This season, children will be sharing more than colds and holiday cheer. Head lice will benefit from kids’ friendly head-to-head contact. And now there’s something new to be mindful of in the fight against these pesky bugs.
“Oh, head lice…Is your head crawling as you’re trying to do this story?”
That’s Carol Varner, the nurse at Gill Elementary School. She said this rural school of 117 students in Franklin County, Massachusetts, only gets two to six cases of head lice a year. But the lice are still troublesome enough to warrant year-round attention.
“The best way to approach it is checking your child every two or three weeks during the whole year, even if they’re not complaining of any symptoms,” Varner said. “Discovery of the tiny red marks around someone’s hairline or the black specks in an expected place, can show up a case very early, and that’s much, much easier to treat. ”
Humans have been plagued by head lice for at least tens of thousands of years. But, in the 1980s, new over-the-counter medications using natural compounds and synthetic chemicals derived from chrysanthemums became available. These products — when combined with combing to help remove the eggs the medications don’t kill — offered safe, effective treatment for head lice. Until a pattern started emerging.
John Clark is an environmental toxicology professor at UMass Amherst. Sixteen years ago, he received a phone call from a medical entomologist at UC Davis.
“He was getting a lot of (sort of) anecdotal complaints that the over-the-counter products didn’t seem to be working quite as well as they used to be working,” Clark said. “And people seemed to be having more problems with louse infestations than had been occurring previously.”
What Clark and other researchers found was head lice across the United States now carry mutations that make the chrysanthemum compounds less effective, and the frequency of these mutations continues to increase.
“We solely had one active compound that we used for a period 25 years, with virtually no other selection going on in the head louse population,” Clark said. “And, so what occurred…wasn’t surprising at all. It’s happened many, many times before.”
Many, many times before in other organisms, such as insects and bacteria, with repeated use of specific insecticides and antibiotics. So then new chemicals, or chemical forms, must be used to eradicate them.
A spokesperson for Springfield’s public schools said there’s no indication its students are currently affected by resistant lice. And John O’Reilly, a pediatrician at Baystate Medical Center in Springfield, agreed the area is not the “hotbed of resistant head lice.” But, he does get calls from parents about every week.
“I go back in pediatrics now almost thirty years,” O’Reilly. “So, in the beginning, things we had over-the-counter were almost the miracles – the Nix Cream, the permethrins — really killed, at that, point almost 98 percent of them. And now, that’s drifted down into the eighties.”
O’Reilly doesn’t believe that’s all about increased lice resistance. He said it’s also about how meticulously parents follow treatment instructions.
There are “higher-level” medications available when the over-the-counter treatments fail, but, O’Reilly said, those prescriptions need prior authorization from insurance companies.
Meanwhile,more itching, more scratching, more distractions from school.
“I’m just glad we’re getting a head start on a lousy problem,” quipped Albert Yan from the Children’s Hospital of Philadelphia. He chairs the American Academy of Pediatrics’ Section on Dermatology.
Like O’Reilly, Yan said the problem is due to both increasing resistance and patients doing a poor job of using easily available treatments. But he knows firsthand what it’s like to deal with this.
“You know, my daughter comes up to me and says, ‘Daddy, why is my head so itchy?'” Yan said. “And, I decided to take a closer look at what was going on under a bright light, and lo and behold, there were some lice.”
Yan started with the conventional treatments, but two to three days after treatment — and lots of combing — the lice were still alive. So he ended up requesting a higher-level medication from his pharmacy. But before the pests died off, he collected some of the lice and put the sample under the microscope.
“And they got a chance to get a lesson on the head lice life cycle,” said Yan. “I don’t know if that’s what most families do when they deal with this, but we had some fun at home.”
Although Yan’s family was able to make the most of a lousy situation, many people have a hard time even hearing about lice. If you’ve found yourself feeling itchy during this story, Yan has some advice, which he read about years ago.
“The gist of the article was that if you end up in a situation where you have to listen to an itch-inducing subject, you should follow it up by looking at pictures of babies and beaches to quench some of that itching,” he said.
While babies and beaches may not solve the growing head lice resistance problem, they may provide some temporary relief.