Just in time for the start of schools and kindergartens, head lice are again a topic of conversation. The parasites are not dangerous, but they are certainly unpleasant: they climb from head to head, suck blood from the scalp and raise the alarm among all parents. If the children come from school or kindergarten with an itchy scalp, quick action is necessary! Treat the head lice infestation immediately, clean brushes and combs, wash caps and the children’s cuddly toys and put fresh sheets on the beds. There is a lot of work to do! In order to prevent the further spread of head lice, the topic should always be dealt with openly. The stigma needs to be overcome. Although head lice infestation has nothing to do with a lack of hygiene, the topic still a source of embarassment. But it doesn't have to be: anyone can get head lice! The only important thing is to take all necessary steps immediately.

The head louse is a wingless insect up to 3 mm in size. It usually lives permanently in the hair of the head. Lice can hold on well to the hair with their legs and move around. With their mouth parts, they prick and suck and consume blood as food several times a day. The salivary gland secretions that they introduce into the wound often lead to itching.

How are head lice transmitted?
The lice crawl from one mop of hair to the next when they come into very close contact. As long as mobile lice are present, infection is possible. Lice can only survive short distances from the head. Only in exceptional cases, for example, is infection transmitted via shared hairbrushes or caps. Head lice infestation has nothing to do with hygiene, so anyone can get it.

Symptoms of head lice infection
Head lice often manifest themselves in severe itching caused by small amounts of saliva entering the scalp during a blood meal. Head lice bites can lead to thickening of the skin (papules). A lack of itching does not mean that there is no lice infestation, because itching often only occurs after some time.

The life cycle of head lice
The life cycle runs in several stages - from the egg (nit) through several larvae or nymph stages (up to 2.1 mm) to the adult louse. Eggs capable of development (0.8 mm in size) are attached to the hair 1 to 2 millimetres from the scalp. The larvae hatch after 6 to 10 days. Since the hair grows about 10 mm per month, nits more than 10 mm from the scalp are usually empty. The empty nits have a whitish shimmer.

Hair and scalp must be thoroughly examined. The lice are often found in places behind the ears, on the neck and on the temples. Merely examining the hair is often not sufficient to find head lice. To reliably determine whether there is a head lice infestation,

• the hair should be moistened and a conditioner applied to make combing easier. This procedure also makes it more difficult for the lice to run away.
• The hair should be pulled from the scalp to the tips of the hair with a fine-toothed comb strand by strand. After each strand, the comb should be placed on a paper towel to check for the presence of lice, larvae or lice eggs.

If lice, larvae or brownish-grey lice eggs are found near the scalp, this indicates an acute lice infestation that needs to be treated. If only whitish lice eggs are found (nits) more than 1 cm from the scalp, this indicates an earlier head lice infestation, since these egg sheaths are empty. There is no risk of infection here.

First of all, panic is unnecessary, because head lice are harmless and can be removed quickly, reliably and gently nowadays!

• It is important to treat the affected person as quickly as possible and to check the persons in the immediate vicinity.
• In order to prevent the head lice from spreading further, parents or guardians are obliged under the Infection Protection Act (§ 34 Para. 5 IfSG) to inform the child’s community institution (school, kindergarten, etc.). In this way, everything necessary can be done to prevent the further spread of head lice in the facility.

Suitable products for the treatment of head lice can be obtained from your pharmacy. Nowadays, not only insecticide-based drugs are available, but also various products that physically kill lice and lice eggs and are nevertheless well tolerated by humans. Parents should keep a few points in mind when choosing a suitable lice product:

Tip 1: Reimbursable? - Yes, please.
Once the scalp itches, there's no way to avoid a trip to the pharmacy. One thing is certain: the pests must be fought consistently. Looking at the many remedies available, it is clear that the treatment is going to be a costly affair. But that doesn't have to be the case. For children, the statutory health insurance covers the costs of selected products - until the child reaches the age of twelve. "Reimbursable" is the keyword that leads to the health insurance company assuming the costs upon presentation of a prescription.

Tip 2: Problems with use? - Simply avoid it.
The thought of combing the hair for hours does not necessarily cause most parents to jump for joy. This makes it all the more important to pay attention to the instructions for use when buying a lice remedy. Some products still have to work for several hours or even stay in the hair overnight.

If the head lice infestation has been successfully treated, the dead lice and lice eggs are removed during the follow-up treatment. For this purpose, the hair can be combed out daily, at the latest four days after the treatment wet with hair conditioner and a comb. One week after application, a follow-up examination should be carried out - again by combing the wet hair with conditioner and a comb. This ensures that all areas of the head have been reached during the treatment and that no lice or lice eggs have escaped the treatment. The time has been chosen in such a way that no new eggs can be laid.

In the past, lice alarms often led to an extensive regimen of cleaning and washing. Today we know that this is not necessary! The transmission of head lice via objects is extremely rare, as lice can only survive for a short time without a host. Only after the affected persons have been treated carefully and the heads of all other family members examined should the following should measures be carried out:

• Thoroughly clean combs and hairbrushes in a hot soap solution, for example with a hand wash brush or an old toothbrush. It is best for each member of the family to use his or her own hairbrush.
• Change towels, bed linen and pyjamas of the person with head lice.
• Keep caps, scarves, blankets and other things that have come into contact with the head hair of the person concerned in a closed plastic bag for three days. Head lice will not survive any longer.
• Stuffed toys and other objects that the child does not want to do without for three days can also be subjected to a thorough visual inspection - possibly with a magnifying glass.
• Sticky nits often stick to the hair even after treatment. Empty nits do not pose any danger, but you certainly want to get rid of them: This can be achieved through further treatment with conditioner and comb. Sometimes, however, they can only be removed with the fingernails.

A child who has been diagnosed with head lice infestation is only allowed to return to the facility again if there is no fear of the head lice spreading further. How proof of this is to be furnished can vary from location to location. In some places a medical certificate is required, in others a written confirmation from the parents that they have carried out the treatment is sufficient.