Head Lice

Head lice are very small insects that live on people's heads and feed on their blood. They're most commonly found in children. These insects typically spread when someone's hair touches another person's hair, directly transferring the lice. This close contact can happen during activities like sharing hats, scarves, or brushes, or even through physical contact like hugs and play.

Head lice are tiny insects that can infest the scalp. Common signs that you or someone you know might have head lice include:

• Itchy scalp, neck, and ears: This is the most common sign. Head lice bite the scalp, and the body's reaction to these bites often causes itching. It might take 4 to 6 weeks for itching to start after you're first infected. The itching is an allergic reaction.
• Visible lice: Head lice are very small and dark-colored, making them hard to see. They tend to stay out of bright light and move quickly. You might see them on the scalp itself, especially near the back of the head, around the ears, and along the hairline behind the ears.
• Lice eggs (nits): Head lice lay tiny eggs called nits that attach to the hair shafts. Nits are often difficult to see because they're so small. They're usually found near the scalp, especially around the ears and the hairline at the back of the neck. Empty nits (those without a live louse inside) are often lighter in color and may be slightly further away from the scalp. Finding nits doesn't automatically mean there are live lice present.
• Sores or irritated skin: Scratching from the itching can cause small, red sores or bumps on the scalp, neck, and shoulders. These can sometimes get infected by bacteria if scratched too much.

If you suspect head lice, it's important to see a doctor or nurse for proper diagnosis and treatment.

If you think you or your child might have head lice, see a doctor first. A doctor can be sure if there are actually head lice. Many people wrongly treat children for head lice when they don't have them. They might be using over-the-counter medicine or homemade remedies.

Some things that look like head lice but aren't:

• Dandruff: This is flaky skin on the scalp.
• Hair product residue: Leftover hair gel, mousse, or other styling products can look like small, dark specks.
• Dead hair fragments: Tiny pieces of dead hair can sometimes be attached to strands.
• Scabs, dirt, or other debris: These are common things that might be found in hair.
• Other small insects: Different small insects might be present in hair. It's important to know what you're looking at.

A doctor can properly diagnose head lice and recommend the best treatment. Avoiding unnecessary treatment is important, as it can be costly and sometimes even harmful.

Head lice are tiny insects, about the size of a small seed, usually light brown or gray. They live on the scalp and suck blood. Female lice lay tiny, sticky eggs, called nits, close to the roots of hair strands, less than a quarter of an inch from the scalp. These eggs are glued firmly in place.

Head lice are mostly spread when one person's head touches another person's head. This means kids who play close together or go to school together are at higher risk of getting head lice. In the US, most head lice cases happen to children in preschool and elementary school. This is because these children are often in close contact with each other.

If your child has head lice and scratches their itchy scalp, the skin might get broken. This can lead to a skin infection.

Head lice are tough to stop from spreading in schools and childcare centers because kids are often close together. While it's less likely lice spread from things like shared toys, you can help prevent it by teaching your child these simple steps:

• Separate Clothes: Encourage your child to hang their clothes on a separate hook or area from other children's clothes. This keeps lice from possibly transferring from one set of clothes to another.

• No Sharing Personal Items: Explain that sharing combs, brushes, hats, and scarves can spread head lice. It's important to keep these items personal.

• Avoid Shared Surfaces: If a child has head lice, remind your child to avoid lying on beds, couches, or pillows that the infected child has used. This reduces the chance of lice transferring to other surfaces.

• Sports and Cycling Gear: Sharing protective gear like helmets or bike pads is okay if it's part of a required activity. This is because these items don't typically hold lice.

To diagnose head lice, doctors follow specific guidelines. The best way to know if your child has head lice is to find a live louse, either a tiny young louse (nymph) or a grown-up louse.

Doctors usually check the hair by first applying conditioner or a similar product to make the hair easier to comb. They then carefully use a special fine-toothed comb (a nit comb) to comb through the hair, starting at the scalp and going all the way to the ends. If no live lice are found, the doctor might check again at a later visit.

Doctors also look for nits, which are tiny eggs that lice lay in the hair. Sometimes, a special light (a Wood's lamp) can help them see the nits more easily because they will appear bluish under this light. However, just finding nits doesn't automatically mean your child has live head lice.

A live nit needs to be close to the scalp to stay alive. If a nit is more than about a quarter of an inch (6 millimeters) away from the scalp, it's probably dead or empty. If a doctor is unsure if a nit is live, they can use a microscope to check.

If a doctor doesn't find any live lice or nits close to the scalp, it's likely that any nits found are leftover from a previous case and don't need treatment.

Dealing with Head Lice: Effective Treatments and Important Considerations

Head lice are a common problem, especially for children. Fortunately, many effective treatments are available. Your doctor will likely recommend over-the-counter (OTC) medications that kill lice and some of the eggs (nits). However, these medications might not kill newly laid eggs. This means a second treatment is often necessary to get rid of the lice that hatch from those eggs before they become adult lice.

Ideally, a second treatment is given 7 to 9 days after the first. But there are other schedules. Always ask your doctor for specific instructions on the best treatment schedule for your situation.

Common OTC Medications:

• Permethrin (Nix): This is a synthetic version of a chemical found in chrysanthemums. It's very effective at killing lice.

  Before applying, wash your child's hair with shampoo, but skip the conditioner. Washing the hair with white vinegar before applying permethrin might help loosen the nits (eggs) from the hair. Follow the package instructions carefully on how long to leave the medication in their hair. Rinse thoroughly with warm water.

  Important Note: Permethrin doesn't kill all the eggs. You'll likely need to repeat the treatment in 9 to 10 days. Side effects can include scalp redness and itching.

• Other Important Considerations: In some areas, lice have become resistant to OTC medications. Also, improper use (like not repeating the treatment at the right time) can also make the treatment less effective.

Prescription Medications: If OTC treatments don't work after proper use, your doctor might recommend a prescription medication.

• Permethrin (Nix): As mentioned above, permethrin is effective against head lice.
• Ivermectin (Sklice): Ivermectin lotion is safe for adults and children six months and older. Apply to dry hair and rinse after 10 minutes.
• Spinosad (Natroba): This treatment is safe for adults and children six months and older. It's applied to dry hair and rinsed after 10 minutes. It often kills both lice and nits, and may only need one application.
• Malathion: This is a lotion that's safe for adults and children two years and older. Apply the lotion, let it dry, and rinse thoroughly after 8 to 12 hours. Important Note: This medicine has a high alcohol content, so do not use a hairdryer or be near an open flame while applying it. A second treatment might be necessary 7 to 9 days later.
• Ivermectin (Stromectol): In addition to the lotion, ivermectin is also available as a pill for oral use. This is an option for children weighing over 33 pounds when other topical treatments haven't worked.

Important Note: Always follow the instructions on the package or from your healthcare provider carefully. If you have any concerns or questions, contact your doctor.

Treating head lice without medication can be attempted, but there's limited scientific proof that these methods work.

Wet Combing: Wetting the hair and applying conditioner or oil can help remove lice and some eggs (nits) with a fine-toothed comb. Combing the entire head, from scalp to ends, multiple times in a session is important. Repeat this process every few days for several weeks, even after you stop seeing lice, to ensure all nits are gone. The effectiveness of wet combing varies from person to person.

Natural Oils: Some studies suggest that certain plant oils, like tea tree oil, anise oil, and ylang-ylang oil, might kill lice by preventing them from breathing. However, there's not enough strong evidence of their effectiveness. Important to note, essential oils aren't regulated the same way as medicines, and they can sometimes cause skin reactions.

Household Products: Some people use household items like mayonnaise, olive oil, margarine, or petroleum jelly, applying them to the hair, covering it, and leaving it on overnight. The idea is that these substances suffocate the lice. But there's no clear proof that these methods work.

Hot Air Treatment: A special machine that uses hot air to dry out lice and eggs is available at some professional treatment centers. This machine uses air that's not as hot as a regular hair dryer, but it needs a high airflow to effectively dehydrate the lice. A regular hair dryer is too hot and could burn the scalp. Training is required to use the machine correctly.

Important Precautions: Never use flammable substances like kerosene or gasoline to treat head lice. Lice need to feed on human blood to survive, so they won't live long off the scalp. Eggs also need the scalp's temperature to survive. This means lice and eggs are unlikely to survive on household items for long.

Cleaning and Prevention: To reduce the spread of lice, clean any items the affected person has used in the past couple of days.

• Wash: Wash bedding, stuffed animals, and clothing in very hot water (at least 130°F or 54.4°C) and dry them on high heat.
• Soak: Soak combs, brushes, and hair accessories in hot, soapy water for 5-10 minutes.
• Seal: Seal items that can't be washed in plastic bags for at least two weeks.
• Vacuum: Vacuum floors and upholstered furniture thoroughly.

These measures can help minimize the risk of spreading head lice. Remember, while these home remedies may be tried, effective treatment often requires a consultation with a healthcare professional for the most effective and safest solution.