Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Search for head lice when hair is wet. Use a
fine-toothed comb (or a louse comb), clear tape (to stick on hair to pick up
nits), a magnifying glass, and a strong light. A comb used to remove fleas
from dogs and cats works well to remove head lice.
Wet combing should be done every two to three days
over a two-week period, with small sections of hair, working out from the
scalp. Some call this "bug busting," and it can be very effective. The
entire scalp should be inspected, not just the neck region.
If lice are found, treat with an anti-lice agent
and repeat in seven to 10 days to kill newly hatched nits.
How to use anti-lice agents: Over-the-counter treatment is available and should be used
first. If after two applications, lice are still present, then
prescription anti-lice agents may be needed. Apply the
anti-lice agent to dry hair for the time listed on the product (usually 10
minutes). Shampoo and rinse hair and comb as directed with a fine-toothed
comb. Repeat anti-lice treatment in seven to 10 days to kill nits that may
Nonprescription anti-lice agents include Nix
Lotion (permethrin 1%) and Rid, A200, and Pronto shampoos (pyrethrin
Check all household members and treat only if lice
or nits are seen. Pyrethrin kills only lice. It does not kill nits and thus
requires retreatment seven to 10 days later to kill the newly matured lice.
Permethrin kills both nits and newly hatched lice for several days after
treatment. However, a repeated treatment is also recommended seven to 10
days later for optimum results. Current recommendations favor Permethrin
over Pyrethrin as a first-line treatment.
If a child is younger than 2 years of age, comb to remove
lice and nits but do not use over-the-counter anti-lice agents. A
prescription product is available from your doctor.
Hair conditioners may coat or cover the lice, so
they should not be used before applying anti-lice agents.
Wash all bed linens and clothing that have been in
contact with the infested person in the past two days. Use hot water and the
hot cycle in the dryer.
Some recommend that water be at least 140 F to
effectively kill the lice and nits. Most hot-water heaters are set at 120 F
for child safety. This lower temperature may be effective.
All nonwashable items such as stuffed animals
should be placed in plastic bags for two weeks then opened outdoors. Dry
cleaning may be an alternative.
Disinfect combs and brushes in hot water or rubbing
alcohol. Soak for more than five minutes in very hot water (greater than
131 F or 55 C).
Vacuum floors and furniture, especially couches and
areas used by children. Throw away the vacuum bag immediately.
Herbal therapy and oil treatments (for example,
olive oil, butter, petroleum) have been used in an attempt to suffocate
lice. A small study done in 2004 did not show any benefit of these
Do not use gasoline, kerosene, or oils. Burns have
occurred. A comb using an electric current generated by a AA battery has
been developed but any reported success is anecdotal and has not been
Do not shave the person's head. This drastic
measure is not necessary.
If lice are seen in a school-aged child, notify the school nurse or teacher in order to limit the spread.
Treatment failures commonly reflect repeated
exposure to those untreated and infected or lack of compliance with therapy.
While resistance is growing to topical treatments, resistant infestation
will often respond when an alternative product is used. It has been
recommended that, should reinfestation occur within one month after
successful treatment, an alternative topical insecticide should be used.
Wash the body thoroughly.
Wash and dry all bed linens and clothes in hot
cycles. Destroy what you can because these nits can survive longer without
human contact (up to 30 days).
Anti-lice agents are usually not needed if clothing is thrown away and bed
linens are thoroughly washed.
Check all household members or close contacts.
Treat them only if lice or nits are seen.
Vacuum floors and furniture. Throw the vacuum bag
Chemical insecticide sprays in the home are not
effective and not recommended.
Use over-the-counter antihistamines (such as diphenhydramine,
[Benadryl]) for itching.
Treat with anti-lice agents and repeat in seven to
Remove nits with a fine-toothed comb.
Check all close contacts. Treat them only if lice
or nits are found.
Wash and dry all clothes and bed linens in hot
Check eyelashes and eyebrows. If lice or nits are
seen, apply petroleum jelly (Vaseline) twice daily for eight days.
Use over-the-counter antihistamines (such as diphenhydramine) for itching.