This article will make you itch. I’m sorry. There’s no way round it. I’m pretty itchy myself, but that’s head lice for you. They warm themselves on Planet Scalp, sifting wisps with their antennae and, as the experts creepily put it, “taking a blood meal”. I have learned to recognise many types of itch since discovering two of the beasts in my hair. Some are a slow, creeping thaw on the head. Others, a fleeting tweak.
Between 8 and 10% of children in the UK are thought to have head lice at any one time and there are an estimated 6-12m cases a year in the US. But lice can also move from adult to adult. You might have hugged a colleague who has caught them from her children. They can ping from the static of a comb. Or maybe you tried on a hat in your lunch break, and a louse moved into its new home. Contrary to popular belief, there is no data to prove that men are less attractive to lice than women. Can you feel that tickle behind your ear yet?
Head lice have been around as long as humans. They have been picked, preserved, from Peruvian mummies, and pried from the teeth of a Roman soldier’s comb. Yet, despite our long acquaintance, humans know little about lice and what makes them tick. (On the bright side, they do know some lousy puns.) I call Community Hygiene Concern’s Bugbusters helpline. “I’ve combed my head obsessively, I’ve applied treatments, and still found only two lice and some unhatched eggs. How am I meant to know if I have caught them all?” As I speak, the colleagues either side of me stop typing. A few minutes later, they start scratching their heads.
If you don’t have lice, you can still catch delusional parasitosis – the mistaken belief that you are infested. One nit-removal professional told me that for weeks after she started her job she dreamed she was being chased by giant lice. They even infest your telecommunications: every time I text the word “love”, my phone autocorrects it to “lice”. Why, after centuries of medical advancement, have humans not found a way to eradicate them? Why are they so good at evading treatment? And is the anti-lice industry really doing all it could to help those of us at the ticklish end of the problem?
On a small parade between a post office and the Floor Crazy flooring shop in Woodford, Essex, is a salon that hopes to provide some of the answers to these questions. From the front, it is a smart beauty parlour. Through a door at the rear – so no one sees you enter – it’s a louse removal specialist. To calm the nerves, four candles burn in the corner of the room, but it is still a relief to be the only client.
Last year, Isma Javid, who owns this business, acquired the UK licence for a device called AirAllé, which claims to kill 99.3% of nits (the eggs) and 88.4% of the adult lice with a dehydrating heat treatment. Javid got the idea for her salon after watching Sarah Jessica Parker’s film I Don’t Know How She Does It, in which Parker’s character takes her kids to a lice treatment clinic.
Now Javid plans to open 100 locations – under the name Lice Clinics of the UK – in health centres, private medical practices, dermatologists’ and pharmacies. Who knows, before long, it might be possible to pop into Boots, take a seat, and be deloused. Her “2017 launch plan is massive”, she says. She has just opened branches in Athens and Saudi Arabia. The parent company operates in 32 countries.
It is easy to see the appeal of a technological solution to the louse problem. Scan any parenting forum on the subject and a host of desperate treatments emerge. Some folks slather mayonnaise on to the infested head; olive oil, coconut oil, vinegar. Some believe in electronic combs that beep upon execution, or use a vacuum to suck out the worst. Others apply heated straighteners, then stow bedding in the freezer to kill any off-head survivors. Some swear by dimethicone treatments. Others try them and curse.
Before the late 90s, life was simpler. As a teenager, head doused in pesticide and bowed over a magazine, I remember lice carcasses dropping with a plink on to the pages. But those days are gone. The lice have developed resistance; the pesticides are unreliable. The nit nurse is long gone and the government doesn’t care. And within this treatment vacuum, a whole industry is thriving. The makers of the AirAllé estimate a $3bn global market. It costs between £100 and £199 to be treated at Javid’s salon (though it’s half price for those in receipt of benefits and she plans to reduce the fee as the business becomes established). A host of lice treatment accessories have appeared, from lice-repellent hairclips to the Lice Combflicker, which promises to clean your lice comb better than dental floss.
The lo-fi, low-cost answer is a comb. But the effort exhausts some carers. Every strand on an infected person’s head must be combed (most people have between 100,000 and 150,000 hairs). According to the charity Community Hygiene Concern, wet hair, slathered in conditioner, renders lice immobile, allowing them to be combed out. The tip of the comb’s teeth must be held against the scalp, then drawn through the hair. Any gap between the teeth and the scalp at the start is an escape route for a louse.
To comb a mid-length head of hair takes about an hour and a half (or that’s how long it takes me), and all family members should be combed on the same day to avoid cross-contamination. In my case, that’s about five hours of combing. It takes a relationship to a whole new level to spend an evening delousing. Lice punish the conscientious. But with practice comes expertise. In time, you will comb a head in 30 minutes. In the US, there are hundreds of clinics that offer a one-stop comb-out, many of them launched by mums who found that their own tenacity was the most reliable solution. It’s a whole new cottage industry.
Javid has spent the past year on a world tour of lice. In India, she found people treating then with a pill; in Nigeria, she saw heads being shaved; in some countries kerosene was applied to the scalp and children left out in the sun. “But there’s so much contradictory information out there. I’m not an expert,” she says, scratching her head. (Her assistants, Natalie and Myna, also scratch their heads continuously – itching is a hazard of the job.) “But I’ve talked to experts, and everyone talks about something different.”
“Everyone’s got the best answer,” agrees Ian Burgess, director of Insect Research & Development Ltd. “No one really knows the answer – but quite a lot of people think they do.” Meanwhile, Javid’s colleague Natalie quietly lays a disposable sheet over a white leather chair. “That’s where you’re going to sit,” she says. “Do you want to try it now?” She is pulling on pink plastic gloves.
John Clark has been studying lice for around 16 years. He has lived with them day and night. For two years, he and his colleagues at the University of Massachusetts wore a small plastic pillbox containing a few tufts of hair and up to 50 lice, taped to their legs, to keep them alive. “They were happy. We weren’t.” A few months ago, the research proved that in some regions of the US, head lice had mutated and developed knockdown resistance to pesticides. These findings, however, came as no surprise to Clark. “We’d seen it many times in agricultural insects,” he says, which is why he dislikes the phrase “super lice”: for Clark, they are only doing what lots of creatures have done before.
But still the research was necessary – “to show why the current over-the-counter products were not working very well” – and still treatments that have been found to be no longer efficacious remain on the market. Brands have evolved, developed new lines, making it hard for consumers to know which to trust. Nix, for instance, was the first over-the-counter product in the US, and it was, Clark says, “almost 100% effective between its launch [in 1992] and 2000, when lice began to develop resistance … But by 2014 a study found that the Nix product had become 25% as effective as when it first came on the market.” And yet Nix and others continue to be marketed as a treatment for head lice.
In Europe, head lice treatments are categorised as class 1 medical products. “They can be sold in general stores, and they self-certify that the device meets the regulatory requirements,” Joanna Ibarra of Community Hygiene Concern explains. No independent assessment is required. In this context, it is not surprising that so many products fail to work on so many people.
For years, the sale of treatments has been characterised by the willingness of companies to market products that did not work well, and of government agencies to overlook, defend or support those claims. In the last few years, new products have finally come to market in the US, bringing what Clark refers to as “resistance management”. In short, with multiple effective treatments on offer, lice’s resistance can be sidestepped. But there is another problem. While many over-the-counter products are ineffective, most of the new products, such as Sklice and Natroba, are prescription drugs. And, as Clark says, “a lot of insurance companies won’t cover the cost”.
Are lice really the problem here?
“No,” Clark says. “Lice are like many insects, nothing really special.”
So why can’t we just eradicate them?
“Short of getting every human being in the country and either shaving them or treating them at the same time …” Ian Burgess trails off. “But as soon as the hair grows back and they come into contact with someone from outside, bingo! You are never going to get a sufficiently concerted effort to get rid of them from one place. You’d have to put up a fortress around the country.”
And yet some people are less susceptible to lice than others. From time to time, Burgess is helped in the lab by his wife. Occasionally, a lice flicks into her hair. She feels it moving. But each time Burgess tracks down a louse in her hair and removes it, he finds the creature “pale and emaciated. They’d rather starve to death than feed off her. Ah, if we could put it into tins …” he sighs.
This is where research interest is now focusing: on the race to bring to market a deterrent that is proven to work in clinical trial. Clark is busy cloning lice odour receptors in order to investigate whether certain smells act as a deterrent. But while there is plenty of evidence that some do – lavender, tea tree, cinnamon – it is not enough to see a louse crawl away from some malodorous drops in a petri dish. What would it do in the field? Is there a scent so repellent that a louse would forgo the safety of a human hair for the long drop to the floor and almost certain desiccation?
At last I take my seat in the white leather chair, while Natalie clips up my hair to check if my home treatments have worked – I applied Nyda, a dimethicone treatment that works on the basis of suffocation rather than poison, and followed up with a thorough comb. I am feeling nervous. But finally she lays aside the comb and says: “There’s literally nothing at all. No eggs. Nothing.” I wish my desk neighbours could hear.
Javid sends me away with some anti-lice products and an information sheet in a bag-for life. I feel hugely relieved. I walk along, swinging my Lice Clinics of the UK cotton carrier. On the tube, I seem to have plenty of space. I feel liberated. I pass a museum, and pop in. The security guy asks to perform a bag check and I open up my carrier. “Ah,” he says, staring at all the bottles printed with “Lice”. For a moment I think he is going to refuse me entry, but he pulls out Javid’s identification sheet. “I have these,” he says, pointing. “Bed bugs.”
See? Lice are just a normal human problem. I almost give him a hug.
