10824 Head Lice

Overview

Head lice are tiny insects that live on the human scalp and feed by biting the skin to get tiny amounts of blood. They are not dangerous and do not spread disease, but they can cause itching and are often passed easily between people, especially children.

Yes, head lice are very common, especially among primary school children and their families. Millions of cases occur each year around the world.

Head lice can affect anyone, but they are most common in children aged 4 to 11. Parents and other family members can also get them from close contact.

Symptoms

Common symptoms

• An itchy scalp, which is often worse at night
• A tickling or crawling feeling on the head
• Tiny white or yellowish eggs (nits) stuck to hair close to the scalp
• Live lice moving on the scalp or hair — they are about the size of a sesame seed
• Small red bumps or sores on the scalp, neck, or shoulders from scratching

Symptoms in children

• Persistent scratching of the head, especially behind the ears and at the nape of the neck
• Irritability and trouble sleeping because itching often gets worse in bed
• Schools and nurseries often notice repeated cases among classmates

Symptoms in older adults

• Itching of the scalp, though it may be less noticeable at first
• Dandruff-like flakes that may actually be nits or lice droppings
• Secondary skin infections from scratching, which can cause redness, crusting, or weeping sores

Causes

Main causes

• Head-to-head contact with a person who has head lice
• Sharing objects that touch the hair, such as combs, brushes, hair ties, hats, scarves, or headphones
• Lying on a bed, pillow, sofa, or carpet that has recently been used by someone with head lice — this is less common but possible

Risk factors

• Being a child between the ages of 4 and 11
• Attending school, nursery, or daycare where children are in close contact
• Having long hair, which makes head-to-head contact easier
• Living with or regularly caring for children
• Family members already infested with lice — the risk of spread within a household is high

When to see a doctor

See a doctor urgently if:

• If you see signs of a skin infection, such as worsening redness, pain, swelling, or oozing fluid from the scalp
• If you have a fever along with scalp sores
• If you have a severe allergic reaction after using a head lice treatment — this is an emergency

Book a routine appointment if:

• If you are not sure whether you or your child have head lice
• If over-the-counter or pharmacy treatments have not worked after two or more attempts
• If you are unsure how to properly wet comb or apply treatment
• If you or your child have a scalp condition that makes checking difficult
• For pregnant women or parents of babies under 6 months, ask a pharmacist or doctor before using any treatment

Diagnosis

Head lice are usually diagnosed by finding a live louse or a fresh nit (egg) on the hair close to the scalp. The most reliable method is the wet combing test.

Tests that may be done

• Wet combing: condition hair with a cheap conditioner, then comb through with a fine-toothed ‘nit comb’ from the scalp to the ends. Wipe the comb on a tissue or paper towel to look for lice.
• Visual inspection: parting the hair in small sections under good light to look for crawling lice or eggs glued to the hair shafts.
• If you find a live louse, you have an active head lice infestation and should start treatment.

What to expect at your appointment

A doctor or nurse can diagnose head lice quickly by examining the scalp and hair. No blood tests or scans are needed. In many countries, pharmacists can also help you identify head lice and recommend a suitable treatment plan.

Treatment

Head lice can be treated successfully, but every treatment must be done carefully and completely. The main approaches are medicated head lice products or thorough wet combing. The goal is to kill the live lice and remove the eggs to stop them hatching.

Self-care at home

• Use a fine-toothed comb to wet-comb the hair every 2 to 3 days for at least 2 weeks — this can remove live lice and eggs without chemicals.
• Wash combs and brushes in hot, soapy water after use.
• Wash bedding, towels, and clothing in hot water (at least 60°C or as hot as the fabric allows) and tumble dry on a hot setting to kill any remaining lice and eggs.
• Items that cannot be washed, such as soft toys, can be sealed in a plastic bag for 48 hours to suffocate lice.
• Do not share combs, brushes, hats, scarves, hair accessories, or headphones with anyone during treatment.
• Check all family members for head lice on the same day, and treat everyone who has an active infestation.

Medical treatments

A pharmacist or doctor can recommend a head lice treatment lotion, spray, or foam. These contain medicines that kill lice and sometimes their eggs. It is important to follow the instructions exactly, including how long to leave it on and whether to repeat the treatment after a week to kill any newly hatched lice. For very stubborn cases, a doctor may prescribe a stronger treatment. Never use an insecticide meant for pets or farm animals, and never use more than the recommended amount.

Living with this condition

During an active infestation, continue with normal activities, but avoid head-to-head contact and sharing hair items until the lice and eggs are gone. Let your child’s school or nursery know so they can remind other parents to check their children. Reassure your child that head lice are common and nothing to be ashamed of.

Lifestyle tips

• Make a regular head check a normal part of your family routine, like brushing teeth.
• Tie long hair back during school and play to reduce head-to-head contact.
• Encourage children not to share hats, combs, or hair accessories.
• Use the same-day, no-blame approach: treat only those with active lice, not the whole family, unless a doctor advises otherwise.

Diet and exercise

There is no special diet or exercise that prevents or cures head lice. Focus on a healthy, balanced diet and plenty of sleep to keep skin and hair in good condition, which may help the scalp recover from scratching.

Mental health and emotional wellbeing

Head lice can cause embarrassment, anxiety, and frustration, especially for parents. You might feel like you are failing, but that is not true. Children may feel upset or excluded. It can help to talk openly, use a calm tone, and avoid scratching in front of others. Remember that head lice are a very normal childhood experience.

Prevention

It is difficult to completely prevent head lice, because they spread so easily through normal play and close contact. But you can reduce the risk by checking your child’s hair regularly, especially after they have been at school or a sleepover, and by treating any infestation quickly and correctly.

Screening programmes

Regular wet combing checks, for example once a week, can help you catch head lice early before they spread. There is no need for formal medical screening unless your school or childcare setting has a policy.

Complications

If left untreated

• Intense scratching can break the skin and lead to bacterial infections, such as impetigo or a scalp abscess.
• Repeated infestations can continue to cause itching and interrupted sleep.
• Rarely, severe untreated scratching can cause scarring or temporary hair loss.

Long-term outlook

Head lice are very treatable, and most infestations clear up within a couple of weeks when you follow the treatment instructions carefully. The outlook is excellent — head lice do not cause serious health problems, and with the right steps you can get rid of them completely and prevent them from coming back.

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