Shaving can be safer head lice treatment than insecticides

Editor—Sladden and Johnson reviewed common skin infections in children.¹ The life cycle of head lice (Pediculosis capitis) was well described and is similar to that of pubic lice. I worked in chronic emergencies in Somalia in 1993 and Sudan 1996-7 among internally displaced populations and in the nomadic Karimajong of Uganda in 1998-9, whose poor hygiene would have been a good breeding ground for head lice. However, head lice were never a clinical problem because these populations know how to interrupt its lifecycle: they shave off their hair, the only place where the eggs (nits) are anchored and glued close to the skin. Lice outside the hair are not transmissible and do not cause infestation.

I recall massive poisoning and some deaths in one institution for mentally handicapped children in Uganda in the 1970s because children licked their hair after it had been treated with insecticide. In March 2005 I mentioned to colleagues that hair shaving is a good way to get rid of pubic and head lice, but they disagreed and preferred treatment with insecticide, with all its attendant poisonous risks. Shaving off hair has become a fashion propagated by famous sports stars in many communities. It was and is common practice for schools, military, and prisons to encourage short hair or shaving. In my consultations for postnatal, family planning, and genitourinary medicine, most patients, especially the women, have cleanly shaven pubic hair.

None of the major websites—the US Centers for Disease Control and Prevention, the National Institutes for Health, and the World Health Organization—mentions shaving in their advice on treatment and control sections. I wonder why.