is not proven. The same applies to sauna stays, which are sometimes recommended against head lice infestation.

Does the rest of the family have to be treated as well?

If a child has head lice, all members of the family should be screened for the parasites, preferably by wet combing. Only those who are infected should be treated.

Head lice: causes and risk factors

While dress and pubic lice have become rare in Germany, head lice still inhabit human hair, especially children. Again and again it comes mainly in kindergartens and schools to a head lice infestation (pediculosis capitis), the Hygiene does not matter plays. The parasite does not care if the hair is clean or dirty. This means that even if you wash your hair every day, head lice can settle.

That almost always happens direct transmission from person to personFor example, when children put their heads together while playing. The parasites then migrate from hair to hair – they can not jump.

Occasionally, head lice become too indirectly transmitted about items that were shared within a short period of time, such as hats, combs, or bicycle helmets. But very often that does not happen because head lice without a host are quickly weakened by lack of blood meals and die. At room temperature, therefore, they usually survive on objects for a maximum of two days (in exceptional cases, three days).

By the way, contrary to popular belief Pets no carriers of head lice!

Where do the head lice most like?

The head lice are especially fond of the temples, behind the ears, on the neck and on the back of the head. Here the skin is very thin and has the optimal temperature for the little bloodsuckers.

Normally, head louse infestation is limited to the main hair. In case of severe infestation, the small parasites can sometimes be found on other hairy parts of the body – in the eyebrows, under the armpits or in the beard.

By the way: Occasionally, head lice are also referred to as hairloss, although this term is misleading and strictly speaking wrong, since ultimately all human lice are “hair lice” (including, for example, pubic lice).

How do the head lice feed and multiply?

The head lice feed on human blood. For this purpose, they pierce the smallest blood vessels (capillaries) in the scalp every four to six hours, and then absorb the escaping blood. The fact that it does not immediately clot prevents the saliva that the animals release into the small wound.

The ever-available food supply allows the head lice to multiply diligently: The female can live 90 to 140 during their four-week lifespan eggs to produce. About 17 to 22 days after fertilization they lay the eggs: they attach them to the hair close to the scalp with a special secretion. This “glue” is insoluble in water, so that the eggs do not peel off during normal hair washing.

The eggs are oval, about 0.8 millimeters long and provided with a chitin shell (Nisse). They usually hatch seven to eight days after they have been deposited larvae (also called nymphs). These develop into sexually mature head lice within nine to eleven days. It takes about three weeks from the freshly laid egg to the fertile louse.

Why do head lice most often affect children?

An attack with head lice is found especially in children between three and twelve years. Because they have more close physical contact with adults during everyday playing and rumbling. This makes it very easy for the lice to change the host. Adults rarely attack and when, most often with their children, bring head lice from school or other community facilities home.

Head lice: symptoms

The head louse is not dangerous for the host, but annoying. An often intense itching forces sufferers to constantly scratch their heads. The reason for this is the head lice saliva, which they release into the small wounds they cause, so that the blood does not clot so quickly. It provokes a local immune reaction: The body reacts to the foreign saliva with itching and the formation of high-red papules at the sting site.

The frequent scratching on the head can leave scratches that can even bleed. These skin damages can easily ignite, which can lead to an eczema rash (“lice eczema”). In addition, bacteria can easily settle on the damaged scalp. This bacterial superinfection can swell the lymph nodes on the head and neck.

Due to the itching, sufferers often sleep very restless.

Head lice: mandatory

Parents whose child is diagnosed with head lice must immediately inform the community facility (such as kindergarten, school) where the child is staying. This in turn informs the health department (without attribution of the child) and takes measures to prevent the spread of head lice.

A child with head louse infestation must stay at home as long as it is contagious, that is, as long as no treatment has been given. Only after a properly carried out initial treatment, it may visit the community facility again. The parents have to provide proof of the treatment. How this proof should look depends on the Community institution. Sometimes a medical certificate is needed, in other cases, the parents’ written or oral confirmation of the head lice treatment is sufficient.

Parents should also inform all persons about the head lice infestation with which the child has closer contact. These can be, for example, playmates (or their parents) or the members of the sports club of the child.

Head lice: prognosis

Head lice are annoying, but harmless. In our latitudes they can not transmit diseases.

Physical symptoms such as itching and scratched skin are sometimes accompanied by mental stress for the entire family. Because in society, an infestation with the parasites is often associated with a lack of hygiene, although this demonstrably plays no role in the infection.

If you perform the treatment correctly and consistently, you will quickly get rid of the head lice.

Prevent head lice

It is difficult to prevent head lice because they work so easily. But if an infestation in the immediate vicinity (family, community facility, sports club, playmates, etc.) is known, one should avoid body contact with the person concerned and not use caps, scarves, combs, brushes, etc. as far as possible.

A “preventive” head liceTreatment of all family members, if someone is infected, is not generally recommended.

Additional information

Book recommendations:

• Picture book for children: Liane Schneider and Annette Steinhauer: Conni and the Läusealarm, Carlsen Verlag, 2016

guidelines:

• RKI guide for doctors: head lice infestation