In head lice outbreaks, ‘selfies’ may be a surprising culprit

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Anecdotal reports about a global rise in head lice cases have prompted warnings from some experts about a popular and universal activity among children and teenagers: taking selfies.

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Head lice, itchy parasites that live on the scalp, are typically spread through direct head-to-head contact, mostly among children. And getting close for group selfies – which often means pressing two or more heads together to fit into a cellphone frame – could give head lice an opportunity to crawl from one head to another, as they cannot jump or fly.

Selfies “serve as a significant transmission source,” Federico Galassi, a researcher with the Pest and Insecticide Research Center in Buenos Aires, said in an email.

Are lice on the rise?

It is not clear whether head lice outbreaks are getting worse. So far, experts said, that has not been widely demonstrated in the scientific literature, though anecdotal reports suggest it might be true. Some head lice removal clinics in North America and parts of Europe are reporting an uptick in demand for their services.

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“We have seen growth all across the country,” said Krista Lauer, national medical director of Lice Clinics of America, a nationwide lice removal company, which saw an 18-percent increase in in-clinic treatments and a nearly 20-percent rise in lice-removal product sales over a 12-month period ending in April.

Clinics outside the United States are reporting similar situations. Shawnda Walker, who owns Nitwits, a lice removal clinic in Toronto, said 2022 was particularly quiet but business started to pick up late last summer and she has seen “a significant increase.” And Lice Squad, which has clinics across Canada, has seen about a 50-percent increase in service requests over the past year, said Dawn Mucci, founder and chief executive of the company.

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“We are seeing the same in the U.K.,” Dee Wright, owner of the Hairforce, which has six clinics across the United Kingdom and is in the process of opening a seventh, said in an email about the rise in demand. “Our clientele are showing a war weariness.”

Clinic owners said many clients seek professional help after failed attempts with treatments at home.

Jennifer Rosa, who owns two Lice Lifters clinics in Plymouth Meeting and Washington Crossing, Pa., said many caregivers who bring in their children have already tried prescription treatments, over-the-counter products or home remedies.

“They’re not working, so that’s why they turn to us for help,” she said.

A lice comeback

Some experts said that many countries simply may be seeing a return to pre-pandemic lice levels. Lice outbreaks fell sharply during the early days of the pandemic when most children were not allowed to go to school or day care or engage in extracurricular activities. Studies from the United Kingdom, Argentina, Poland and elsewhere have reported pandemic drops in lice infestations among schoolchildren.

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“We know that kids are back in the classroom, doing playdates, playing sports, doing the activities they used to do,” Albert Yan, a pediatric dermatologist at the Children’s Hospital of Philadelphia and one of the of the clinical report on head lice from the American Academy of Pediatrics, said in an email. “It’s not surprising that we are returning to what I suspect are more expected levels of head lice infestation.”

Ian Burgess, director of the Medical Entomology Centre in Cambridge, said this could be interpreted as a surge, “but it’s a bit like waves in water, just undulating up and down.”

At least one expert is skeptical, however, saying that because many of the reports of lice infestations come from commercial lice-removal clinics, the anecdotal reports may reflect marketing efforts.

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Richard Pollack, a public health entomologist from Harvard University who has studied the over-diagnosis of lice infestations, reported that, in his research, the majority of children who were presumed to have lice did not. Many had other types of bugs in their hair – aphids, ants, beetles – from playing outside, or other culprits, including dandruff, hair spray residue, and even cookie crumbs, he said.

Or, other experts said, it could be that clinic visits are on the rise because lice have developed resistance in some regions to over-the-counter lice removal products that people use at home.

In the United States, unit sales for lice treatments have been on the decline in recent years at brick-and-mortar stores, according to data from the research firm NIQ. In the 52-week period ending on May 18, unit sales were down 1.5 percent compared with the year before. Compared with the same period four years ago, unit sales were down by 33 percent.

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How do you get rid of lice?

Head lice, which are typically considered only a nuisance, are treated with prescription and over-the-counter topical medications, home remedies or by repeatedly combing through lice-infested hair, though experts said combing alone is not enough to eliminate lice. Some people use olive oil, mayonnaise or hair conditioner sprinkled with baking soda to smother or stall live crawling lice, then repeatedly comb with a fine-toothed comb to remove both live lice and unhatched eggs that have attached to hairs, as well as the empty eggshells. Many home remedies, however, are time-consuming, messy and may not kill all lice and their eggs, some experts said.

In a 2004 study, researchers tested six home remedies on head lice – vinegar, isopropyl alcohol, olive oil, mayonnaise, melted butter and petroleum jelly – and found that the only product that caused significant mortality to the lice was petroleum jelly. This treatment was difficult to remove from hair, and none of the treatments prevented lice from laying eggs.

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Certain essential oils, which are more commonly used against lice in South America, can work but vary in effectiveness. Research shows that eucalyptus, pennyroyal, marjoram and rosemary may be useful to treat head lice. And a study in Israel reported that a citronella formulation was effective as a repellent against them. But until more data are available on the safety of essential oils to treat head lice, the American Academy of Pediatrics said essential oils should not be used on babies, children or adolescents.

“Parents should avoid local remedies with unproven effectiveness on patients with head lice,” Matthew Falagas, director of the First Department of Internal Medicine at Hygeia Hospital in Athens, and an adjunct associate professor of medicine at Tufts University School of Medicine, said in an email.

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Most prescription and over-the-counter lice-removal products consist of a topical agent such as a shampoo that aims to kill lice and their eggs, sometimes called nits.

A challenge with using over-the-counter topical medications at home is that many people do not understand the life cycle of lice, said Sherry Torkos, a pharmacist in Ontario. Oftentimes, these chemicals must be applied more than once, including reapplication seven to nine days after the first treatment to kill any eggs that survived and subsequently hatched.

“If you don’t kill the lice and the eggs, the cycle perpetuates,” Torkos said.

Also, research shows that lice have built up resistance to many popular over-the-counter lice products that contain permethrin and pyrethrin, which are insecticides. A prescription anti-parasitic agent known as Natroba has replaced permethrin as the go-to treatment in the United States, said John Clark, a pesticide toxicologist who studies lice at the University of Massachusetts Amherst.

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Alternatively, there are products containing dimethicone, an insecticide-free silicone-based polymer that suffocates lice, killing them at all life stages, experts said.

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A Food and Drug Administration-cleared medical device, which is used at Lice Clinics of America, uses heated air to eradicate lice and their eggs in one treatment. Because lice do not have a heavy exoskeleton and are not well protected from water loss, blowing hot air dehydrates and kills them, said Clark, whose laboratory helped test the product.

Experts urged caregivers not to use hair dryers to achieve similar results as it may burn the scalp or blow lice onto others.

How do you prevent head lice?

Lice are a common concern in childhood and are not related to personal hygiene. There is no surefire way to prevent them, but caregivers should regularly check their children’s heads for lice, particularly when children are scratching, said Kate King, president of the National Association of School Nurses.

While sharing brushes, combs and clothing such as hats is not a common way to spread lice, King advised against it.

Additionally, caregivers should encourage children to avoid head-to-head contact, particularly with anyone who may have lice.

Children with long hair may be able to reduce their risk by pulling back their hair in a ponytail or a bun during activities requiring close contact with other kids to try to keep their hair from intermingling.

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