Nitmix

1. What are head lice?
Head lice are small creatures that live and breed only on human heads. They have been with humans for thousands of years. If you dig up an ancient burial site even Kings of Eygpt had head lice.

2. Where do head lice come from?
They come from your friend’s heads. They are the only people you have enough close contact with to catch head lice. Sharing a hug or cuddle, sitting close enough to share a book or a computer screen at school would all be typical ways to pass on head lice.

3. Who is at risk for getting head lice?
Because we don’t live in isolation anyone can come into contact with head lice. It has nothing to do with age, social groups, money, cleanliness, it is just luck, who you happen to know.

4. How did I get head lice?
Head to head contact. Head lice walk along a hair strand, then grab the next available hair strand. If that second strand of hair is yours then you have a head louse in your hair.

5. What do they look like?
They are never bigger than a sesame seed, you know the ones on a burger bun. And their colour varies between light golden brown and dark brown. When they first hatch they are very tiny, about the size of a grain of sand. Their colour changes when they feed and fill up with blood, this makes them dark brown. As they digest their meal they turn lighter and lighter.

6. How do I tell if my child has head lice?
Always suspect that a child can have head lice any time. They are always around and if your kids have great social lives or are at school then assume that from time to time they will get head lice. You can never say for sure “my kids are clear of head lice”.

7. What are the signs and symptoms of head lice infestation?
“Tell tale signs of head lice”.

Itching and scratching.
Pale pink rash on the skin above the hairline around the back of the neck and behind the ears.
Small mobile bugs on the scalp and in the hair about the size of a sesame seed or smaller.
Little white/cream buds on the hair shafts, usually near the skin, that won’t slide down the hair when pulled.
Very tiny black specs in the roots of the hair, on the pillow or in your comb. These are either tiny baby lice or lice faeces.

8. How is head lice infestation diagnosed?
Head lice are diagnosed by actually finding live head lice in the hair. Some clinics send away samples to labs but this is a bit dramatic. A simple combing session with a fine toothed comb and NITMIX Wet Combing Aid will soon drag out any active lice.
Some schools, especially in America, treat children with eggs in their hair (nits) the same as children with lice. This causes a lot of problems and really isn’t a correct diagnosis. Eggs may be dead, sterile, very old or may even be harmless hair casts or dandruff. Also all the viable head lice could have been killed using a strong chemical and the child would be lice free, but not nit free, and would still be excluded.
Exclusion for head lice is unusual in the UK where they are considered a minor social problem rather than a medical emergency. Excluding children from school because of a harmless condition really should be discouraged.
When it comes to information on head lice few sources can match the Harvard School of Public Health and Richard J Pollack. Just put it into a search engine!
In his conclusion to a paper entitled, Over diagnosis and consequent mismanagement of head louse infestations in North America. He wrote:-
“Conclusions. Pediculicidal treatments should be applied solely after living nymphal or adult lice or apparently viable eggs have been observed. Because health care providers as well as lay personnel generally misdiagnose pediculosis, and because few symptoms and no direct infectious processes are known to result, we suggest that the practice of excluding presumably infested children from school may be more burdensome than the infestations themselves.” Clear enough?

9. Can I always see head lice if they are there?
Visual inspection is a very poor way to check for head lice.
In a study from Israel diagnosis of louse infestation using a louse comb was found to be four times more efficient than direct visual examination and twice as fast. The direct visual examination technique underestimates active infestation and detects past, non-active infestations.
A Belgian study, reported in the prestigious British Medical Journal found that "False results are a worry since they lead to non-infested children being treated unnecessarily and infested children missing out on effective eradication treatment. The study suggests that despite the extra effort involved, wet combing is the gold standard for detecting head lice."
In the study 30% of supposedly positive results and 10% of negative results turned out to be wrong. One in three kids would have been treated unnecessarily and one in ten kids with lice would have gone unnoticed.

10. What is in the most common head lice treatments?
The most common active ingredients are pyrethrums, permethrins, lindane and malathion.
Pyrethrums are derived from chrysanthemums. Just because they occur in nature doesn't make them any less concerning, Nature is more than capable of producing very powerful poisons.
Permethrin, a synthetic pyrethrin, is used to control insects on animals, house or gardens, and in agriculture. If you read the active ingredient label on wasp & hornet killer, flying insect killer, ant & roach killer, house foggers and fumigators, yard sprays, and commercial insect killers, you will see you may be applying the same chemical to your child. (Although at different concentrations depending on the product.)
Lindane is an organo-phosphate, yes that's right the same type of chemical as used in sheep dip, nerve gas and timber treatment. In the progressive state of California it is banned outright due to concern over it's potential to cause cancer and nerve damage while also polluting the water supply.
Malathion is another organo-phoshate produced to a drug grade (USP) which, in its less pure form, is used widely to kill medfly and mosquitoes. It is a prescription only preparation and is highly inflammable so watch out!
There is a lot of concern, information and, no doubt, miss-information about all these products about. We don't know any more about what it true and not true than you do, save to say, it would take a vast amount of research to sort it all out and that money is just not being spent in that way. What we do know is that parents are not getting the results they want from some of these products and that's what counts.

11. Which head lice medicine Is best for me?
Whichever one your are comfortable using and produces the results you are looking for. It is a parent’s own decision whether to use a manual method to remove lice or a chemical solution that causes lice to die. There are sources of information from the manufactures of lice products that attest to their safety. There are also a growing number of sources of information about possible harm being done to some children by these products. Parents have to weigh up the information, as best they can.
NITMIX’s only contribution is a reminder that head lice have never hurt any child and therefore we don’t consider it to be worth any risk whatsoever to get rid of them. We believe in the motto for any treatment.
“Firstly, do no harm”

12. Why does my child get more lice than her friend?
Not all families experiences of head lice is the same way. Some kids are untroubled whilst others seem to be cursed. We have experienced both situations with our two children, one a head lice free zone, the other a magnet. There may be many reasons such as; who your kids play with, how they interact with other kids i.e. do they cuddle up to their friends a lot. Some kids also get a lot more lice than their own brothers and sisters and friends in the same class. Our younger daughter was like this. Lice just love some kids and it’s their skin chemistry that does this. Until their yummy skin scent is hidden by using NITMIX as a preventative they continue to get far more bouts of lice that their friends and classmates.

13. Where are head lice most commonly found?
Lice need warmth as well as food from their host, this means they stay close to the skin and especially around the back of the neck and behind the ears. There are big blood vessels under the skin like hot water pipes and hair hanging down like a blanket keeps the heat in. When you lift the hair you can sometimes see a soft pink blush on the skin and little white eggs in the hair itself. You should check all around the head as some lice will stray further around the head.

14. Do head lice jump or fly?
Head lice walk, nothing else. They have stubby hooked legs and cannot jump or fly, no way, no how. If you see something jump or fly near your child’s head it will be a flea or a flying insect of some description but not lice.

15. Do head lice burrow into the skin?
Lice don’t burrow into the skin, again their physical makeup doesn’t make this possible. They stay on the surface of the skin or on the hair shaft.

16. What colour are head lice?
Head lice have a hard ex-skeleton, a sort of bone on the outside like a shell and this is a light brown colour but very thin. In clear light this makes them a light brown colour. When they feed they fill up with blood this changes their colour to dark brown. As they digest or excrete their meal they lighten up in colour. So when looking for lice you have to remember that they may be any colour from light brown to dark brown.

17. How do head lice grow?
Head lice grow in stages, climbing out of their hard shell each time. This leaves behind a dead skin which is very light brown and looks like a dead louse. These empty shells will come out on your comb with NITMIX Wet Combing Aid and may make the situation look worse than it really is. They may also fall from the hair on to pillows which caused people to suspect that head lice are spread this way.

18. Do head lice like clean or dirty hair?
Head lice don’t care what the condition of hair is. They are only interested in food, warmth and shelter. Unwashed hair will contain more debris and many head lice egg cases and shed skins but that only makes the situation appear worse than it is.

19. Will I get less lice with bleached or dyed hair?
There is little evidence that hair treatments make any difference to the incidence of head lice.

20. How long do head lice survive of the body?
Head lice die from lack of food or moisture in about two days if dislodged from a head. They may not live this long if it is very cold or they had not fed before being dislodged. Being dislodged means almost certain death for a head louse so they will avoid this if at all possible. They don’t wander on to furniture or clothes very often as this would result in the death of the louse in most cases.

21. Do head lice spread in clothes, hats etc?
A head louse could be transferred by a hat or scarf but this is a very minor transmission risk. They have to be on humans to survive so they are highly unlikely to make the mistake of climbing onto anything other than another head in the first place! Anything other than a head generally means death to a head louse. Obviously you can avoid this risk by not sharing hats and brushes etc but it is not a huge risk in the first place.

22. Do head lice climb on furniture?
Head lice don’t transfer via the furniture, as above, these are tiny, tiny risks and not really worth worrying about. A quick vacuuming to make you feel certain is the absolute maximum effort, if you must.

23. Do I need to scrub the house?
Scrubbing the house is a complete and utter waste of time. Australian scientists Speake and Buettener (1999) from James Cook University did a study by sweeping the floors of 100 classrooms used by kids that they knew were teaming with head lice. You know how many lice they found? None, nadder, zip! While the floors were being examined the kids were inspected elsewhere and over 7,000 actual lice were removed from the kids. 7,000! And not one found its way to the floor.

24. Should I wash and spray the bedding?
In a different piece of work Speake, Cahill and Thomas (2003) found the chance of getting a live louse in a pillow after whole nights sleep was about 1 chance in 1000. In other words you could sleep in the same bed for nearly three years before you got a louse on the pillow. Spraying bedding with pesticide sprays just doesn’t make sense.

25. Should household sprays be used to kill lice?
Do not fall for this possibly dangerous rubbish. You are being ripped of and you are putting possibly toxic materials into your house to kill lice which ARE NOT THERE!

26. Should I have a pest control company spray my house?
Any reputable Pest Control Company won’t even take your money because they know this is rubbish. Any Company that says they will is not a Company I would trust in my home. Ask Steven Blum, Director of the National Pest Control Association or look it up in the Pest Control Operators Handbook ( 7th Ed) “Not a job for us” They say. Shame no body told the spray makers.

27. Can head lice transfer on to the pets?
Head lice don’t transfer via your pets. Pets have there own fleas and lice, some of which will bite humans given the chance but you should treat the animals appropriately if you suspect they are infested not yourselves. Cat and Dog fleas have more stages of development than head lice and can live in bedding and carpets. Generally cat and dog fleas end up in your carpet and show up as big lumpy bites around your ankles.

28. Can head lice spread in swimming pools?
Transmission by sharing a swimming pool or spa is nonsense. Don’t worry about it.

29. Should I shave the kid’s hair?
Shaving heads always cures a case of head lice but most kids hate it. It is most likely unnecessary and will cause the kids to be teased or ridiculed at school. So far we at NITMIX have never known it to be necessary to shave hair off to clear up a simple case of head lice.

30. Should I cut their hair?
Cutting the hair shorter does not really reduce your workload much and we wouldn’t recommend it especially it the kids are going to resent it. Most head lice activity takes place close to the scalp where the warmth and food is. Once long, thick or curly hair is oiled it can be combed very easily and rapidly and length makes very little difference. Dred locks are about the only genuinely problematic kind of hair as combing is pretty well impossible.

31. Should I put the hair up or down?
If long hair is left flowing loose it will increase the possibility of direct contact with someone else’s hair and hence passing on head lice, tying it back is therefore sensible. Much head to head contact is actually around the front of the hair when little kids put their heads down to share a secret or a book, hairstyle doesn’t make any difference in this instance.

32. Are head lice resistant to pesticides?
Head lice may be starting to get resistant to some types of head lice treatment but this is difficult to prove absolutely. This kind of work needs very large studies conducted under very carefully controlled conditions. These tests are very difficult to conduct, cost a lot of money and are usually only conducted to prove that a new treatment works before it is sold to the public. It is very difficult to see who would want to provide a lot of money to prove a treatment has stopped working. Public Health Authorities generally don’t have the money and also have rather more important issues to deal with.
One day we may have an answer to this question but in the meantime you can avoid the uncertainty by not trying to use any treatment that attempts to kill head lice.

33. Can I prevent head lice?
You can prevent head lice. You could isolate your kids but that is really not sensible. You can conduct a daily search of their hair and remove any little visitors before they have a chance to lay eggs and nip the problem in the bud which would be time consuming but effective.
You can also make life difficult for head lice by disguising the kids natural body scent. This means that any visiting head louse won’t realise that it is actually on a suitable host and just leaves the hair without feeding or breeding. NITMIX, used as a disguise is not a treatment or “repellent”. Head lice like our kids because they offer warmth, food and shelter. If any of these things are missing they cease to be a suitable climate for the head louse to thrive in. We don’t want cold kids and we discussed shaving heads earlier and that is not advisable. So, that just leaves the food to disguise.
Head lice are very host specific, in other words they only live on human heads. That is the scent that says “FOOD”. If we disguise that they loose interest in us entirely. NITMIX can be used to provide a new smell in the hair that is enough to cover over human scent while not medicating the child or the louse in anyway but helps to retain lice free healthy hair.

34. Should I treat myself to prevent being infested?
Don’t ever resort to putting lice treatment on yourselves or your kids “just in case”. You should only treat proven cases of head lice or use a wet combing aid to help you establish that there really is a problem to solve. Very few treatments that act as a head louse killing agent can possibly be used as a preventative as you must wash them out completely after use. If you are leaving any useful level of residue of these pesticides in the hair then you risk exposing your child to its toxic effects over an extended period.

35. Should I keep my kid’s home if they have lice?
There is a huge variation in approaches to head lice in different parts of the world.

Generally in America kids are excluded with head lice or even nits and it causes chaos, financial hardship and much stress to working parents, especially single parents. But from our experience we get more enquiries and letters from desperate parents from America than anywhere else.

They also seem to have just as many cases of head lice as anywhere else. In the UK, Australia, New Zealand and most of Europe head lice are dealt with by parents after a simple letter from school is sent home asking for everyone to check their kids hair. Some parents get stressed when simple over the counter treatments don’t work but they aren’t under financial pressure or social pressure from other parents. The kids get treated by whatever means their parents choose and back to school they go.

Our sympathy at NITMIX is definitely with the live and let live attitude outside the US. No matter what the arguments about treatment and policy one fact remains, head lice are perfectly normal condition for a child to experience and are perfectly harmless to the child. More harm seems to occur when parents resort to using strong measures to remove head lice or suffer financial stress trying to get their kids back to school.

In 2002 the American Academy of Paediatrics (AAP) produced a clinical report on dealing with head lice in a school setting which contained a well balanced summary of the tiny health threat posed by head lice and, amongst other things, recommended the ending on exclusion and “No Nits” policies. Unfortunately it also trotted out the usual pesticide based recommendations which many parents are finding less and less acceptable. In it’s defence the report also covered the merits of manual removal and touched on some alternative treatments.

In response the National Pediculosis Association (NPA), which is in effect an anti pediculocide lobby group, issued a broadside attack on the whole report’s recommendations especially, the pesticide treatment regime, ending the No Nits policies and ceasing inspections of children in school. No wonder poor parents are confused!

We feel that the NPA rather threw out the baby with the bath water on this one. If read impartially the AAP report contained some very balanced and rational arguments as to why head lice shouldn’t meet with a hysterical response and underlined several times how harmless head lice are. So far so good. If parents took this part of the report and just said to them selves “ OK, but I don’t want to use the poison stuff” They would have found another treatment and everyone would have benefited.

By supporting a continued head lice ban the NPA actually run the risk of driving desperate parents straight into the arms of the pesticide peddlers because they don’t consider head lice to be being harmless. We fear they may have scored a bit of an own goal here. As ever, parents should make up their own minds by reading the original articles in the Press sections of the AAP and NPA web sites. Good luck!

Many parents will complain that they don’t want their kids exposed to lice but this is pandering to very selfish and often irrational fear. We don’t exclude kids with a runny nose, or warts or many other normal childhood problems. We teach tolerance of differences and disabilities. So we should with head lice. If schools become places where irrationality and intolerance form policy we really are heading for trouble. Head lice are just harmless little visitors.

Another point has to be made here. Years ago smallpox claimed the lives of our kids and a huge effort managed to eradicate it World-wide. But head lice are not in this category. Suspicion that head lice may transmit disease has hardly got past the supposition stage and there certainly aren’t waves of disease being passed around western schools as a result. There will not be a time when mankind gangs up on head lice to remove them forever, it just isn’t going to happen. So please don’t start campaigns or protests about it, just learn a few simple steps to brush them of your kids, if and when they get them and move on.

36. Why are the kids still scratching?
Most living creatures have little mechanisms in their bodies for fighting off anything that invades them. They also have warning systems to tell us something is not right. When we get stung or bitten by a bug a very complicated reaction gets set off which is partly warning, partly healing. Swelling, redness and itchiness are all part of this reaction.

With head lice we need to get bitten many times before we feel the itchy bit, some people don’t get itchy at all. When you have cleared away head lice the old bites don’t know that the threat is over and some of the healing is still going on. Hence the itching often continues for quite a while after successful treatment. You may also get a little infection in the scratches you make on your own skin these usual heal up on their own. You could use a little medicated shampoo to help them heal up quicker. If the itching really goes on a long while ask your Pharmacist for a mild anti-histamine spray, cream or tablet just to tell the body it is all ok to shut down the warning signals.

37. What do the eggs look like?
Head lice eggs are a small bud like attachment to the hair strands, never on the scalp. They are variously described as white, grey or cream. Most are laid very close to the scalp where heat from the body keeps them warm however in a very warm humid climate they may be further away from the scalp. The further from the skin the more likely an egg is to be old, cold, empty or dead.
There may be some differences in appearance between live eggs, dead eggs or empty eggs but under normal lighting conditions it is unreliable to try and tell them apart.
Head lice eggs are easily distinguished from other rubbish in the hair. If you put your finger nail below the egg and try to slide them down the hair shaft they don’t budge at all. Flakes of skin, dandruff, cradle cap etc all slide along the hair.

38. How long do head lice live?
Head lice live about a month after hatching. It takes about a week for an egg to mature and hatch. The nymph louse grows to maturity in about a week to ten days. This leaves about three weeks of active life in the hair.

39. Do all head lice lay eggs?
Not all the lice you see can lay eggs. Some may be male lice, others unfertilised females, these don’t lay eggs. When combing hair parents sometimes spot large adult lice in the hair and fear they may be in the grip of a head lice outbreak but nothing else happens. They have probably found a male or unfertilised female.
If you suddenly find an adult (large) louse on previously clean hair it has almost certainly just climbed onto this head from someone else. Large adults can’t just appear. If a mixture of large and small lice is found then a full-scale infestation is present. When little lice are found they must have hatched on that head juvenile lice do not travel from head to head they are just too weak and too small.

40. What is the best type of comb to use?
The best comb is one that is fine enough to catch all sizes of lice and also detach eggs. That means very fine indeed. However, very fine combs won’t go through some kinds of hair without tugging, pulling or snagging.
The best way to get around this is to use a very, very fine comb but lubricate it so that the hair still slides easily around the teeth. NITMIX Wet Combing Aid achieves this for all types of hair.
One way to make the comb work even harder is to turn the comb at an angle as you pull it through the hair to make the strands bend or zigzag through the teeth. With well lubricated hair you can create a quite sharp turn through the teeth which catches egg cases and forces them off the hair strands.

References

www.NPA.org

www.AAP.org

HEAD LICE, AMERICAN ACADEMY OF PEDIATRICS
CLINICAL REPORT, Guidance for the Clinician in Rendering Pediatric Care
Barbara L. Frankowski, MD, MPH; Leonard B. Weiner, MD; the Committee on School Health; and the Committee on Infectious Diseases, Pediatrics, Volume 110, Number 3 September 2002, pp 638-643

Speare, R. and Buettner, P. Prevalence of head lice in a primary school in Australia and implications for control. International Journal of Dermatology 1999;38:285-290.
Speare R, Cahill C, Thomas G., Head lice on pillows, and strategies to make a small risk even less,Int J Dermatol. 2003 Aug;42(8):626-9.

Mumcuoglu KY, Friger M, Ioffe-Uspensky I, Ben-Ishai F, Miller J., Louse comb versus direct visual examination for the diagnosis of head louse infestations.
Pediatr Dermatol. 2001 Jan-Feb;18(1):9-12.

Jan De Maeseneer, Wet combing versus traditional scalp inspection to detect head lice in children: observational study) BMJ Volume 321, pp 1187-1188.

RICHARD J. POLLACK, PhD; ANTHONY E. KISZEWSKI, DSC; ANDREW SPIELMAN, SCD, Over diagnosis and consequent mismanagement of head louse infestations in North America, Pediatr Infect Dis J 2000 August;19(8):689-694

World Health Organisation Fact Sheet Nos. 162, Epidemis Louse –Bourne Typhus, May 1997

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