Parents, schools dealing with chemical-resistant ‘super lice’

Remember when you were little? If you had head lice, all it took to get rid of them was overcoming the embarrassment of buying some over-the-counter shampoo.

No more. Parents and schools are battling “super lice” – itchy, six-clawed pests resistant to drugs. And it could cost you hundreds of dollars to get rid of them.

Having lice is already a stigmatized hassle. But to compound the problem, the days of ridding lice with some over-the-counter shampoo look like history.

Drug-resistant head licehave grown over the past several years.

With the school year well underway, here’s what you should know about super lice.

How did we get here?

Common over-the-counter lice treatments consist of insecticide-infused shampoo to kill the live lice and a fine-toothed comb used on wet hair to remove the lice eggs, or nits, which are sticky and close to the scalp.

Sara Zukoff, assistant professor of entomology for Kansas State University, compared insecticide resistance in lice to antibiotic resistance in people.

Naturally, she said, a small segment of insects carry resistance to pesticides. But she said when those pesticides are used over and over, the pesticide kills the bugs not resistant to treatment and the ones with resistance slowly become more common.

“The days of being able to wash with some pesticide-infused shampoo are gone,” she said.

Most head lice are not resistant to prescription treatments, which offer more pesticide variations.

But Zukoff said even if the prescription treatments became available over-the-counter, the combination doesn’t have enough variance to prevent lice from developing another resistance in the future.

Lice are about the size of a sesame seed, have six clawed legs and are tan to grayish-white. But they can appear darker in dark hair, according to the Centers for Disease Control and Prevention.

Lice can live in someone’s hair up to 30 days and feed on a person’s blood several times each day. They also lay eggs up to eight times a day.

But once lice are off someone’s head, they die in about a day.

Head lice do not transmit diseases and are not considered a health hazard by the CDC. Sores from scratching can become infected with bacteria from a person’s skin, but those do not originate from the louse itself.

“There’s really not a serious medical risk; it’s more of a nuisance,” said Gretchen Homan, a pediatrician for the University of Kansas School of Medicine-Wichita.

Lice in the United States are less common among African-Americans than other races because the lice are less adapted to grasp the shape and width of African-Americans’ hair, according to the CDC.

How do you treat it now?

Some companies offer in-home lice treatment with workers trained to remove lice by hand. A national lice-removal company, called LiceDoctors, expanded to the Wichita area about two years ago.

In-home treatments work because of the process workers go through to remove by hand all the eggs from a person’s hair. But the treatment comes with a price.

LiceDoctors charge $175 for the first hour of work and $100 each following hour. Karen Sokoloff, a partner at LiceDoctors, said on average it takes two to three hours to treat a family of four. She said it’s rare for just one family member to have lice in a home.

LiceDoctors use an oil mixture to first suffocate the lice and then comb out the nits by hand. The combing might sound simple, but the sticky texture of nits makes the process a time-consuming and laborious endeavor.

Sokoloff said nits are impenetrable.

“Not only are the chemicals ineffective because they don’t kill the bugs, they don’t do anything to the eggs,” she said.

“The bottom line is, generally, the chemicals don’t work.”

Nit removal is key to ridding a person of lice; otherwise, the cycle starts again when the eggs hatch.

“Parents would have a false sense of confidence and would think the kids are fine and send them back out in the community,” Sokoloff said about using over-the-counter shampoos to treat lice. “It was backfiring, using the chemicals, because if they didn’t (use the shampoo), at least they would know the kids still have it.”

Homan, the KU Medical School pediatrician, said not following directions of over-the-counter shampoos is a large part of the problem.

“It’s hard to know if you’re dealing with lack of compliance, resistance or re-infestation,” she said.

She said she thinks it’s worth trying alternative methods to lice treatment, like the one used by LiceDoctors, but to be thorough with the process and to check the hair periodically after the treatment.

Homan said lice can be hard to suffocate, so methods like the one used by LiceDoctors require a commitment and effort to pull out all the nits and lice from the hair.

She said if people try over-the-counter treatments without success, they should call their doctor.

“That’s how the lice formed resistance in the first place,” she said. “Because we used that particular product so much.”

School policies more lenient

In 2010, the American Academy of Pediatrics recommended schools abandon no-nit policies, which meant that students could not attend school if they still had nits in their hair.

In reaction to the academy’s recommendation, the Kansas Bureau of Epidemiology changed its policy to no longer include the nit-free requirement.

Previously, no-nit policies caused children who were otherwise healthy to miss several days, sometimes weeks, of school. Because lice don’t present health hazards for disease, schools loosened the policies.

The Wichita Public School District does not require children be nit-free for school.

Over time, the district also relaxed other lice practices in school. Kimber Kasitz, coordinator of health services for Wichita Public Schools, said Wichita school nurses no longer check students one by one and instead check only if a teacher refers the student because of symptoms.

Kasitz said the district stopped individually checking students’ hair because it didn’t think it was a good use of nurses’ and students’ time.

She also said the school does not notify all parents at a school each time a student has lice because of potential student identification. But she said schools send out general educational information about lice.

Last school year, 1,203 Wichita students were identified with lice. As of Thursday, 271 students had been identified with lice during the current school year.

But it’s nearly impossible to get an accurate picture of lice cases, because so many go unreported.

Zukoff, from K-State, said lice and bed bugs carry similar stigma related to hygiene and socioeconomic class, even though both are unrelated to those stigmas.

She said many schools stopped checking for lice because of ineffective treatment coupled with stigma of the diagnosis.

“It’s kind of an uphill battle with the drug-resistant head lice being so prevalent,” Zukoff said. “The schools are in between a rock and a hard place.”

This story was originally published November 1, 2015 at 7:45 PM with the headline "Parents, schools dealing with chemical-resistant ‘super lice’."