DR. HOOK- Nit picking: Pediculosis can louse up a day

"I'm hairy noon and night. Hair that's a fright. I'm hairy high and low. Don't ask me why. Don't know" (Hair, the musical). 

At my school, Denison University, when we produced Hair, they actually had a nude scene, though the lights were spinning all over the place, and I could tell a bum bum from a tum tum. But there was a lot of hair! What if some of it had lice?

Don't laugh! When I saw a different musical, Naked Men Singing, one guy had a fungal infection, tinea versicolor, and another was recovering from shingles. I almost jumped up on the stage to apply creams. Yikes!

Pediculosis is the medical term for lice, and there are three types: pediculosis humanus capitus (head lice), pediculosis corporis (body lice), and phthirus pubis (pubic lice, aka "crabs"– or in royal circles King Crabs– hmm). 

Head lice are most common in kiddies, and in fact lice is the #2 communicable disease in North American elementary school students! In 1997, one in four had head lice at some point. The louse doesn't jump or fly, so it's contracted by direct contact between folks– through sharing clothes, hats, combs, headphones, beds, towels, etc. 

Even hanging jackets besides each other in the classroom can spread lice, because the louse can survive away from a human body for 55 hours.

Adult females are about 3-4mm in length, live about a month, and lay 10 eggs (nits) a day that stick to the bases of hair shafts. The eggs hatch in eight days, and the nymphs mature in eight days. (The crazy ones are called nymphomaniacs– or not.) 

These creepy crawlers suck blood from the scalp, eyebrows, and other hairy places on the head and neck. The bites can cause an allergic reaction, like a mosquito bite, leading to itchy bumps. Scratching the bumps can lead to bacterial infections.

The white nits are easier to spot than the mobile lice. If you catch a louse, you might put it in a ziplock bag for the doctor to view under a microscope.

Nits are truly nit-wits because they stick to the hair even after hatching or treatment for lice. So a fine-toothed nit comb is used to wipe them away. Topical medicines like permethrin (Nix), pyrethrin (Rid, A-200, Pronto, Clear), and malathion can be used. A second treatment might be needed a week or two later.

But like the nasty bed bugs haunting hotels, lice have become more resistant to topical medicines. So oral medications are sometimes needed, like ivermectin (Stromectol) or adding Bactrim to permethrin.

In South Pacific, Nellie says, "I'm gonna wash that man right out of my hair..." and that applies to lice too. Sheets, carpet, couches, towels, clothes, hats– all need to be cleaned to prevent recontamination and contaminating other household members.

Body lice occur more in folks who are homeless or have poor hygiene. The lice live in clothing (in particular, seams) and then feed on the body-– in particular, the armpits and waist where the seams of the clothes are.

Pediculosis pubis is usually sexually transmitted– the creatures look like tiny translucent crabs, without the Old Bay seasoning. An adult female is 2-3mm long, lives about a month, and lays three eggs a day. The nits and lice hang out in the pubic region, but can go to the armpits and even eyelashes. Lice poop looks like brown dots on the skin, and little bruises can form from louse bites.

Lice are pretty horrible. I wonder if Andrew Zimmern, of Bizarre Foods, would ever eat them. Just make sure, if you eat dinner with him, that if he serves you fried rice, it isn't flied lice. 

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.

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