Lice. They can make your scalp itchy just thinking about them.

With children in school and hats coming out, lice aren’t far behind. Also, in an age where children are often crowded around smartphones and other electronic devices, they are more likely to touch heads.

Then add selfies to the equation.

There are many ways to combat the scourge, with new, chemical-free options popping up. Patty Ziegler offers one such method.

Ziegler’s daughter was in third grade when she came home from school with lice.

“I was panic stricken because she was one of the asymptomatic kids. Only 40 percent itch or react to them, so 60 percent of the population that has lice really doesn’t react. They don’t itch, they don’t get a rash.”

It was a scary time for Ziegler, who quickly started looking for something other than the over-the-counter treatments. “So I’m looking for an alternative, because I’m reading, even five years ago, about chemical resistance, neurological reactions.”

She ended up driving to the Twin Cities, where she found a company that uses an FDA-approved medical device called AirAllé (“Air-a-lay”). The machine uses heated air to dehydrate and kill head lice in one 30-minute treatment. It kills all stages of lice, including lice eggs called nits.

Ziegler got both her children treated, because she discovered her son had them, too. “You would think with short hair that he wouldn’t have it, but he did. Because they like each other, and when they’re little, they touch heads.”

The nine-hour round-trip drive was worth it, Ziegler said, for the “utter relief” it provided. On the way home, her children suggested she buy a similar machine and help people in Wisconsin.

Her family is entrepreneurial, after all. She, her husband and her parents own Antiques Mall of Madison on Cottage Grove Road, and she and her brother started Picasso’s Pizza on Verona Road.

Now, she uses her own AirAllé at The Bright Side, her lice treatment center at 600 W. Main St., in Sun Prairie. Like the Minneapolis business, she’s part of Lice Clinics of America. Ziegler’s territory is Dane County, and she has the only franchise in the area.

‘A nuisance’

Lice are most commonly found in elementary-aged and preschool children and those who live in the same household as infested children. Although there’s no reliable data, the U.S. Centers for Disease Control and Prevention estimates there are 6 million to 12 million cases each year in the United States among children 3 to 11.

Ziegler sometimes goes into schools to do checks, particularly private schools. The staffs get worn out looking through hair, she said.

But over the past five years the Madison schools have taken a hands-off policy on lice, no longer routinely checking for lice or sending notes home that it has been found on someone in the class.

“What they are saying is true. Lice isn’t a health hazard, lice is a nuisance,” Ziegler said. “And they get that from the CDC. The Center for Disease Control came out with the report, and that’s exactly what they said. Madison schools took that and they ran with it and they eliminated their lice policies and they let kids stay at school with a head full of bugs.”

Sally Zirbel-Donisch, the Madison School District health services coordinator and a registered nurse, indeed calls it “a nuisance disease.”

“It really doesn’t have any serious health ramifications. It’s just that it’s bothersome to those that get it,” she said.

Schools are following the guidance of the CDC, the National Association of School Nurses and the American Academy of Pediatrics. Those guidelines say that children should stay in school until the end of the school day and then be sent home with recommended treatments. They should be treated at home, and can then come to school the next day.

The switch was made because often the teacher and the school are unaware that a child has lice, and that child may be in the classroom for two weeks or a month before the lice are discovered, Zirbel-Donisch said.

“Also, it’s not a disease in the sense that other kids are going to get seriously sick from it,” she said.

There are some children who have repeated or chronic cases, and those students would be missing a lot of school, she added.

‘Strand by strand’

Deena Garcia, a nurse’s assistant at Lowell Elementary School, runs a service called D-Lice, where she comes into homes, and by using a bright light and lots of patience, she gets rid of lice, one bug or nit at a time.

Each case is different. She’s cleaned anywhere from three bugs to 30. It depends how long the person has had the problem, Garcia said.

An adult louse is about the size of uncooked rice, while the nits are smaller — about the size of a sesame seed, she said.

“There are a lot of different treatments and products — chemicals or natural remedies, but no matter what you try, you have to still comb and pick. Just be really diligent and thorough. I go strand by strand,” Garcia said.

Even after Ziegler uses her heating machine at The Bright Side, she still goes through and combs and picks, which takes an additional half hour. The treatment costs $175 per head.

D-Lice is $25 for an initial assessment and then $80 per hour, with most treatments taking about an hour.

How long a treatment takes depends on the case. Included in the cost is a return visit a week later to make sure the lice and nits are gone.

Garcia treats two or three families a month as a side job. For Ziegler, it’s full-time, and she generally treats about 100 children per month. In the busy season — mid-July to mid-November — she averages closer to 130 per month.

Reducing stigma

While Ziegler is critical of MMSD’s hands-off policy, Garcia agrees with it and said she hasn’t seen an increase in lice cases since it went into effect.

In the past, when a letter went home, it tended to stir up a panic, Garcia said. In the 10 years she’s been at Lowell, she’s never had to check whole classrooms, but she can imagine how humiliating it would be for a child if lice are discovered.

Not checking or sending letters home provides more confidentiality and minimizes bullying, she said.

Before, when schools were required to be nit free, even one egg on a child meant they were sent home, and that led to parents having to miss work and students missing instruction time, Garcia said.

Now, even if a parent contacts the classroom teacher to report a child with head lice, the school doesn’t send a letter home to the other families. That stopped about two years ago.

Instead, nurses are encouraged to get information out about lice, and classroom teachers are instructed to discuss lice in their weekly newsletters when a case develops in a classroom, said the district’s Zirbel-Donisch.

Children can be sent to the nurse’s office to be checked if a teacher sees them itching a lot, she said.

Also, if a parent calls to report that their child has lice, the school will often check the child’s close contacts, siblings at the school or friends, Zirbel-Donisch said. But Garcia said that’s not often done at Lowell because it can be too stigmatizing.

If there are several cases in a classroom, the other parents will be notified, Zirbel-Donisch said.

Over-the-counter treatments

Dr. Laura Houser, a pediatrician at UW Health East Clinic, who has a daughter in first grade in the Madison school district, agrees with how schools are handling lice.

Schools still need to make sure students are getting the appropriate treatment and aren’t spreading the lice to other kids, she said.

Houser, who probably gets one or two calls about lice per day, tries to avoid having patients come to the clinic if it’s pretty clear they have them. Nurses end up giving recommendations over the phone instead.

Often over-the-counter treatments like Nix or Rid are all people end up needing, she said. Those products cost about $20 per treatment.

“Most of the time, if the family does use them correctly and follows all the directions, washing clothes and putting clothes in a bag for a few days, that can take care of it,” Houser said.

When she gets repeated phone calls from families, it’s either because the treatment wasn’t done correctly or the lice were resistant, Houser said.

Some lice, she notes, can be immune to even the prescription treatments.

Houser understands why some people don’t want to use chemicals on their children, but said that can get tricky “because almost anything is a chemical.”

There are certain products she wouldn’t use on very young children because of risks, but she said the ones she recommends are safe if used property.

Some families may turn to alternative treatments because of the fear of chemicals and the stress of repeated treatments. “They might be interested in paying the higher amounts of money for those other treatments,” Houser said.

She’s had patients use the heat treatment successfully and said it’s a valid treatment method. The biggest drawback for some families is the cost.

‘One and done’

Christa Papke didn’t really flinch at the cost after getting her children treated at The Bright Side. She was just glad to be “one and done,” as Ziegler describes her heat treatment.

Papke is a fifth-grade teacher in Rockton, Illinois, who recently had to postpone an evening of parent-teacher conferences at the last minute to make a trip to see Ziegler.

Papke had treated her 7-year-old daughter the night before with an over-the-counter product and she still had lice in the morning. That same day, her 9-year-old son’s school nurse called to say he had them, too.

“It was the third time since the end of August that they both have had it. This is ridiculous,” she said.

Papke learned about The Bright Side from her school’s nurse, and said the cost and the hour-long drive each way was worth it.

“I had to take care of this because this is driving me nuts and apparently the lice or the nits are becoming immune to the over-the-counter treatments,” she said.

Papke was impressed by how kid-friendly and welcoming Ziegler’s office was, with electronic tablets for the children, snacks and drinks.

The next day, her children went back to school, and were found to be lice- and nit-free.

“I would go back again,” Papke said about The Bright Side. “Hopefully, I won’t have to.”