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Infestation of the head by head lice is very common especially in young children aged 4-5 years. The condition does not in any way indicate a lack of hygiene - in fact, lice are said to prefer a clean head! There are two types of treatment for lice - one treats, the other prevents. These are totally different and separate, and one cannot do the other's job. The lice have first to be killed with an insecticide (see below), and then prevented with a suitable repellent. The use of an insecticide to prevent lice causes head lice to become resistant to insecticides. Insecticides are therefore reserved purely for the treatment of head lice infestation. Infestation is best checked for by combing the patient's hair with a fine-toothed comb over white paper, even when using a repellent this check should be carried out once a week. The lice appear as small pink or brown specks. Lice prefer to live in warm sheltered areas and so are mainly found at the nape of the neck and behind the ears.

Lice feed off the blood supply of the scalp and their salvia can cause an allergic response - this is what causes the itch. This response may take weeks to develop so absence of itching does not mean the absence of head lice. Because they feed directly from the blood supply an infected person may be very run down and may require a MULTIVITAMIN for a short period.

Lice lay their eggs on the head and make sure that these stay on the head by gluing them to the base of the nearest hair shaft. These "nits" remain firmly stuck to the hair even after treatment has killed all the lice. The only way to remove nits is with a fine-toothed comb. People often make the mistake of thinking that treatment has failed when these are present in the head.

Make sure that lice are actually present. If this is confirmed, the patient is not just the affected individual, but all of the family must be treated as well. It is most important that all family members be treated together to prevent continual passing of the lice backwards and forwards.

If you have tried a treatment already, what product was used - many products have been on the market for so long that Irish lice have got used to them - this means that some lice on the head will survive. It takes them about three days to breed back the rest.

NOTE: Asthmatics and those with sensitive skin are treated with a water-based insecticide rather than with the others, which are all alcohol based. Evaporating alcohol can bring about an asthmatic attack. Some repellents are also unsuitable.

For alcohol based preparations the lotion should be rubbed gently into dry hair, with care to cover the whole scalp, especially back of neck and behind the ears. Allow hair to dry naturally - no heat, hairdryers, etc., because of the presence of alcohol in the preparation, stay away from naked flames. To ensure total kill the lotion should be left in for the period of time indicated in the instructions before shampooing out (this can be done overnight) and use a nit comb while wet to remove dead eggs. One application is usually enough, but it is recommended that treatment be repeated after 7-9 days.

FINE-TOOTHED COMB A good one is essential for nit removal after treatment and for weekly checking. While some of the products contain free combs, the IVORA fine-tooth combs and far better and will help early detection of any new infestation. If head lice are present over a prolonged period the victim may be run down and out of condition, a good multi-vitamin is worth considering e.g. McCabe's Kiddies Tonic. Lice feed on blood in the scalp that is very rich in our B Vitamins so these have to be replaced.

Practical Points
- It is essential that the directions for these preparations are followed precisely.
- All family members should be treated at the same time of the day on the same day to kill all the lice together.
- Head-lice treatments do not kill eggs as they have a protective coating. Any newly laid eggs will hatch within seven days and therefore treatment should be repeated then to prevent the newly hatched lice from laying more eggs and causing a re-infestation.

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