Head lice infestation (pediculosis capitits) is the infection of the head hair and scalp by the head louse (Pediculus humanus capitis). Itching caused by the lice bites is quite prevalent and may lead to disturbed sleeping patterns. During the first infection, the itch may not develop even up to six weeks however, if the person gets infected again the symptoms occur more rapidly. Head lice are tiny, wingless insects that live on the scalp and feed on human blood. They are mostly found in children aged three to 11 years old, although anyone can get them. Head lice spread through direct head-to-head contact with an infected person. Contrary to popular belief, head lice do not discriminate based on cleanliness, as they can infest hair regardless of hygiene levels.

 

Transmission

The most common mode of transmission for head lice is direct head-to-head contact with an infected person. During close interactions such as playing, hugging or leaning heads together, lice can easily crawl from the hair of one person to another. This direct contact provides an opportunity for lice to move from one individual to another, particularly in settings where children gather closely together, such as schools, day-care centres and sleepovers.

Head lice can also be transmitted indirectly through the sharing of personal items that encounter the hair. Common items that may facilitate the spread of lice include hats, hairbrushes, combs, hair accessories, headphones and helmets. When individuals share these items, lice or nits may be transferred from one person's hair to another, leading to infestations.

While less common, head lice can potentially be transmitted through shared clothing, bedding or upholstered furniture, particularly items that come into close contact with the head. Lice or nits that have fallen from an infested person's hair onto these surfaces may survive for a short period and potentially transfer to another individual upon contact.

Contrary to popular belief, head lice do not discriminate based on personal hygiene or socioeconomic status. Individuals of all ages, genders and socioeconomic backgrounds can get head lice. However, factors such as crowded living conditions, frequent close contact with others and lack of awareness about preventive measures may increase the risk of lice transmission in certain populations.

Schools, day-care centres, sports teams and other community settings, where children gather closely together, are common environments for the transmission of head lice. Close contact during play, group activities and shared spaces increases the likelihood of lice spreading from one individual to another. Additionally, the exchange of personal items and lack of awareness about head lice prevention may contribute to outbreaks in these settings.

 

Signs and symptoms

Itching: The most common symptom of head lice is itching, caused by an allergic reaction to lice saliva. However, not all children experience itching, particularly during the early stages of infestation.

Visible lice: Adult head lice are extremely small, about the size of a sesame seed, and can be challenging to spot, especially in thick or dark hair. They are typically found close to the scalp, behind the ears, as well as at the back of the neck.

Nits (Lice eggs): Nits are oval-shaped and attach firmly to the hair shaft near the scalp. They can be mistaken for dandruff or hair debris but are often more difficult to remove. Nits may appear yellowish-white or brown and can sometimes be seen moving if they are still alive.

Irritability and difficulty sleeping: Persistent itching and discomfort from head lice can lead to irritability and difficulty sleeping in affected children.

Scratch marks and irritated skin: Excessive scratching of the scalp may cause scratch marks, redness and irritation. In severe cases, secondary bacterial infections may occur due to scratching.

Presence of lice eggs on personal items: Lice eggs can sometimes be found on personal items such as hats, hairbrushes or pillows, particularly if they have been in close contact with an infested individual.

 

Treatment

Over the counter (OTC) lice shampoos or lotions: OTC lice treatments typically contain insecticides such as pyrethrins or permethrin, which are effective against head lice. These products work by killing adult lice and, in some instances, nymphs (young lice). It is important to follow the instructions carefully, including application time and repeat treatments if necessary.

Manual removal with a fine-toothed comb: Manual removal of lice and nits using a fine-toothed comb, can be an effective treatment method, particularly in conjunction with other treatments. Wetting the hair with conditioner or a specialised solution can help loosen nits and make combing easier.

Prescription medications: In cases of severe infestations or when OTC treatments have been ineffective, healthcare providers may prescribe prescription-strength medications. These can involve topical treatments such as malathion or oral medications such as ivermectin.

Natural remedies: Some parents may prefer to use natural or home remedies to treat head lice. These may include essential oils such as tea tree oil or neem oil, mayonnaise or olive oil treatments, or herbal shampoos containing ingredients like rosemary or lavender. Caution should be exercised when using them, especially in children with sensitive skin or allergies.

Environmental measures: In addition to treating the child's hair and scalp, it's essential to take steps to prevent reinfestation by treating the child's environment. This includes washing bedding, clothing and personal items in hot water and drying them on a high heat setting to kill any remaining lice or nits. Vacuuming carpets, upholstery and car seats where lice may have fallen can also help prevent reinfestation.

Follow-up: Regardless of the treatment method used, it's essential to follow up with retreatments as recommended to ensure complete eradication of lice and nits. Failure to do so may result in persistent infestations and further spread to others.

 

Prof. Renald Blundell is a biochemist and biotechnologist with a special interest in

Natural and Alternative Medicine

He is a professor at the Faculty of Medicine and Surgery, University of Malta

 

Andrea Weronika Gieleta is a registered nurse and is currently

a medical student at the University of Malta

 

 

Photo: AI-generated images created by Prof. Blundell