Lice – Diagnosis and Treatment
Diagnosis
Evaluating for Lice on the Head
Providers check the scalp and hair for live lice, nymphs, or eggs (nits). They often use a magnifying lens to look for small lice or nits near the roots, about 6 millimeters from the scalp.
A Wood’s light can make nits glow pale blue, making them easier to see. Finding live lice or nits close to the scalp means there is an active infestation.
Key Signs:
- Itching and scratching
- Live crawling lice
- Nits attached to hair shafts
Checking for Lice on the Body
Body lice usually hide in the seams of clothing and bedding. Providers diagnose body lice by finding crawling lice or eggs in clothes or by spotting a louse on the skin after it moves there to feed.
Itchiness or red bite marks often signal body lice.
Diagnostic Steps:
- Check seams of clothing and linens.
- Look at the skin for bites or crawling lice.
Detecting Lice in the Pubic Region
Pubic lice, or crab lice, appear on coarse body hair such as the pubic area, legs, chest, or even eyelashes and brows. Diagnosis involves seeing crawling lice or nits stuck to hair in these areas.
Common Findings:
- Lice or nits on coarse hair
- Itching in affected areas
- Scratching or skin inflammation
Treatment
Eliminating Lice on the Scalp
Head lice are usually treated with over-the-counter lice treatments. One commonly used product is a topical insecticide shampoo, which works by affecting the lice’s nervous system.
It is important to follow package instructions closely to minimize skin irritation and ensure effectiveness.
Another non-prescription option is a topical anti-parasitic lotion, approved for use in adults and children over six months of age. It is applied to dry hair, left on for about 10 minutes, and then rinsed off.
This treatment helps eliminate lice by interfering with their ability to survive on the scalp.
If lice persist despite over-the-counter treatments, a healthcare provider may recommend prescription-strength lice treatments, which may include stronger topical formulations or oral medications, depending on the case.
Prescription Medicines:
- Oral Antiparasitic: Taken as a tablet in two doses, eight days apart. Children must weigh at least 33 pounds. Side effects can include nausea or vomiting.
- Topical Organophosphate Lotion: Applied to the hair and scalp. It is flammable, so avoid heat sources. Pregnant or breastfeeding people and children under two should only use it with medical advice.
- Topical Neurotoxin-Based Treatment: Applied for 10 minutes on dry hair and then rinsed. It usually does not need to be repeated, but a second use is possible after a week. It is not for children under four years old.
Some people may have irritation or allergic reactions to these products. If this happens, contact a healthcare professional.
Fine-tooth combs or nit combs help remove lice and eggs from the scalp. Comb through small sections of hair, especially after using medication, to increase removal of nits.
Steps for Treating Lice on the Body
Good hygiene and laundering control body lice. Wash the body with soap and water. Apply permethrin cream to affected skin before bed and wash it off in the morning. Repeat the treatment nine days later.
Wash clothing, bed sheets, and towels in hot water (at least 130°F/54°C) and dry them at high heat for 20 minutes or more. For items that cannot be washed, seal them in a bag for two weeks.
Clean the living area by vacuuming floors and furniture. If lice persist, see a healthcare provider.
Addressing Lice in the Pubic Area
Treat pubic lice with the same medications used for head lice. Both nonprescription and prescription products can work. Follow directions on the treatment packaging to avoid irritation.
If lice or nits are on the eyebrows or eyelashes, consult a health provider. Special creams or other methods may be needed to protect the eyes.
Home Cleaning and Self-Treatment Routines
Self-care is important in any lice treatment plan.
Use a fine-tooth or nit comb to remove dead lice and eggs after treatment. Clean all personal items, hats, brushes, bedding, pillows, towels, and clothes in hot, soapy water and dry on the hottest setting.
Items that cannot be washed should be sealed in an airtight plastic bag for at least two weeks. Clean the environment by vacuuming upholstered surfaces and carpets. Avoid sharing combs, hats, and hair accessories.
Prevention Tips Table
| Step | Description |
|---|---|
| Use treatments as directed. | Too much product can irritate the skin. |
| Comb hair after treatment. | Removes dead lice and nits. |
| Clean or seal personal items and bedding. | Hot water or airtight bag for 2 weeks. |
| Clean living areas. | Vacuum to remove stray lice. |
| Avoid sharing personal items. | Prevents re-infestation and spread. |
Lice treatments often require two applications, usually a week apart, to catch any lice that hatch after the first round.
Lifestyle and Home Remedies
Getting rid of head lice at home requires careful cleaning and routine steps.
Key steps for lice removal:
- Inspect all family members for lice and nits. Treat anyone who shows signs of lice at the same time.
- Over-the-counter shampoos or lotions can kill lice. Follow the package directions and repeat treatment after 9–10 days if needed. Always check age restrictions before using on young children.
- Wet hair and use a fine-toothed nit comb to remove lice and nits. Repeat every three to four days for at least two weeks to catch newly hatched lice. This method is especially helpful for infants under two months old.
Laundry and cleaning tips:
| Action | Items | How to Clean |
|---|---|---|
| Wash and dry | Bedding, clothes, hats, stuffed toys | Use hot water (at least 130°F/54°C) and high heat in the dryer for 20+ minutes. |
| Seal in plastic bags | Non-washables | Store in airtight bags for two weeks. |
| Clean hair tools | Combs, brushes | Soak in hot water (at least 130°F/54°C) or rub with alcohol for an hour. |
| Vacuum | Floors, furniture | Vacuum thoroughly. |
Lice do not survive long away from the scalp. Washing and drying clothing and bedding with heat kills any lice or nits left behind.
Regularly disinfect combs, brushes, and other hair accessories. Pets do not get head lice and do not need treatment.
Natural and Nontraditional Approaches
Some people try home remedies like mayonnaise or olive oil to get rid of head lice. These methods aim to smother lice, but there is little proof they work.
| Treatment | Effectiveness | Safety Concerns |
|---|---|---|
| Mayonnaise/Olive oil | Not proven | Generally safe |
| Hot air machine | Professionally used | Needs special training |
| Hair dryer | Not recommended | Risk of burns |
A special hot air device can dry out lice and their eggs, killing them. Only professional lice removal centers use this machine, and trained staff operate it.
Regular hair dryers should not be used, as they can get too hot and may cause burns.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Preparing for a lice-related appointment can help the process go smoothly.
- List all symptoms, even those that seem unrelated, such as itching, rash, or trouble sleeping.
- Note when symptoms began and if there was contact with someone who has lice or with possible contaminated items.
- Think about who else in the home may have been exposed. List household items like bedding, towels, and hats that might need washing.
- Gather a list of all medications, vitamins, or supplements being taken.
- Prepare questions for the provider, such as:
- What are the best treatment options?
- Can I use a less expensive, generic treatment?
- How often should I use lice medicine?
- What’s the best way to clean household items?
- Who else should be told about this?
- How can I prevent lice from coming back?
- Are printed or online resources available for more information?
- Is a follow-up visit needed?
A sample table:
| Information to Bring | Details to Provide |
|---|---|
| Symptoms | Itching, rash, fatigue, etc. |
| Exposure Details | When, where, and how exposure happened |
| Medications/Supplements | Names and dosages |
| Questions | Treatment, prevention, cleaning, etc. |
Bringing this information saves time and ensures important details are not forgotten.
What Your Provider Might Ask or Do
During the appointment, a healthcare provider will ask about the symptoms and possible exposure.
They may ask:
- When did symptoms begin?
- Was there a known exposure, and how did it happen?
- Has anyone else in the household been affected?
- How severe is the itching or discomfort?
If over-the-counter treatments have not worked, the provider may suggest prescription treatments or refer to recommendations from organizations like the American Academy of Pediatrics.
In some cases, they may recommend contacting the local health department for extra support.
