Head Lice – Diagnosis and Treatment
Diagnosis
When you check for head lice, you usually start by looking closely at the scalp and hair. The real goal? Spotting a live nymph or an adult louse—because if you find one, it’s proof of an active infestation.
Health providers often suggest using a fine-toothed nit comb on wet, conditioned hair. Conditioner makes combing smoother and helps trap any lice or nits.
Here’s what you do:
- Add conditioner to the hair.
- Use a fine-toothed nit comb, starting right at the scalp and pulling all the way to the hair’s tip.
- After each stroke, wipe the comb on a white tissue and check for lice or nits.
If you don’t find live lice, you might need to repeat the check later to be sure. Sometimes, a magnifying glass helps you catch those tiny moving bugs.
Health care workers also look for signs like itching or small red bumps from bites. If you’re searching for nits (lice eggs), special lights like a Wood’s light can help.
Nits close to the scalp are more likely alive, but if you see them farther than 6 mm from the scalp, they’re probably old, empty, or dead.
You can even check suspicious nits under a microscope if you want to get fancy.
| What to Look For | Details |
|---|---|
| Live lice or nymphs | Small, moving, tan-to-gray bugs on scalp/hair |
| Nits/lice eggs | Tiny white or yellowish oval shapes stuck near scalp |
| Itching/pruritus | Common symptom but not always present |
You confirm an active case of lice by finding a live nymph or adult louse. Only finding nits doesn’t always mean there’s a current infestation, especially if they’re far from the scalp or look empty.
Treatment
Products You Can Buy Without a Prescription
You can find several head lice treatments at the store—these are called over-the-counter solutions.
Most work to kill lice, and a few can kill their eggs (nits), but you’ll usually need a second round to make sure you get them all.
Permethrin is a very common choice. It’s a man-made version of a chemical found in certain flowers. You use a shampoo or cream with permethrin, then rinse it out as directed.
Permethrin kills lice, but not the eggs that were just laid. So, you’ll probably need another treatment 9 to 10 days after the first. Sometimes it causes redness or itching on your scalp.
Ivermectin Lotion is another option you can get without a prescription for adults and kids over 6 months old. You put this lotion on dry hair and rinse it out after 10 minutes.
Besides medicine, using a fine-toothed nit comb really helps. Comb wet hair to pull out dead lice and nits. Some people like to use white vinegar before washing to loosen the sticky glue holding nits to the hair.
Tips for Over-the-Counter Treatments:
- Always read and follow the instructions.
- Use a nit comb to get rid of nits after treatment.
- Retreat 7 to 10 days later to kill any new baby lice that might have hatched.
Medications That Need a Doctor’s Prescription
If lice remain after using over-the-counter products, they may be resistant to treatment or the medication may not have been used correctly. In such cases, doctors can prescribe stronger pediculicide (lice-killing medications).
- Topical Pediculicide: This prescription treatment is approved for children 6 months and older. It typically requires just one application to eliminate both lice and their eggs (nits), and follow-up treatment is rarely needed.
Organophosphate Lotion: This potent topical medication must be applied and allowed to air dry naturally, then rinsed out after 8 to 12 hours. It kills both lice and nits. Caution: Do not use a hairdryer with this product, as it is flammable. A second treatment may be repeated after 7 days if necessary.
Oral Antiparasitic Agent: Available in tablet form for children weighing over 33 pounds, this medication is typically used when other treatments fail. It kills lice and nits through systemic action.
| Medication | How It’s Used | Kills Nits | Age Guidelines | Doctor Needed |
|---|---|---|---|---|
| Topical Pediculicide | Apply to dry hair, rinse after 10 min | Yes | 6 months & older | Yes |
| Organophosphate Lotion | Apply, let dry naturally, rinse after 8-12h | Yes | 2 years & older | Yes |
| Oral Antiparasitic Agent | Taken by mouth | Yes | Over 33 pounds | Yes |
After treatment, combing with a lice comb helps clear out nits and dead lice. If you still find lice after using prescription meds, your doctor might suggest a different treatment plan.
Always ask for written instructions and stick to every step for the best shot at getting rid of lice. Getting rid of head lice really comes down to timing, using the right product, and being thorough with a fine-tooth comb or nit comb.
Taking Care of Head Lice at Home
Removing Lice by Wet Brushing
A special comb on damp hair can help you get rid of lice and their eggs. Start by wetting the hair and adding some conditioner or olive oil.
This makes it easier for the comb to slide through. Comb from the scalp to the ends, covering every section at least twice.
Repeat the process every 3–4 days, and keep going for at least 2 weeks after you find the last louse. Regular combing is key, especially for school-aged kids who are always in close contact.
Using Plant-Based Oils
Some folks try plant oils, or essential oils, to fight lice. These might include tea tree, anise, or ylang-ylang oil.
A few small studies suggest they might help by blocking lice from getting oxygen, but honestly, there isn’t enough solid proof they really work.
Essential oils aren’t strictly regulated, and some people get skin rashes or allergies from them. If you want to try, test a small spot first.
Trying to Suffocate Lice
People sometimes use home products like mayonnaise, butter, petroleum jelly, or olive oil to try to smother lice. The idea is to cover the scalp, put on a shower cap, and leave it overnight.
This method tries to block the air lice need to survive. But there’s not much evidence that these products fully remove lice. Most experts don’t think these methods work as well as other options.
Using Special Drying Treatments
Some lice treatment centers use machines that blow moderate heat and strong airflow to dehydrate lice and their eggs. Only trained staff at these centers use these machines.
Don’t use a regular hair dryer—it can burn your scalp and won’t kill lice or their eggs anyway.
Unsafe Substances That Should Not Be Used
Some people have tried kerosene or gasoline to get rid of lice. These chemicals are dangerous and very flammable.
Never put them on your skin or hair for any reason.
Keeping Your Home Clean
Head lice spread mostly through direct contact and don’t survive long off the scalp. Still, basic cleaning helps you avoid getting them again.
- Washing: Wash clothes, bedding, and stuffed toys that touched the person in the last 2 days in hot water (at least 130°F or 54.4°C) and dry them on high.
- Cleaning hair items: Soak combs, brushes, and hair clips in hot, soapy water for 5–10 minutes.
- Sealing items: If you can’t wash something, like hats or soft toys, seal it in a plastic bag for 2 weeks.
- Vacuuming: Vacuum floors, sofas, and other furniture.
These steps are usually enough. You don’t need to go overboard—lice just don’t live long away from the scalp.
Getting Ready for Your Visit
Let your healthcare provider know if your child has been around anyone with head lice. It helps to jot down a list of places your child has been lately and any treatments you’ve already tried.
