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Head Lice
Questions

Head lice are easy to get?

Lice are spread only mainly by head-to-head contact. They are much harder to get than a cold, flu, ear infection, pink eye, strep throat, food poisoning, or impetigo.

Pets spread lice?

Human head lice (pediculosis humanus capitis) are species-specific. You can only get human lice from another human. You cannot get another animal’s lice.

Any nits left in the hair can cause lice to come back?

Any nits farther away than one quarter to one half of the hair shaft are already hatched and pose no risk to others.

Head lice prefer dirty or unwashed hair?

Head lice do not discriminate between washed and unwashed hair. Head lice seek warmth for their eggs and a place close to regular food (both being fulfilled by proximity to the scalp). Hygiene makes absolutely no difference. You get lice by close personal head-to-head contact with someone else that has lice, not by being dirty.

Selfies transmit head lice?

Yes, they may. Any activity allowing head lice to pass hair-to-hair between existing and potential hosts bears the risk of head lice infestations. Other than that, head lice have no quarrels as regards hair colour, timing of last hair wash, hair accessories or social standing of the host. Head lice treat all humans as equals, given the opportunity.

Can head lice spread in the office?

Without close enough contact for head lice to move from host to host, head lice will not spread. In the typical office, there is probably not a whole lot of hugging and pillow-sharing going on. If it is, head lice might be the least of potential concerns.

Head lice are most active in the dark?

Very true.

Swimming pools can spread lice?

Although head lice are not killed by chlorine levels in swimming pools and can survive under water for many hours, head lice will not spread in a swimming pool. Instead, head lice will hold on tight for dear life to the human hair they are already clinging on.

Can I catch head lice at a hair salon?

There is a real risk that head lice can spread from the use of towels between infested and non-infested persons at hair salons, even if the towel was washed in-between. Head lice can easily survive a washing cycle, unless at temperatures above 60 °C or the towels have been treated with a steam iron.

Can I catch head lice from going by Ojek and accepting a borrowed helmet?

Sure you can and your chances are higher the busier the Ojek was before giving you a ride. If you use regularly Ojek, bring along your own helmet.

Do different hair types and styles matter?

People of all races, hair types, colors, and lengths get head lice. Certain hairstyles can also contribute to a reduced risk of head lice. For example, closely cropped hair, tight braids (especially when braided into rows where areas of the scalp are exposed) and hair extensions all have attributes that make infestation less likely. Hair styling and style maintenance are in any event not reliable ways to control head lice. Using permanents or hair coloring to control head lice can result in temporary or permanent hair damage, allergic reactions and other unwanted health effects. Relaxers, perms, and hair color should not be used on anyone with an active or recent infestation since broken skin may be painfully irritated by these chemicals.

Treatment
Head Lice
Actions

Neurotoxin-based / Insecticides

Permethrin-based product

One registered product available in Indonesia, though wrongly registered as medicine.Can be bought over-the-counter at your grocery store or pharmacy. No published data on product efficacy, though Permethrin resistant head lice stems have been reported worldwide.

Permethrin is low in toxicity (to humans), but is not non-toxic. It is not known to rapidly harm most mammals or birds, but is toxic to fish and cats. In cats it may induce hyperexcitability, tremors, seizures, and death. In 2015, a head lice study carried out by researchers of the Southern Illinois University at Edwardsville found that 104 out of 109 lice populations sampled in 30 states across the US were tested to have high levels of gene mutations linked to resistance to pyrethroids. Pyrethroids are a type of insecticide that is not only used in certain neurotoxin-based head lice products, but also in a variety of other products such as sprays against mosquitoes, cockroaches and flies. If the same chemical, whether lindane or pyrethroids, is used over and over to poison these parasites, head lice will eventually develop resistance. High responsibilities are vested in Indonesian government and research institutions to monitor and inform of the total balance of a product’s efficacy, health and environmental impact.

Physical working mechanism-based

5% Benzyl Alcohol Lotion (5% BAL)

A pioneering neurotoxic pesticide-free head lice treatment development, which very detailed working mechanism description contributed to the global breakthrough of modern, highly efficacious, health and environmental impact-friendly head lice products, which are in addition free from resistance build-up common to insecticide-based products[L1] . Used by different manufacturers under different trademarks around the world.

Enters and blocks a louse’ breathing tubes (tracheoles), which end as body openings (spiracles) through which head lice breath and excrete water. Plugs the breathing holes of nits (very small openings at the top of a nit called aeropyles), which causes the nits to suffocate too.

Safe to use on children from the age of 6 months on. Suitable for sensitive skin. Use once a week, for 3 weeks, a 10 min application.

Various other proven formulations

Although 5% BAL is one of the most internationally tested and studied treatments, many other proven physical working mechanism-based product formulations or devices exist. Those aim typically at causing the louse’ death by asphyxiation/suffocation (through physically blocking the louse’ moisture and oxygen exchange) or by dehydration (through dissolving the waxy layer of a louse’ exoskeleton protecting it against uncontrollable moisture loss).

Nit Combs

Combing can be very time consuming and tedious, but it is a safe way to treat head lice. Wet the hair and add a little cream rinse or conditioner to make it easier to move a nit comb through the hair. This will also stop the ability of head lice to just ‘race’ through the hair and crawl out of sight. Wipe off what you comb out into a tissue or paper towel and throw it in the wastebasket or bag. Concentrate at first on removing every insect you find and always focus most on the area near the scalp. Then work on the eggs and any bugs you missed as you work your way through the hair.

Not recommended, avoid these treatments!

Hexachlorocyclohexan (Lindane) based product

Predecessor of Permethrin by the same manufacturer, but based on a different pesticide. Lindane’s purpose is to kill adult head lice and nymphs, but not to kill eggs. The efficacy of this product against resistance risk can be questioned without the effort of any studies. Since this product was allowed to be the de-facto monopoly head lice treatment product in Indonesia for decades (respectively hundreds of millions of cumulative head lice infestations).

Unquestionable however, is that this product’s safety warnings were not designed, nor updated to appropriately address by any international benchmarks (as in not even mentioning) the potentially lethal risks of Lindane for humans.

We recommend to stay away from this substance.

Fake and ‘look alike legitimate’ products

Decades during which only one single head lice treatment product with product registration number was available in Indonesia, has contributed to an abundance of product offerings (mostly through the internet), which are not backed up by credible verification of their efficacy, product content formulation, manufacturing standards, health and environmental impact (‘unvalidated product’). Some of these manufacturers may be driven by the genuine desire to provide relief based on ingredient formulations believed not to be harmful. Products without registration number, but marketed as ‘head lice medicine’, or products displaying ‘more registration numbers than possible’ (e.g. pesticide registration number from Ministry of Agriculture RI together with registration numbers issued by the Food and Drug Control Agency RI as Quasi Medicine and by Directorate General of Pharmaceuticals and Medical Devices as pesticide household product) are by design misleading. Remember that head lice products are most commonly used on children. Think if it’s worth it to entrust your child’s safety to the use of an unvalidated product from a manufacturer that miscategorizes its product with intent to mislead you.

Household & Garden Pesticides (Danger: Toxic)

Never use household and garden pesticides to treat head lice. They are toxic and strictly intended for different purposes! There is a risk of serious illness, injury, or death any time household or garden pesticides are used for the treatment of head lice.

Kerosene (Danger: Flammable)

Never use kerosene to treat head lice. It is flammable! There is a risk for serious illness and injury if kerosene is used to treat head lice.

Mayonnaise

People have reported both success and failure using mayonnaise to treat head lice. This treatment requires a thick application of high-fat mayonnaise to a person’s head. Treatment times range from 12 to 24 hours. In order to keep the product from staining linens, furniture, and clothing it is recommended that a shower cap or plastic wrap be worn. It has also been recommended, by some sources, to gently heat the mayonnaise-covered scalp with a hair dryer. Since mayonnaise is an oil-based product, accidental overheating could cause scalp burns. Mayonnaise is a food product and could promote bacterial growth under the right conditions. If bacterial growth does occur, getting mayonnaise into the mouth or eyes could cause serious bacterial infection.

Recommended holistic treatment approach
Head Lice
Actions

Detect

Good lighting is important. As head lice move fast and avoid light, look close at the scalp, at the bottom of the neck and behind the ears.

Part hair in small sections, moving from one side of the head to the other. Check carefully, looking close to the scalp.

A magnifying glass and a bright light to look for moving lice and unhatched eggs are commonly used by healthcare practitioners.

TREAT YOUR FAMILY SAFELY

We recommend the use neurotoxic pesticide-free and efficacy-proven head lice treatment options.

The effectiveness of neurotoxic insecticide-based treatment options has been undermined by the emergence of drug- / pesticide-resistant lice. Neurotoxic insecticides are also often referred to as ‘pesticides’ with reference to those insects affecting human livelihoods negatively as ‘pests’ by feeding on the food of humans or as parasites on humans themselves. ‘Neurotoxic’ explains the working mechanism of such insecticides (or pesticides) by poisoning the parasitic insects.

There are 2 major risks to be considered with pesticide-based products:

  • Pesticides are potentially harmful not only to the targeted, but also to other organisms including humans; and
  • Pests (and very much so head lice) have proven to be very adaptive by developing resistances (meaning survival mechanisms) against such poisons.

Asphyxiation- or suffocation-based head lice treatment products present modern, effective, health and environmentally conscious alternatives to neurotoxic pesticide-based products. These products use a physical working mechanism against which head lice cannot develop immunity (resistance).

Treat and repeat treatment of your household members at the same time.

Regularly check for re-infestation and be prepared to repeat treatment more often than just the recommended initial and past 7 to 10-days treatment.

TELL FRIENDS AND FAMILY

A household with one member suffering from head lice will most likely have several or all members affected though the degree of symptoms may very much vary.

Domestic workers with close physical contact to a household’s children must be included in all treatment activities.

The more members per household, and the longer head lice infestation has persisted untreated, the more live head lice in all stages and nits, and thereby the more treatment efforts must be expected.

Encourage your friends and family, who are not household members, to treat themselves at the same time as you do.

TREATING YOUR HOUSEHOLD

Expose head lice to high heat or strong cold

Head lice perish quickly above 60 °C or below freezing temperatures (the higher or lower the temperature, the less time required to kill head lice and all nits effectively).

After treating your household, change all sheets, pillowcases, clothes, blankets, towels, clothes and wash them at 60 °C or tumble dry them. As washing machines with heating cycles or tumble dryers are less common in South East Asia, please follow alternatively the ‘Isolate’ option further below.

Soak combs, brushes and any other belongings, which may carry live head lice or nits in hot water (>60 °C) for 10 minutes.

Your favorite scarves or your child’s favorite soft toy may not be suitable for washing at high temperatures, in which case you may consider placing them in a plastic bag in a freezer for 2 hours.

The fabric of car seats or the inside fabric of helmets may be exposed to live lice depending on their exposure to head lice. An empty car will generate enough heat when standing in the sun with all windows closed to kill all head lice in it. The same can be achieved with a motorbike helmet placed in sealed black plastic bag in the sun.

Put sun light on head lice

Head lice flee from bright sun light to avoid dehydration and overheating. Larger items, which could be the source of re-infestations, such as carpets, foam mattresses (unless too big in which case please follow the ‘Isolate’ option) will not fit into black plastic bags, washing machines or freezers, but you may be able to place these items for several hours into bright sun light to kill head lice by dehydration.

Isolate head lice

Wipe the frames of beds and the surface of leather couches. Vacuum carpets and other fabrics that could have very recently been exposed to live head lice. Head lice captured in the dust bag of vacuums will not manage to find their way back to the host.

Alternatively cover couches and sofas potentially exposed recently to live head lice with plastic and a blanket on top for comfort.

Stow away favorite pillows, soft toys or other items, which cannot be washed at high temperatures or vacuumed effectively, in plastic sacks. Separate, after treating yourself and your household members, recently used clothes, unless washed at high temperatures, from clothes that you intend to use in the coming days.

Another alternative is to treat your family just before going on holidays, such as to hotels. The beddings in hotels are normally washed at temperatures that head lice do not survive. Remember, a head louse will die about 2 days after feeding (i.e., being isolated from a host). A newly laid nit may hatch a nymph 7 to 10 days later and will die without a host to feed on the same day.