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Experience Matters With Head Lice Detection; Misdiagnosis Happens

Updated on April 17, 2017

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We at LiceDoctors have been looking at head lice infestations for many years. Occasionally we get calls from parents who think that they see lice or nits (eggs) and we arrive to find that they are mistaken. Sometimes medical people check heads and tell folks that they have nits in their hair when, in fact, they are looking at hair casts (white sticky debris). We have gone to homes where one child is told she has lice, and she does not, while the "clear" sibling does have it. How commonplace is misdiagnosis and how is a parent in El Paso or Las Cruces to know if a child has an infestation? Misdiagnosis of Head Lice Research done at the Harvard School of Public Health suggests that cases of head lice are "often" wrongly diagnosed. "Researchers at the Laboratory of Public Health Entomology at the Harvard School of Public Health (HSPH) have found that health care workers, parents and school officials often misdiagnose and inappropriately medicate head lice infestations. Their study is published in the August issue of The Pediatric Infectious Diseases Journal. Via their informational website, the researchers asked readers to submit samples of what they thought were head lice or louse eggs. The readers completed questionnaires that asked them their relationship to the infested person and the measures taken to treat the perceived infestation. 'An uncomfortably large proportion of the submissions had nothing to do with head lice, yet in every case someone suspected they were head lice or louse eggs,' said Richard Pollack, instructor in immunology and infectious diseases in the Department of Immunology and Infectious Diseases and lead author of the study. Of the 614 submissions, 41 percent had nothing to do with head lice, but instead were objects such as other types of bugs, dandruff, scabs, knotted hair, and clothing fibers..." More information: The Centers For Disease Control also states on its website that head lice may be misdiagnosed. "Misdiagnosis of head lice infestation is common. The diagnosis of head lice infestation is best made by finding a live nymph or adult louse on the scalp or hair of a person. Because adult and nymph lice are very small, move quickly, and avoid light, they may be difficult to find. Use of a fine-toothed louse comb may facilitate identification of live lice. If crawling lice are not seen, finding nits attached firmly within ¼ inch of the base of hair shafts suggests, but does not confirm, the person is infested." More information:

Experience Matters When Diagnosing and Treating Lice As with many things, the more you do it, the better you get. Head lice detection and removal is no different. "Pollack et al (13) found that expertise is key to diagnosis. They documented that health care providers and lay personnel frequently overdiagnosed and misdiagnosed pediculosis (13). Many failed to distinguish active from extinct infestations, particularly if they were relying only on nit detection. School nurses were particularly adept at spotting nits but appeared to lack the expertise, equipment, time and inclination to distinguish active from inactive infestations." Pollack RJ, Kiszewski AE, Spielman A. Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA 02115 Why Are Cases of Lice Misdiagnosed? Alma, a mom in El Paso, called us to say that her daughter had been told by the pediatrician that she might have lice. We checked out the girl and she had a lot of dandruff but no head lice. Alma wanted to know why it is hard to diagnose lice. The reason it is difficult if you are inexperienced is that other objects in the hair can be mistaken for lice and nits (eggs) while nits can go unnoticed because they are small and blend in with the hair. The more you treat heads, the better able up you are to identify a case of lice. Implications of Misdiagnosis of Lice What happens when a case is misdiagnosed. Well, if you are told that you have a case of lice when you don't this is what may unfold:

  • Your child misses school for no reason
  • You apply potentially toxic products on her head
  • You waste lots of money and time on treatments and house cleaning
  • You endure stress and turmoil for no reason

If your diagnostician misses a case of lice that is active in your hair, you can expect the following:

  • The case will get worse until you diagnose it and treat it effectively
  • Each bug will lay up to 10 eggs a day
  • You will likely transmit the case to other family members and classmates
  • You may feel very itchy and uncomfortable

It is in your best interest for all of these reasons to get yourself treated by an expert. LiceDoctors will come to your home day or night any day of the week, including holidays. If you do not have lice, the lice technician will tell you; if you do, she will treat you safely and effectively and will show you how to recognize lice if you are ever exposed in the future.  She also will give you tips on how to help prevent future infestations. Call LiceDoctors in the El Paso and Las Cruces area today at at 915-257-6221. You will be glad that you did.

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