Provided courtesy of Advice on Lice.
Step 1: Apply a pediculicide in a shampoo form using our method.
Our first step is to treat any infested heads with an OTC lice killing shampoo. We stock a brand called Rid which we find to be relatively pleasant and effective. We do not insist on clients using this brand exclusively, but we always discourage anyone from using the product, Nix, as it has proven grossly ineffective in our experience. Another alternative is a new prescription “Ulesfia” which is a non pesticide shampoo. What we do insist upon is that whatever lice killing shampoo is used is done according to the method we have developed which has a much greater success rate than the usual product directions. These instructions are accessed on the FAQ’s page of our web site, www.adviceonlicemd.com, and are available in the office in printed form.
Step 2: Comb and pick the head two times a day for two weeks.
After the initial shampoo treatment it is necessary to thoroughly detangle and manually remove any lice (hopefully dead, but not necessarily) and all of the nits. To achieve this we recommend two comb outs a day for two weeks. One of these is a quick comb out and the other is a thoroughly sectioned comb out with the Lice Meister Comb.
- The thorough comb out consists of sectioning the hair into 6-8 sections, picking through each section while dry and then applying a white conditioner (we recommend Pantene Classic Care Conditioner) and water (applied with a spray bottle) to each section, distributing and detangling with a regular comb, and then combing with the Lice Meister nit comb (which is in a white cup of isopropyl alcohol) along the scalp and all the way off the hair in every direction. Nits and bugs may be trapped in the tines of the comb, and they can be removed with a barbeque skewer in the cup of alcohol if they do not wipe off on a paper towel. Nits and bugs will appear brown against a white surface.
- The quick comb out consists of applying a detangler or leave in conditioner (we recommend BioSilk Silk Therapy) to the entire scalp and distributing through the hair by combing with a regular comb and some sprayed water followed by an all out comb out with the Lice Meister comb along the scalp and all the way off the hair in every direction for about 5 minutes. The comb can be wiped off intermittently to check for bugs and nits. We then recommend braiding the hair if possible for the least amount of exposure for protection. Our regimen takes into account that there is a tremendous margin for product failure and human error when we are trying to eradicate head lice. Therefore, it is necessary to repeat the nitpicking and combing process twice a day for the first two weeks followed by a third week of once a day nit combing.
- After each use, the Lice Meister Comb should be sterilized with boiling water. It is best to boil a full kettle of water so that it is whistling hot, and pour the entire contents over the comb and leave it to soak for at least ten minutes.
Step 3: Repeat a pediculicide shampoo on day ten.
We believe it is more effective to wait ten days before reapplying lice killing shampoo because the over the counter products are supposed to kill bugs and will have no real effect on viable nits. Furthermore, the nits take seven to nine days to hatch, so we believe it will be more beneficial to use the chemicals after any undetected nits have had an opportunity to hatch, but before the bug is mature and able to reproduce. The program we have devised is labor intensive and repetitive because it is based on the science of the life cycle of human head lice. Following the second shampoo changing or drying the linens with high heat will no longer be necessary.
Step 4: Comb once a day for a third week.
It is our opinion that the life cycle can best be broken if the head is combed and monitored for three full weeks. We often compare this to the concept of antibiotics to cure infections. The symptoms may subside, but if the medication is halted too soon, it is likely the infection will return and be even more resistant to treatment. If the manual removal of lice and nits is not completed, the infestation may reappear and require more work to eradicate. We recommend during this third week to alternate between the thoroughly sectioned comb out and the quick comb out as described above
Step 5: Clean the environment most thoroughly on the day of the first treatment, and maintain measures on any items which contact the infested heads on a daily basis.
We strongly advise washing and drying all bed linens in hot water and high heat on the first day of detection. During the 10 day time frame between the first and second lice killing shampoo treatments all bed linens should be either changed or dried in the dryer for 30-40 minutes on high heat.
It is a misconception to think that an environment is infested with human head lice. Sometimes hairs with viable nits attached may fall out or be brushed out, and sometimes actual bugs may walk or drop out of a head. Each instance is very individual, and the potential infectious possibilities are impossible to predict. Subsequently, it is advisable to maintain a level of cleanliness. Vacuuming couches and carpets on the first day is recommended, and some people then find it helpful to cover the furniture with a sheet or towel which can be put through the dryer once a day. It is unadvisable to use pesticidal sprays on mattresses, carpets, and car seats, and clothing. These products are not particularly effective unless sprayed directly on the lice, and they can be very unhealthy for humans and pets. It is best to remember that your house or school is not infested with head lice; the people are infested. Articles of clothing and hair implements and accessories should be dried on a high temp for 30 minutes, sanitized with boiling water or run through the dishwasher, or frozen for 8-12 hours (in Ziploc bags in the freezer, or in a garage or porch during the winter months).
Step 6: Continue to check all family members every couple of days during the outbreak, and routinely screen all family members no less than every ten days.
The best prevention is always early detection, so it is important to be on the alert for other possible infestations. At times, an infestation can be undetectable, so it is necessary to screen regularly. During an active infestation this is one more thing to do on a very long list. On the other hand, if it is a routine occurrence that is comparable to brushing our teeth to prevent decay, it can be less tedious. Some people even find the weekly prophylactic screenings to be “quality time.
*We understand that this treatment plan is labor intensive, and can be overwhelming when there are multiple family members to be treated. We hope it can be modified by our clients when need be, and we believe that the process will become easier as the days progress. We strongly caution our clients to remain vigilant because in our experience, if we discontinue the manual combing too soon, the lice will seize the opportunity to thrive again.
* I have found the directions inside the OTC treatments to be confusing. What is the best method for using these products?We recommend starting to apply the pediculicide to clean dry hair. I always suggest that the head to be treated should first be flipped upside down and brushed vigorously over a sink or bathtub. Often, this will result in live bugs falling out of the head, and these creatures should be immediately washed down the drain. We are performing this task to dislodge as many bugs as possible, and to force the smallest bugs that may be on the scalp to move down into the length of the hair. This will enable the product to better contact the live bugs. The treatment should be applied liberally from the nape of the neck all the way to the front hair line, saturating the hair from root to tip all over the head. Most products say to leave them on for ten minutes, but because the lice today are so hardy, I usually suggest leaving the treatment on the head for 30-40 minutes for children and up to an hour for adults. Most people prefer to cover the hair with a plastic conditioning cap for the duration of this time. After waiting for whatever time you are comfortable with, it is necessary to add some warm water to the hair (the eyes of the person being treated should be covered with a dry towel) and the product should be lathered up like a shampoo for 3-5 minutes. Finally, the product should be thoroughly rinsed out with warm water directly from the head down the drain.
Advice on Lice
10400 Connecticut Ave. Suite 403, Kensington, MD 20895