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Head lice questions answered

I have been “making the rounds,” and speaking to concerned families, staff members and administrators at lots of schools and daycares in recent weeks about head lice symptoms, detection, treatment options and prevention.  I was at a lovely private Pre-K through 8 school this morning talking to and answering questions from parents, one of the school’s nurses and a few of its administrators.

There is so much mis-information about head lice, and it seems that many of the same questions surface at every talk.  I therefore thought I’d let you know what I’ve found are some of the most frequently asked questions about head lice:

How do you check for head lice?

I remember when my daughter was in Pre-K and the notes would come home about a case of head lice in her class or grade.  There would be an instruction, to “check your child.”  I’d brush her hair, move it around a little, maybe even flip some strands and peer at the part.  Otherwise, I hadn’t a clue.  Thankfully, I’ve learned a thing or two over the years, and I’m thrilled to share that knowledge with you.  Here are detailed instructions for how to perform a proper head check at home.  (At today’s presentation, the Principal, truly a good sport, allowed me to perform a modified head lice check on her for those in the audience to see.)  Alternately, you can always schedule a head lice check with Elimilice for between $10 and $20 per person where we’ll not only head check you/your family member(s) but will also teach you in person how to perform a head lice check at home.

Aren’t the head lice eggs/nits white?

Viable head lice eggs are generally tan to dark brown in color.  A casing (the shell of an egg that’s hatched) may appear somewhat white and/or translucent.  When you have casings, you generally have bugs (as again, there has been hatching.)  The magnified image below reflects what appears to be a viable nit flanked on both sides by head lice shells or casings.

viable head lice nit and head lice casings

(presumed) viable head lice nit surrounded by head lice casings


A viable nit will appear as bulbous and somewhat dark and cannot be removed with just a flick.  Frequently, when you see something white, if you can move it easily, it is dandruff, other scalp secretions or product residue.  Additionally, head lice nits are often laid in a quarter or half-dollar sized cluster.

I don’t even remember hearing about head lice when I was a kid.  Why does it seem that it’s everywhere now?

In August 2010, the American Academy of Pediatrics’ Council on School Health produced its first report on head lice since 2002. The updated document noted increased patterns of resistance among head lice to over-the-counter products designed to kill them and their eggs.  Resistance to the commonly utilized treatment products results in cases that linger, exposing others and an ongoing cycle.

Although head lice never disappeared in United States, their prevalence was once so low – because of widespread use of DDT (until its ban in 1972) that many children growing up during the “Baby Boom” years had no concept of head lice outbreaks.

Finally, with the advent of handheld cameras, video games and other electronics plus the manner in which many children work in school environments (collaboratively, at tables (vs. individual desks), etc.), there appears to be much  more head to head contact than perhaps in prior generations.

Why is combing with a premier head lice comb every week so important for prevention?

I emphasize the importance of weekly combing and even addressed this in a blog post after a school presentation I gave last year.  All of my details with  respect to preventive techniques are the same, and it is specifically important to head lice comb every seven days or less to prevent a full case of head lice ever “taking root.”  If you comb a fertilized female louse out before she can lay numerous eggs and/or before eggs start to hatch, you will preempt a full blown case.  If during a once a week check, you comb out an adult louse and some nits, you can work on this (without any significant treatment or the risk of exposing others), but if you let it go to the point that nits are beginning to hatch (approximately 7 to 10 days), with nymphs maturing, the treatment will be more onerous.

Is Ulesfia a good treatment product?

I recently discussed some of the head lice prescription treatment product options.  Ulesfia is one that has gained a bit of popularity with pediatricians.  It is a non-toxic lotion with a benzyl alcohol base that received FDA approval at about the same time as I started this business.  We love that there is no insecticide in it but we’ve also seen weekly “fails” (i.e. families that have tried the product but are still coming to us with evidence of active cases of head lice.)  Ulesfia does appear to suffocate the bugs but does not really do much for the nits that were previously laid by the bugs.  The theory seems to be, in using the product on Day 1 and Day 8 that you will kill any bugs that hatch in between Day 2 and Day 8 with the second application on Day 8.  But what about exposure of others to the nymphs that are on the head after hatching?  And what about eggs that hatch on Day 10?  Additionally, contingent upon your pharmacy, the drug retails for approximately $50 – $60 a bottle and long/thick-haired individuals will require multiple bottles (and again, two applications.)  Some “generous” prescription reimbursement plans might reduce the end payer’s cost, but we have had clients spend more than $300 for the product that still did not eliminate the head lice.


For the answers to other questions or other assistance with head lice, please do not hesitate to contact us.