The Lice Breakers

By Arnold Mann

Julie Karp doesn't know how the little bloodsuckers got into her three-year-old daughter's hair. None of the other kids at Michelle's preschool had them. Maybe it was at the movie theater, or from the airplane seat on their trip to Indiana a couple of weeks earlier. Her husband was the first to notice the tiny dark specks, then the larger crawling ones. "I treated her with Nix, and I've been picking stuff out and vacuuming and cleaning ever since," Karp says. "Now I'm here."

"Here" is Lice Source Services in Plantation, Fla., where, at $85 for a two-hour session, Karp, from nearby Boca Raton, and other parents come and consign the lice to Lidia Serrano and her team of nitpicking nurses. With four treatment rooms and a lab for testing the killing times of products, Serrano and her staff know as much as anyone about getting rid of head lice. It is all they do.

While Michelle sits quietly, watching cartoons, nurse Edith Engel, wearing disposable white coveralls, divides the child's hair into sections and examines each blond strand under the fluorescent magnifying lamp, hunting down everything the nit comb missed. This job will take two hours; heavier infestations take as long as six hours. "It's something you have to do," says Serrano, who has found bugs in her own hair twice since she opened a year ago. "We check each other every day."

The tedious task of nitpicking seems oddly out of date in an age when modern medicine has made so many gains against maladies far more serious than lice. Why, 20 years ago, a bottle of Kwell, a hot dryer and a good cleaning did the job. But today's louse, a.k.a. Pediculus humanus capitis, which nests in 12 million new heads annually, is a hardier bug, having grown resistant to the prescription drugs lindane and Elimite and the over-the-counter permethrin drug Nix, which remain imperfect mainstays in the treatment of lice. "The pyrethrins [RID, Pronto and A-200 Pyrinate] aren't working as well as they used to either," says University of Miami lice expert Terri Meinking. Such insecticide products all have side effects. And none are 100% ovicidal, which doesn't cut it with today's "no-nit" policy in schools. Some parents have taken to dousing their kids' heads with kerosene, which is both highly dangerous and futile. "Another hot item," says Meinking, "is Front Line--the stuff they put on dogs for fleas."

Not only are the conventional delousing drugs less efficient, researchers say, but they can also engender maddening side effects, like the "lindane crazies": a drug-induced syndrome that isn't in the medical literature but is nonetheless real for its victims. "They come in with things taped to little pieces of paper," Serrano says. "It's just bits of cotton or lint. They say, 'I feel them right here,' but there's nothing. When you ask them what they've been using, they say, 'I've been using lindane for the past six months.'"

Lindane can damage the nerves in the scalp, resulting in biting and stinging sensations "that you don't get with head lice," says Meinking. In extreme cases, the feeling of infestation precipitates paranoia and delusions. Some describe bugs crawling out of their skin; others wind up fumigating their homes. "It's a vicious cycle," Meinking says. "The more infested they feel, the more lindane they use."

Fortunately, pesticides aren't the only way to go. Serrano uses "only natural products," such as HairClean 1-2-3, Not Nice to Lice and Lice Be Gone, all available in health-food stores. Made of various enzymes and oils, these "delipidizing" agents kill lice by breaking down their cuticles, or outer shells. But because they don't kill all the eggs, you still have to repeat the application. They are, however, nontoxic, says Meinking, and they're proving to be just as fast as--or faster than--the pesticides at killing lice. Meinking recently completed an FDA study using HairClean 1-2-3 and, with the help of Serrano's nitpickers, is now using the stuff to clean up entire schools.

For the record, lice don't fly or jump. It takes direct contact with an infested person or object to get them, and a good nit comb to get rid of them (Serrano swears by the National Pediculosis Association's LiceMeister), plus hands-on follow-up. "Here," Serrano says, picking out a single blond strand with a barely visible oval nit. "You can't get that out with the comb. You have to clip it out. Now go wash your hands."

In the long run, it all comes back to the nitpicking--and knowing the enemy. Adult females lay their eggs close to the scalp. When they hatch, 10 days later, the nearly transparent nymphs attach themselves to the scalp, where a nit comb can't get them. The only way to remove the nymphs, Serrano says, is by "sweeping them out with a nylon brush." Use a magnifying lamp, but know that lice are fast and they don't like light. "They shy away from it," Serrano says. "They can go back and forth, laying eggs, so you have to go back and double-check your work."

And keep checking--every day--for any nits or newly hatched nymphs. Wash everything, and vacuum and check everyone, until there's nothing left of them. "Anyone can do it," Serrano insists. "Would you like us to check you before you leave?"