Head-lice nit.

A nit (egg). Those red spots are eyes. When you check for head lice, the nits look like white dandruff, but they don’t brush off easily.

by James Hubbard, M.D., M.P.H.

It’s back-to-school time. And soon afterwards, a young child’s rite of passage—the note from the teacher stating your little darling has head lice.

I can hear the collective “but we’re not a nasty family” now. For the umpteenth time, no one—not the teacher nor the principle nor the doctor—thinks you are. It’s not a question of cleanliness.

Truth be told it doesn’t have to be related to school. It can happen anytime one person’s hair comes in contact with another person’s hair that has the lice. You can also get it if you use a contaminated brush, comb, hat, barrette, or scrunchy and a louse (singular for lice) catches a ride for fresh blood. School just makes the odds more likely because there are more people close together.

In that way, school is like a survival shelter. Many people from multiple places are packed into a small room. Any time there’s a crowd in close contact, the risk goes up.

How to Check for Head Lice
  1. Make sure both the lice checker and the checkee are comfortable. You don’t want to rush this. Find some good lighting and stand or sit above the person, looking down on the scalp.
  2. Be psychologically ready. Back when I first started practice, I remember examining a prim and proper elderly lady who was in for something else but said, “Oh, by the way, my scalp’s been inching a lot lately.” Confident I would find a red scalp from some sort of allergic reaction or maybe a bad case of dandruff, I was somewhat taken aback when I parted the perfectly-perm gray hair and spotted a couple of bugs crawling around.
  3. Be ready to squash those critters. In the case above, I admit I wasn’t. Wear gloves if it makes you feel better. Think of the little critters as ants or gnats are something. They aren’t going to attack you. They like where they are. If you just can’t bring yourself to kill them, that’s okay. I list some treatments below that’ll do the job.
  4. Check for the nits (eggs). They’re attached, really cemented, to hair strands. Sometimes they’re all you’ll see. You’ll usually find them within a fourth of an inch from the scalp. They’re pretty tiny but definitely noticeable. Good lighting and a magnifying glass can help. Dirt and dandruff can be confused for nits, but they brush off easily. The nits don’t.

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How to Treat Head Lice

If you use a product, follow all of its directions exactly. Don’t use a conditioner prior since it can coat the hair, making it hard for the lice treatment to work. If conditioner’s been used, I’d wash the hair with plain shampoo or soap and water before treating.

1. Pick a lice killer:

Mayonnaise and plastic for head lice

To kill head lice, you can coat the scalp with mayonnaise and cover it with plastic for thirty-six hours. Obviously, use caution and your best judgement if you decide to put plastic on children’s heads, and don’t do it with young kids.

    • Your fingers, to squish the lice.
    • Mayonnaise. Slather it over the scalp and seal it with a shower cap or some sort of plastic for thirty-six hours. This will kill the lice but not necessarily all the nits.
    • Shampoos that contain pyrethrin, such as Nix, which kill the lice and the eggs.
    • Neem oil or shampoos containing it, which work okay, but you’ll need to shampoo for twenty minutes and leave them on for an additional ten.

2. Pick out the nits after you’ve finished the topical treatment. You could sit in a tub or do it outside, or seal the nits in a plastic bag. A fine-tooth comb is good for this. You can buy one in any pharmacy. Wet and comb the hair. Pick out every egg that’s within a half-inch or so from the scalp. The lice lay their eggs close to the scalp and, of course, the hair grows. So nits found further than half an inch from the scalp have probably already hatched and are empty casings.

3. If you haven’t used a treatment that kills the nits, you’re going to want to repeat this nit-picking daily for about nine days.

4. Repeat the treatment about seven to nine days later to get rid of any lice hatched from nits that survived the first treatment.

You can save yourself a lot of trouble by just shaving the head. Okay, this is probably not the first option for most. Even cutting the hair short is going to make it easier to find those nits.

But, even in a disaster setting, keep the psychological impact in mind. And it’s really not that much harder to check long hair for nits since it’s the first one-fourth to one-half inch from the scalp you’re concerned about.

How to Prevent Head Lice

Treat everyone who’s been in close contact with the person who has lice. Also treat people who used the person’s hair accessories or slept in the same bed within 48 hours prior to the diagnosis.

Wash all potentially contaminated materials in water that’s 130 degrees F or hotter. If you can’t do this, either throw the materials away or seal them in a plastic bag for two weeks. The lice and nits can’t live away from the comfort and food (blood) of a good scalp for more than a few days.

What’s been your experience?

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Nit photo courtesy CDC/ Dr. Dennis D. Juranek.