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Understanding and Managing Head Lice

Understanding and Managing Head Lice

Head lice are tiny wingless insects that infest the hair on your head, as well as the eyebrows and eyelashes. Tiny louse eggs called nits are tightly attached to individual hairs and live close to the scalp, where they may be difficult to see.

Lice are easily spread, especially among school-aged children. Lice cannot jump or fly but are spread by direct head-to-head physical contact, sharing clothing, such as hats or bedding, and sharing combs or brushes with someone who has head lice. Having head lice does not mean you have poor cleanliness. Head lice do not carry diseases.

Signs and Symptoms

  • Extremely itchy scalp
  • Small red bumps on the scalp or neck
  • Tiny white nits on the hair close to the scalp that are difficult to remove
  • Crawling sensation on the head

Lice are easier to see in bright light and by parting the hair to see close to the scalp. They are also easier to see near the ears and the nape of the neck.

Head lice are extremely contagious. Close contact or sharing personal belongings, such as hats or hairbrushes, puts people at risk. Children ages 3-11 and their families get head lice most often. Personal hygiene has nothing to do with getting head lice. Head lice do not spread disease.


Treatment for head lice is recommended for people with an active infestation. All household members and other close contacts should be checked. Anyone who has an active infestation should be treated. All infested people and their bedmates should be treated at the same time.

Over-the-counter lotions and shampoos that contain pyrethrin—a common synthetic chemical used as an insecticide—or one-percent permethrin are often the first choice. The package directions should be followed exactly. These products may continue to kill lice for two weeks after treatment; many clinicians recommend a second treatment seven to nine days after the first.

Side effects of permethrin may include burning or stinging, itching, red skin, or numbness. Prescription-strength five-percent permethrin, malathion lotion, or benzyl alcohol lotion may be needed. Lice are becoming resistant to permethrin, so the other medications may be used.

There is no clear scientific evidence that lice can be suffocated by home remedies, such as mayonnaise or olive oil, but they may be suffocated by Cetaphil cleanser. Tea tree oil is another helpful natural remedy.

It is very important that the nits are removed. This can be difficult because they cling tightly to the hair. Special nit combs are available at drugstores. You should do a second combing seven to 10 days after the first. Nits may live for two weeks.

Hats, scarves, coats, and bedding should be washed in hot water and dried in a hot dryer for at least 20 minutes. Combs and brushes should be washed and the room of the infected person should be vacuumed.


Children should be cautioned not to share hats, combs, or brushes with others. Policies regarding school attendance for children with head lice vary.

Sources: National Library of Medicine, Centers for Disease Control and Prevention, American Academy of Dermatology, American Academy of Pediatrics

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Fall 2015 Issue: Volume 10 Number 3 Page 12-13