What to Do About Tough-to-Treat Head Lice

Effective medication available if over-the-counter preparations don't work

If you think your child has head lice that appears resistant to over-the-counter treatments, don’t panic.

No serious medical conditions are transmitted by the lice, said Dr. Bernard Cohen, a professor of pediatrics and dermatology at the Johns Hopkins Children's Center in Baltimore.

“So it’s a social disaster, it’s not very pleasant, but nobody’s ever died from head-lice infestation,” he said.

Researchers at the American Chemical Society’s 250th meeting in Boston said Tuesday that prescription medication may be needed to treat lice resistant to over-the-counter treatments. The lice have been found in 25 states, including California, Florida, Massachusetts and Texas.

Cohen said he thought the most common cause of persistent infestation or re-infestation remained a failure to treat everyone in the family and other close contacts. An over-the-counter treatment should be used at least a few times spaced by a week or 10 days before it is declared a failure.

But if it does not work, and lice are still present, there are prescription medicines that are effective and safe, among them ivermectin, spinosad and benzyl alcohol, he said. A pediatrician or nurse practitioner should also make sure that your child actually does have lice, he said.

Some parents wrongly believe their children have lice when they mistake scales on the scalp or other skin conditions for lice eggs, called nits, or do not realize that the nits are dead.

And if your children do get lice, it is not a sign that they are not well cared for, he said.

In fact, he said, “Head lice like you clean.”
 

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