The (Lice) Drugs Don’t Work … Or Do They?

For those of us in the northern hemisphere, summer is drawing to an end and that means back to school – and the annual wave of panic about head lice. It seems that cramming hundreds of children together in one building leads to lice outbreaks, panicky teachers, and distraught parents. Right on schedule, in last week’s Globe and Mail under the heading “Medical Rethink” was the article Chemical Lice Treatments May Not Work. The article isn’t available at their website, probably because it’s copied nearly verbatim from the Wall Street Journal, where it’s online with the less provocative title Tired of Nit-Picking? Lice Are Peskier Than Ever.

The article was based on the newly-updated American Academy of Pediatrics Clinical Report on Head Lice. Well since I blogged about head lice about a year ago, I thought I’d better review the new guidance and see if my interpretation of the evidence needs to be updated. Science-based practice is always tentative, and subject to change if persuasive evidence emerges. So what’s up in the new report?

I’ve covered off the broad treatment strategy for head lice in my previous post. The key point I made is that you don’t need any drugs at all to treat head lice. There are chemical and non-chemical options, and both work – as long as you’re fastidious. Chemicals kill the lice, or you can physically remove them with a comb. Both strategies need to be repeated over several days. Slip up with either approach, and the lice won’t be eliminated. So what’s the new report say about the chemical treatments? Is a new strategy warranted? Continue reading

Got Lice? Use Science, Not Placebos

Pediculus_humanus_var_capitisWith the return to school earlier this month, we’re in prime lice season. I was recently forwarded a copy of a Toronto public school’s communication on head lice. Here’s an excerpt:

Oil & vinegar lice treatments do not kill live (unhatched) nits & have to be hand picked. It must be repeated daily until no nits (eggs) are found. Both light (hatched) and unhatched nits must be removed by hand (lice combs won’t pull all nits), and the hair needs to be checked daily for new nits.  As much as no-one wants to put chemicals in their child’s hair, in severe cases it might be advisable. Medicated shampoos and cream rinses have a residual effect, but daily nit picking is required. As well a second treatment with the same treatment in a week is required. Homeopathic treatments are available, but eggs must be picked daily. Teatree oil, as a shampoo or oil (massaged in the scalp) is said to be a preventative. However, if you already have nits or lice, it will not kill or remove them. Remember: One nit left on the hair will keep the cycle going.

This paragraph is so full of inaccurate information, it’s astonishing.  First a bit of background, then let’s examine the evidence supporting this school’s advice. Continue reading