A lousy essay about cooties

By Richard P. Holm M.D.

Remember a cruel playground game about cooties or “you’re it?” Also called pediculosis capitis, cooties, or a head louse infestation truly is something from which to run. Head lice are small wingless insects that get into the hair and scalp. Except for the common cold, this infestation is the most common communicable condition of childhood, affecting something like 10-20 million people per year.

They do not jump or fly, or live on any other animal but humans, but these little blood-sucking invaders are extremely easy to spread by head-to-head contact. This happens especially in pre-school, kindergarten, grade-school spaces, where kids will be kids, and personal hygiene has nothing to do with it.

The diagnosis is confirmed by finding the louse, which is clear to tan and the size of a sesame seed, crawling around the ears and at the nape of the neck, or discovering tiny white to grey eggs, also called nits, attached to hair shafts.

It is nice to know that head lice generally do not crawl outside the scalp, and other than causing severe itching, the condition does not cause any other important problem or carry any illness.

This is in contrast to their cousin “body lice,” who reside below the scalp, after feeding set up in the creases of clothes, and can carry infectious diseases such as typhus, trench fever, and relapsing fever. Head lice are also different from bed bugs who are brown and larger, can live away from the human body, and can feed off warm-blooded mammals other than humans. It is a relief to know that bed bugs carry no disease, which is similar to head lice but unlike body lice.
The treatment of head lice involves attacking from several directions. Start with over-the-counter Permethrin lotion (Nix), or Pyrethrin (Rid, A200, or Pronto shampoo). These need repeating in one week to get the next egg hatch. (Suffocating with mayonnaise, herbals, olive oil, or butter does not work.) What is most effective and yet underutilized is to thoroughly comb wet hair every two days for two weeks with a special fine-tooth comb. Finally wash all bed linens and clothing that came in contact with those infested, drying in a hot dryer for 40 minutes. Bagging stuffed animals and clothing for two weeks also works.

So when your little one comes home with cooties, don’t panic and don’t run. Get out a fine-tooth comb, special lotion, and get to work.