Lice Work, If You Can Get It

By Elizabeth Agnvall
Special to The Washington Post
Tuesday, December 18, 2007

The world is full of lousy jobs, but Karen Franco just might have one of the lousiest. As a professional nitpicker, the 45-year-old Silver Spring woman spends a good part of her week searching for live lice in hair and their tiny eggs, called nits.

Armed with a fine-toothed metal comb, wooden barbecue skewers (to part the hair and clean the comb), magnifying glass, head lamp and scissors, she answers up to seven calls a week from parents desperate to rid their households of the parasites.

About Lice

Franco has been busy lately -- some say, with reason. Lice complaints peak in December and January, according to University of Florida entomologist Phil Koehler, perhaps because that's when the pests reach a critical mass in school or kids are more apt to get cuddly with friends and relatives. (Harvard School of Public Health entomologist Richard Pollack dismisses "lice season" as a myth. New year "increases" probably stem from stepped-up head checks after holiday vacations, he says.)

Franco, a part-time art teacher, stumbled into debugging 10 years ago when lice invaded her oldest daughter's third-grade class. Dissatisfied with the school's lice control measures, Franco and eight other parents got permission to screen all the children. They found lice or nits on about a third of them, including her daughter.

"That day was horrifying," she says. Her 2-year-old had lice as well. "From that point on, somebody had to step up, and we needed to deal with it correctly. It became a personal mission." Franco turned herself into the go-to person for lice advice in her school and community.

Between 6 million and 12 million children nationally, most between ages 6 and 12, are estimated to have lice infestations each year, according to the American Academy of Pediatrics. Because lice cases don't have to be reported to state departments of health or the Centers for Disease Control and Prevention, it's impossible to know how many Washington area children are affected. But one statistic suggests how common the problem is locally: Montgomery County records show that 1,356 students required treatment for lice last year, up from 1,073 the year before. For the past five weeks, Goshen Elementary School in Gaithersburg has battled an outbreak affecting more than 45 children and 27 staff members.

Today, Franco gets $50 an hour for her fine-toothed combing. She says she has seen everything from one tiny nit on a scalp to cases "where the entire head is a moving mass of bugs."

While hers might seem an unpopular profession, some major cities are, well, fairly crawling with professional nitpickers. Hair Fairies is dedicated to outing lice in Los Angeles, its home town; the business also has salons in San Francisco, New York and Chicago.

Maggie Prieto met Franco this spring after her third-grade daughter was sent home from Lafayette Elementary in Northwest Washington with lice. By the time she called Franco, Prieto had already tried an over-the-counter lice treatment, a comb-through and prescription Ovide, which she used despite her worries that the active ingredient, malathion, was toxic.

(Many parents share such worries, judging from conversations with more than a dozen parents who have battled lice in the past year. That, plus a conviction that lice have become resistant to over-the-counter medications, has led some to turn to unproven treatments.)

Several weeks later, the vermin reappeared. Prieto's youngest daughter, in pre-kindergarten, got lice, and so did Prieto.

"I'm thinking, how the heck am I going to treat myself?" she says.

Another Lafayette parent told her about Franco, who swept into the Prieto household with her color-coded nit-picking system.

First, Franco uses the barbecue skewers to check the whole head for lice or nits. Then, working outside when weather permits, she divides the hair into small sections and puts small rubber hair bands around each. Next, she dips her comb in rubbing alcohol and begins weeding the insects out, slipping a colored band on each section that's nit- and bug-free. When she finds a nit, she snips off the strand. She chats reassuringly all the while.

She advised Prieto of her recommended routine: Wash and dry all bedding, pillows and towels, vacuum the mattress, house and car seats. Sterilize combs and brushes with alcohol or by boiling in water. Put all bedding in the dryer for 20 minutes every day after that for two weeks -- it's the heat that kills the lice -- and do a cleaning (including vacuuming) every third day. (The CDC recommends somewhat less stringent cleaning.)

Franco advised Prieto to re-treat a week later, using herbal products she sold her: one that claims to dissolve nit glue, a sticky substance that binds nits to hair; and another that's said to kill the lice after it's left on the head one to two hours. Then, she told Prieto, comb thoroughly with a nit comb while the products are in the hair. Next, wash the products out, first with dishwashing liquid and then shampoo. Comb twice a day and re-treat if you see more nits.

"To have somebody who is willing to do this for money and is very good at it, is totally worth it to me," Prieto said. "I found her services to be really invaluable."

Experts are more divided.

Treatment Controversy

Several studies suggest that lice have developed increased resistance to permethrin, the most common active ingredient in OTC treatments.

In 2002, University of Miami researchers found that, after the recommended application time of 10 minutes, Nix killed 3 to 5 percent of lice, while Rid killed 8 percent after 20 minutes. By contrast, prescription Ovide, which contains the insecticide malathion, killed 88 percent at 10 minutes. Lindane shampoo killed only 2 percent of lice at 20 minutes. When the Miami researchers compared their results to similar 1986 and 2000 studies, they found Ovide was the only product that had not become less effective.

Resistance can be compounded by failure to follow treatment instructions.

Alternative remedies, such as the natural oils that Franco recommends, are largely unproven. Some experts also caution that such products don't have to meet Food and Drug Administration safety standards.

"There's not a body of evidence out there that would satisfy scrutiny that the stuff is efficacious or safe," says Harvard's Pollack.

He recommends parents start with an over-the-counter treatment and use it as recommended. If that doesn't work, he advises a prescription product that contains a different insecticide, because "resistance to one insecticide doesn't necessarily mean resistance to another."

Pollack warns that misdiagnoses and mismanagement of lice infestations are common. The maniacal household cleaning such as that recommended by Franco is overkill, he says. Pollack also wants to dispel the notion that head lice are associated with filth, poor parenting or poor housekeeping.

"Lice don't give a damn," he says. "First, they want human blood. Second, they need a way to gain purchase to their favorite spot, the head hair. They don't care how many times a day you vacuum."

So, is hiring a nitpicker worth your while?

Koehler says it could be, depending on skill and speed. "The kids don't want to sit still for long." Pollack is skeptical.

"If people have the financial sources and desire to hire people to do this, fine," he says, adding, "I'm not convinced that some of these nitpickers know what they are doing or are successful."

Franco shrugs off the criticism. Her clients recognize, she says, that bringing in an outsider can help ease the tension that can seize a household after an outbreak. "Sometimes your kids are more receptive to an adult who is not Mom," she says.

And once she's on the case, she adds, she's confident the critters won't get away. "At a certain point, there's nowhere left to run. I can anticipate where they are going to go." ¿

Elizabeth Agnvall is a frequent contributor to the Health section.

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