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Home > Skin & Beauty > Hair & Scalp > How to Identify and Treat Head Lice Infestation

How to Identify and Treat Head Lice Infestation

July 7, 2020 - Updated on August 2, 2021
7 min read
By Maryam Afshar, MD | Dermatologist

In this article:

  • How Common Is Head Lice?
  • Who Can Get Head Lice?
  • Appearance of Lice on the Head
  • Causes of Head Lice
  • Symptoms of Head Lice Infestation
  • Medical Treatment for Head Lice
  • Alternative Treatments
  • Diagnosing Head Lice Infestation
  • When to See a Doctor
  • Final Word

Pediculushumanuscapitis, or the head louse, is a tiny 6-legged, pale-gray parasitic insect. Found on the head of people, these insects feed on small amounts of blood from the scalp.

treating head lice

They may also be present in the eyebrows or eyelashes. Head lice can live up to 2 days without a meal.

How Common Is Head Lice?

Head lice infestation is a common problem across the globe, with a higher frequency in developing countries. It is more prevalent among children 3–11 years old, especially girls. (1)

Children carry around 10–20 mature head lice at a time that can live up to 4 weeks if not treated. (2)

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In the United States, approximately 6–12 million head lice infestations occur every year. (3) Therefore, there is a high cost of treatment, with $120–240 million for permethrin only. (4)

Who Can Get Head Lice?

who are at risk of head lice infestation?

While head lice can infest any person, regardless of age, gender, hair type, or profession, they are more commonly seen in:

  • Children aged 3–12 years
  • Girls (in comparison with boys)
  • Preschool and elementary school students (as they play closely together)
  • Family members of school-aged children
  • Employees of preschools, elementary schools, and daycares

Appearance of Lice on the Head

The lice may be present on the head in any of the following forms:

1. Eggs

Known as nits, hair lice eggs appear as tiny yellow or brown dots on the hair shaft, where the temperature is warm enough for their hatching. These are more common than adult forms.

2. Nymphs

The eggs hatch into baby lice known as nymphs, which take a week to mature. Nymphs feed on the blood for growth and survival.

3. Adult lice

These can live up to 30 days on the head by feeding on blood from the scalp and 2 days on any other surface. The lice look darker in people with dark hair.

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Causes of Head Lice

what causes head lice?

Head lice spread from one person to another through direct or indirect contact:

1. Head to head contact or body to body contact

This is the most common reason head lice infestations occur among children as they tend to play closely together.

2. Proximity to infected belongings

Infected clothing, pillows, blankets, stuffed toys, and combs stored in a locker or side by side with other items can result in the spread of head lice.

3. Sharing of items

Sharing things such as coats, scarves, hats, hair accessories, combs, towels, and brushes can spread head lice. In fact, the exchange of towels, headgear, and soaps was found to be the primary cause of head lice transmission among children. (5)

4. Contact with contaminated furniture

Items such as pillows, beddings, carpets, and cloth-covered furniture that were previously used by an infected person can spread lice for up to 2 days.

Symptoms of Head Lice Infestation

Head lice infestation generally manifest the following symptoms:

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  • Itching and scratching due to lice bites
  • Scratch marks
  • Small red bumps as a reaction to the lice saliva
  • Tickling
  • A sensation of movement in the hair
  • Irritability
  • Difficulty sleeping
  • Enlarged neck glands

Medical Treatment for Head Lice

medical treatment options for head lice

You may use over-the-counter products or prescribed medications for treating head lice.

1. Over-the-counter products

Various OTC creams and shampoos that kill lice are available at pharmacies. These products may contain the following agents:

  • Pyrethrin with additives (Rid): This compound is toxic to the nymphs. However, since it does not act on the eggs, treatment should be repeated after 10 days of application. Avoid using it in children below two years of age.
  • Permethrin (Nix): This ingredient is a synthetic version of pyrethrin and is used similarly, with repeated treatment in 10 days. Permethrin is found to be more effective than pyrethrin and piperonylbutoxide in head lice treatment. (6)
  • Dimethicone: This silicone oil acts by suffocating the lice and inhibiting its ability to regulate water.

Note: Apply OTC products as directed on their labels for their duration, dosage, and use. Rinse the hair over a sink with warm water thereafter.

2. Prescription medications

You may consult a doctor if OTC products do not work for you or the infestation is highly troublesome. The doctor may suggest medications containing:

a. Benzyl alcohol

This deprives the lice of air, thus killing them. Refrain from using this on children below 6 months. (7)(8)

Note: Benzyl alcohol is not sold for medicinal purposes in the US.

b. Malathion

This lotion is allowed to dry naturally after application and rinsed after 8–12 hours. Reapplication may be needed after 7–9 days.

c. Ivermectin

This product is toxic to lice and is found to be a safe and efficacious topical treatment in 0.5% concentration. (9)

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Refrain from using it in children below 6 months or less than 15 kg or in pregnant and breastfeeding women as it can potentially cause neurotoxicity by crossing the blood-brain barrier. (10)

d. Spinosad

It is applied on dry hair, followed by a warm-water wash after 10 minutes to kill lice. It is safe for anyone above the age of 6 months, and reapplication is generally not required. (11)

Alternative Treatments

alternative treatment options for head lice

Multiple alternative treatments are available on the market that claims effective lice removal. These include:

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  • Shampoos with herbs and oils
  • Suffocants such as mayonnaise, petroleum jelly, tea oils, margarine, and butter
  • Enzymes that claim to soften the glue by which nits hold on to the hair shaft

However, none of these treatments have been proven to be effective or safe and are not approved for the treatment of hair lice. Therefore, it is best to avoid their use.

Diagnosing Head Lice Infestation

The presence of lice can be detected through a close inspection of the head, which involves:

1. Checking the scalp

The presence of nymphs, adult lice, or nits on the hair shaft, located within ¼ inch of the scalp, indicates an infestation.

2. Observing movement in the hair

A magnifying glass can be used to get a closer look at the hair scalp to detect any movement.

3. Wet combing

Combs with tooth spacing lower than 0.3 mm are run through wet hair, catching head lice and nymphs. This procedure takes around 5–15 minutes, depending on the hair length and thickness. This technique is found to be more effective (around four times) and two times faster than direct visual examination in the detection of head lice. (12)

When to See a Doctor

While head lice can be resolved with treatment, you should consult a doctor if:

  • The treatment does not work, especially after two sessions.
  • The affected individual has crusting or open sores on the scalp.
  • The affected individual has enlarged lymph nodes or fever.
What you may ask your doctor
  • What steps can I take to remove head lice?
  • Do I need a special shampoo?
  • What may be the reason of my child being infected with head lice?
  • Should I check the family members for head lice?
  • Do I need a special comb?
  • When will the problem resolve?
  • Are there chances of the head lice coming back?
What your doctor may ask you
  • When did you first notice the head lice or the symptoms of infestation?
  • How were you exposed to head lice?
  • Are your symptoms extremely discomforting?
  • Is there anyone that you might have exposed to head lice?

Final Word

Head lice infestation is a common problem and has no association with poor hygiene. It is important to get proper treatment once you are exposed to head lice. Additionally, ask all your family members and close contacts to check themselves for lice, and get treatment if they have an active infestation.

Continue Reading Continue ReadingHead Lice: Home Remedies, Do's and Don'ts
References
  1. Dalimi A, Mahdavi Poor B, Rashedi J, Asgharzadeh M, Abdolalizadeh J. Is Hair Lice Still a Public Health Problem? Iranian journal of public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5207115/. Published December 2016.
  2. Cummings C, Finlay JC, MacDonald NE. Head lice infestations: A clinical update. Paediatrics & child health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814977/. Published February 2018.
  3. Meister L, Ochsendorf F. Head Lice. Deutsches Arzteblatt international. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5165061/. Published November 11, 2016.
  4. van der Wouden JC, Klootwijk T, Le Cleach L, et al. Interventions for treating head lice. The Cochrane Database of Systematic Reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494540/. Published May 22, 2018.
  5. Saraswat N, Shankar P, Chopra A, Mitra B, Kumar S. Risk Factors Associated with Head Lice Infestation in Rural Pediatric Patients. Indian dermatology online journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001420/. Published January 13, 2020.
  6. Verma P, Namdeo C. Treatment of PediculosisCapitis. Indian journal of dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458933/. Published 2015.
  7. FDA Drug Shortages. accessdata.fda.gov. https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Benzyl+Alcohol+%28Ulesfia%29+Lotion+5per.
  8. Meinking TL; Villar ME; Vicaria M; Eyerdam DH; Paquet D; Mertz-Rivera K; Rivera HF; Hiriart J; Reyna S; The clinical trials supporting benzyl alcohol lotion 5% (Ulesfia): a safe and effective topical treatment for head lice (pediculosis humanus capitis). Pediatric dermatology. https://pubmed.ncbi.nlm.nih.gov/20199404/.
  9. Deeks LS, Naunton M, Currie MJ, Bowden FJ. Topical ivermectin 0.5% lotion for treatment of head lice. The Annals of pharmacotherapy. https://www.ncbi.nlm.nih.gov/pubmed/24259731. Published September 2013.
  10. Smith CH, Goldman RD. An incurable itch: head lice. Canadian family physician Medecin de Famille Canadien. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3418981/. Published August 2012.
  11. CDC – Lice – Head Lice – Treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/parasites/lice/head/treatment.html. Published October 15, 2019.
  12. Sangaré AK, Doumbo OK, Raoult D. Management and Treatment of Human Lice. BioMed research international. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978820/. Published 2016.
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