With lice on resur­gence, a new need for nit­pick­ers

The Washington Post Sunday - - FRONT PAGE - BY LYN­D­SEY LAY­TON

The cars, some from as far as Georgia, pull up to the stately brick home tucked into an af­flu­ent Wash­ing­ton sub­urb. Some of the peo­ple who emerge are tear­ful, oth­ers are pan­icked. Most are itchy.

A small sign wedged into the ground gives the only hint of the death and re­newal tak­ing place in­side: The Po­tomac Lice Lady.

The cot­tage industry of pick­ing — pro­fes­sion­als who painstak­ingly re­move head lice, those six-legged par­a­sites that make them­selves at home on hu­man scalps and don’t give up with­out a fight — is ex­plod­ing, thanks to a com­bi­na­tion of in­sect evo­lu­tion,

school pol­icy and youth cul­ture.

Head lice have grown in­creas­ingly re­sis­tant to over-the­counter sham­poos and treat­ments, ac­cord­ing to a grow­ing body of re­search. At the same time, school dis­tricts across the coun­try have re­laxed their lice poli­cies, al­low­ing chil­dren with nits — lice eggs — to at­tend school in­stead of re­quir­ing them to stay home. And head-to-head con­tact — the most com­mon way that lice spread — is ris­ing among chil­dren and teens as they hud­dle to­gether over smart­phones, iPads and other de­vices.

A prob­lem that used to be an oc­ca­sional nui­sance a gen­er­a­tion ago has turned chronic for some.

“I am so ready to be done with this,” said Ashby Mims, co-pres­i­dent of the PTA at Key Ele­men­tary in the Dis­trict, whose two sons, in kinder­garten and sec­ond grade, each had lice twice in the past two months.

At Key, lice cases were re­ported at the be­gin­ning of the school year, about a month later and again last week. Nearly ev­ery grade has been af­fected, Mims said.

Two moth­ers were in tears re­cently at the school’s front desk, over­whelmed by the task of deal­ing with lice, she said. “I’ve felt that way my­self,” Mims said. “If you haven’t had it, you don’t know what to do.”

No one tracks the num­ber of head lice cases in the United States, and there is no es­ti­mate of the num­ber of in­fes­ta­tions in the na­tion’s schools. The Cen­ters for Dis­ease Con­trol and Preven­tion es­ti­mated in 1997 that there were be­tween 6 mil­lion and 12 mil­lion cases of lice in­fes­ta­tion an­nu­ally, with chil­dren ages 3 to 12 most likely to fall vic­tim.

Head lice, which are not con­sid­ered a health hazard be­cause they do not carry dis­ease, can­not fly or jump. Lice feed on hu­man blood sev­eral times a day, and each louse can lay up to 10 eggs a day, which strongly af­fix to hair shafts and hatch af­ter a week. Once a louse is re­moved from a scalp, it will die in about 48 hours.

Sci­en­tists have found in­creas­ing ev­i­dence that over-the­counter sham­poos and treat­ments are not as ef­fec­tive in the United States be­cause head lice have mu­tated and grown im­mune to the pes­ti­cides, re­searchers said. Stronger med­i­ca­tions are avail­able but re­quire a pre­scrip­tion, and some are con­sid­ered toxic. Ex­perts say that man­ual comb­ing to re­move eggs and lice is ef­fec­tive if it’s thor­ough.

That’s where Lau­ren Salzberg comes in.

A one­time preschool teacher, Salzberg be­came adept at pick­ing nits and went pro­fes­sional, be­com­ing the Po­tomac Lice Lady. At first, she made house calls but even­tu­ally built a salon in her garage so cus­tomers could travel to her. And they do. So far this year, Salzberg has treated more than a thou­sand fam­i­lies, up from 836 fam­i­lies through Oc­to­ber 2014 and 445 fam­i­lies dur­ing the same pe­riod in 2013. As she worked on a suc­ces­sion of cus­tomers on a re­cent morn­ing, her phone kept ring­ing with calls from oth­ers itch­ing to make an ap­point­ment.

Salzberg, 46 and a mother of three, does not use pes­ti­cides or chem­i­cals, pre­fer­ring the painstak­ing process of man­ual re­moval of nits and lice with a pro­fes­sional-grade nit comb.

Dressed in pas­tel scrubs and a sur­gi­cal head cap, Salzberg wets her cus­tomer’s hair with a comb­ing so­lu­tion and me­thod­i­cally works her way around the head, wip­ing her comb on white nap­kins and toss­ing live lice and nits into the trash. A typ­i­cal ses­sion takes an hour to 90 min­utes, de­pend­ing on the sever­ity of the in­fes­ta­tion and the cus­tomer’s hair length. She charges $90 an hour for lice re­moval; there’s a $25 fee to check for lice.

To en­ter­tain her younger clients, she of­fers a flat-screen tele­vi­sion tuned to chil­dren’s pro­gram­ming and doles out candy and prizes. Her salon is dec­o­rated with thank-you cards scrawled in crayon.

Two of three cus­tomers on a re­cent visit asked not to be iden­ti­fied, un­der­scor­ing the so­cial stigma that per­sists about lice.

“I would just never want to put her in a sit­u­a­tion where peo­ple know, and then she might not get in­vited to play dates and that sort of thing,” said one fa­ther of a kinder­gart­ner who at­tends a D.C. pub­lic school.

That urge for pri­vacy can also ag­gra­vate the prob­lem. When par­ents don’t re­port lice out­breaks, other fam­i­lies don’t know to check their chil­dren and don’t catch them early.

“No­body wants to ad­mit they have it,” said Ellen Van Ber­gen, of Po­tomac, Md., whose daugh­ter had lice twice last year. An­other girl at their mid­dle school had lice, but her mother de­nied it to other par­ents, Van Ber­gen said. “I get there are things you pro­tect your child from, but the right thing to do is to tell peo­ple.”

Tammy Col­lis drove an hour and a half from In­wood, W.Va., to the Po­tomac Lice Lady last week, bring­ing her 9-year-old daugh­ter, Ad­di­son.

They had been bat­tling lice since Novem­ber, al­most a year.

“I just keep get­ting it, over and over again,” said Ad­di­son, a fourth-grader. Her mother had spent more than $200 on over-the-counter reme­dies, as well as pes­ti­cide fogs that she det­o­nated in Ad­di­son’s bed­room and play­room. She chopped eight inches off her daugh­ter’s long, blonde tresses. But it didn’t make a dif­fer­ence.

“Ob­vi­ously, we didn’t get the stuff out,” Col­lis said, not­ing that the fi­nal straw came last week­end, when Col­lis saw Ad­di­son scratch­ing her head while they were in a GameS­top store. “I didn’t even wait un­til we got home, I called the Lice Lady right there in the car.”

Salzberg found Col­lis also had an in­fes­ta­tion, but much milder. The to­tal cost of the out­ing was $266, which in­cluded re­moval, a comb, comb­ing mousse and scented hair spray.

Many school dis­tricts around the coun­try have re­cently re­laxed their ap­proach to head lice, fol­low­ing a 2010 rec­om­men­da­tion from the Amer­i­can Academy of Pediatrics to end “no-nit” poli­cies and al­low stu­dents in school even if they’ve got louse eggs in their hair; be­cause the eggs are fixed to hair shafts, they can’t trans­fer to oth­ers.

“It doesn’t make you sick, you don’t get a fever, you don’t end up in the hospi­tal,” said Bar­bara Frankowski, a Ver­mont pe­di­a­tri­cian who co-au­thored the AAP rec­om­men­da­tion. “Your head itches and that’s it. And you treat it and it’s done. Why would you ex­clude a child from school when you don’t ex­clude kids who come to school with colds, runny noses and cough­ing?”

Frankowski said she has re­ceived hate mail from par­ents and school nurses, who blame her or­ga­ni­za­tion for their chil­dren’s head lice. “Who would have thought it was go­ing to be so con­tro­ver­sial?” she said.

Ad­vo­cates of “no-nit” poli­cies say that nits can hatch into live lice, which can crawl from head to head, spread­ing in­fes­ta­tion.

“They can say it’s just a nui­sance, but I’m sorry, it’s highly com­mu­ni­ca­ble,” said Deb­o­rah Alt­shuler, pres­i­dent and co­founder of the Na­tional Pedicu­lo­sis As­so­ci­a­tion, which ad­vo­cates for comb­ing in­stead of chem­i­cals to re­move lice. “If eggs are not re­moved, they will hatch new lice and chil­dren will come back to school to share lice among their peers. That’s why we’re in this mess.

“None of the over-the-counter treat­ments are 100 per­cent ef­fec­tive against the nits, so if they’re not re­moved, they will hatch new lice,” Alt­shuler said.

Frankowski dis­missed the Na­tional Pedicu­lo­sis As­so­ci­a­tion as “a bunch of wealthy sub­ur­ban Bos­ton women who the worst thing in their lives that’s ever hap­pened is their child get­ting head lice.”

She sug­gested that so­cioe­co­nomic is­sues un­der­score the de­bate about no-nit poli­cies. Low-in­come and work­ing-class par­ents of­ten can’t af­ford to take time to care for chil­dren ex­cluded from school be­cause of head lice and of­ten face more ur­gent prob­lems, such as pay­ing rent, she said.

“It’s nice if you’re rich and can pull out sev­eral hun­dred dol­lars to pay one of those ladies to come to your home,” Frankowski said. “You can be self-right­eous the next day at school and say you don’t want your child sit­ting next to ‘those chil­dren.’ ”

In Bev­erly Hills, Calif., the school board fol­lowed the Amer­i­can Academy of Pediatrics rec­om­men­da­tion in 2013 and got rid of its no-nit pol­icy. And then it re­versed it­self last year.

School board mem­ber Noah Margo said his three chil­dren and wife all got head lice in 2013 af­ter Bev­erly Hills re­laxed its pol­icy. “There was def­i­nitely con­cern from par­ents and con­cern from the ad­min­is­tra­tion, say­ing that we were invit­ing trou­ble” by al­low­ing stu­dents with nits in school, he said. “This was a no-brainer. One stu­dent miss­ing a day is bet­ter than keep­ing that kid at school and it gets worse and then 10 kids miss school.”

Af­ter try­ing to get rid of the lice them­selves, the Mar­gos hired a mobile nit­pick­ing com­pany, whose tech­ni­cians came to their house. “You re­ally need skilled peo­ple,” Margo said. Like the Po­tomac Lice Lady. Salzberg’s phone rings in­sis­tently as she works on a cus­tomer, care­fully comb­ing through hair.

“We have lim­ited avail­abil­ity for this af­ter­noon,” she told the caller. “We do the bulk of it here in the salon. But you will also have to comb at home af­ter­wards. It’s a process. There are no short­cuts to lice.”

“I am so ready to be done with this. . . . If you haven’t had it, you don’t know what to do.”

Ashby Mims

BRAD HORN/THE WASH­ING­TON POST

Lau­ren Salzberg, the Po­tomac Lice Lady, treats Tammy Col­lis.

BRAD HORN/THE WASH­ING­TON POST

ABOVE: Tammy Col­lis, seated, and her daugh­ter drove from In­wood, W.Va., to be treated by Lau­ren Salzberg, stand­ing, who is known as the “Po­tomac Lice Lady.” Col­lis brought her daugh­ter, Ad­di­son, to be treated and learned she had them, too. The Col­lises had been frus­trated try­ing to erad­i­cate the pests for al­most a year. RIGHT: Lice have be­come more re­sis­tant to over-the-counter reme­dies, and schools are re­lax­ing poli­cies that once forced stu­dents to stay home.

WAL­TRAUD GRU­B­ITZSCH/DEUTSCHE PHOTO APETUR VIA AS­SO­CI­ATED PRESS

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