Last October, Melanie Greifer’s two daughters came home with head lice. The Manhattan pediatrician spent two weeks buying over-the-counter treatments and diligently combing out the girls’ hair, but she could never completely rid them of the infestation. Greifer finally turned to a business called Lice Treatment Center that sent someone to pick the lice and eggs, or nits, from the girls’ scalps and treat them with special shampoos. Greifer didn’t blink at the $100-an-hour fee. “At that moment, I’d have given my left arm to have someone come and take care of this,” she says.
As lice in some areas have become resistant to conventional remedies, desperate parents are turning to newfangled shampoos and pricey delousing house calls. Aside from a handful of treatments vetted by the Food and Drug Administration, the lice business is unregulated. There’s little to stop anyone from setting up shop to sell homegrown anti-lice formulas or comb critters out of kids’ hair. “The louse servicing businesses seem to be spreading faster than the lice themselves,” says Richard Pollack, an entomologist who teaches at the Harvard School of Public Health.
Pediculosis capitis, or head lice, are sesame seed-size parasites that live on human scalps and feed on blood, causing itching in their hosts. They’re most common in children and spread by head-to-head contact. Unlike their body lice cousins, which live on skin and clothing, head lice and pubic lice (better known as crabs) don’t carry disease.
That doesn’t stop parents from freaking out—and shelling out cash for professional help. Lice Treatment Center typically charges between $200 and $500 for a house call, says Liz Solovay, who co-founded the business eight years ago with a pediatrician in Connecticut. They now have 100 employees in 14 states ready to make house calls, and the company will be checking heads at 50 camps this summer. Between nit-picking and selling oil-based treatments, revenue is in the millions, Solovay says.
Risa Barash started Fairy Tales Hair Care in 1999 to sell “lice prevention” shampoos made from plant oils such as rosemary, citronella, tea tree, and lavender. The 14-employee company ships more than $4 million worth of lice products each year from a 12,000-square-foot warehouse in Passaic, N.J. While Barash, a former publicist and stand-up comic, acknowledges that it’s difficult to prove prevention works, she cites a study in Israel suggesting natural oils repel head lice. A 12-ounce bottle of Rosemary Repel shampoo retails for $12.
Like many lice industry entrepreneurs, Barash and Solovay highlight their products as “natural” and contrast them to pesticides sold in over-the-counter or prescription lice treatments. But parsing the meaning of such labels is tricky. Pyrethrin, an FDA-approved drugstore remedy sold by Bayer under the brand name Rid, is derived from chrysanthemums, but rivals call it toxic.
In addition to Rid and a similar over-the-counter treatment called Nix, the FDA has approved five prescription lotions or shampoos and eight combs or other devices, including a heat-based gadget called the LouseBuster. Yet many lice treatments don’t need the FDA’s blessing, and there’s little evidence to prove or disprove makers’ claims. “A lot of the sales of these products come from fear and disgust,” says Dr. Barbara Frankowski, a professor of pediatrics at the University of Vermont who has researched head lice. “For natural or herbal remedies that don’t fall under that blanket of [FDA] supervision, it’s kind of buyer beware.” Still, it’s true that over-the-counter treatments, on the market for decades, are ineffective in some communities where lice have developed resistance, Frankowski says.
Those bugs are what M.J. Eckert calls “a superlouse.” A former school nurse, she co-founded Lice Happens in Annapolis, Md., in 2009 to make delousing house calls. The company now employs 16 louse removers from North Carolina to Connecticut. It uses an enzyme treatment that helps break down lice and nits, but Eckert says the secret is thorough nit-picking, which costs $50 to $200 per visit. “You have to comb everything out of the hair completely,” she says. Eckert says Lice Happens teaches clients how to remove nits so they don’t have to make repeat appointments, but it’s clearly a job many parents prefer to outsource. “To be perfectly honest,” she says, “our clients are people who have more money than time.”