Head Lice

Overview

Head lice are tiny, wingless insects that live on the human scalp and feed on blood. They are not a sign of poor hygiene and do not spread disease.

Yes, head lice are very common worldwide. Many children get them at some point, and adults can get them too, especially if they have close contact with children.

Head lice most often affect children aged 4 to 11, but anyone with hair can get them. Girls tend to get them more often than boys, probably because of more frequent head-to-head contact. Adults can also be affected, especially parents of young children.

Symptoms

Common symptoms

• An itchy scalp, especially behind the ears and at the nape of the neck
• Feeling like something is moving in the hair
• Small red bumps on the scalp, neck, or shoulders from scratching
• Visible lice eggs (nits) attached to hair shafts, usually near the scalp

Symptoms in children

• Children may scratch their head more than usual.
• They might have trouble sleeping because lice are more active in the dark.
• Irritability or fussiness from the constant itching.

Symptoms in older adults

• Older adults may have less itching because their immune response is weaker.
• They might mistake the itching for dry scalp or other conditions.
• Lice can be harder to spot in grey or white hair.

Causes

Main causes

• Direct head-to-head contact with someone who has lice – the most common way lice spread.
• Sharing hair brushes, combs, hats, or pillows can sometimes spread lice, but this is much less common.

Risk factors

• Being a child between 4 and 11 years old
• Attending school, daycare, or camps where children are in close contact
• Living in the same household with someone who has lice
• Having long hair (though lice can affect any hair length)

When to see a doctor

See a doctor urgently if:

• If you have a very sore, oozing, or crusty scalp that does not improve with home care.
• If you have a fever along with scalp sores.

Book a routine appointment if:

• If you've tried over-the-counter treatments twice and still see live lice.
• If you are unsure whether it's lice or something else (like dandruff or scabies).
• If a pregnant or breastfeeding person has lice and wants advice on treatment.

Diagnosis

Healthcare providers diagnose head lice by finding a live louse on the scalp. They may use a fine-toothed comb to check the hair.

Tests that may be done

• Wet combing: applying conditioner to wet hair and combing through with a detection comb. This is the most reliable way to check for lice.

What to expect at your appointment

The provider will examine your child's or your scalp, especially behind the ears and at the nape of the neck. They may use a magnifying glass or a special light to see the lice or eggs. No blood tests or X-rays are needed.

Treatment

Treatment for head lice usually involves using a medicated lotion or spray that kills the lice, followed by combing out the dead eggs. Some treatments need to be repeated after a week to kill any newly hatched lice. You can also use 'wet combing' alone with conditioner and a fine-tooth comb every few days for several weeks.

Self-care at home

• Use a fine-toothed comb (detection comb) to remove lice and eggs from wet, conditioned hair.
• Repeat wet combing every 3-4 days for at least 2 weeks if not using chemical treatments.
• Wash bedding and hats in hot water (60°C or more) to kill any lice.
• Soak combs and brushes in hot water for 5-10 minutes.
• Avoid sharing hats, brushes, or pillows until the lice are gone.

Medical treatments

Medicated lotions or sprays are available from pharmacies. They usually contain a substance that kills lice. Always follow the instructions carefully. Some treatments are applied once and need to be washed out after a set time. A second treatment is often needed after 7-10 days to kill any newly hatched lice. Your pharmacist can help you choose a product. If you are pregnant, breastfeeding, or caring for a young child, ask for advice before using any product.

When is surgery considered?

Surgery is not used for head lice.

Living with this condition

Having head lice can be annoying, but it is temporary. You can go to school, work, and socialize as usual once treatment starts. Avoid head-to-head contact until you are sure the lice are gone.

Lifestyle tips

• Check your hair regularly with a detection comb, especially if you have children.
• Tie long hair back to reduce the chance of lice spreading.
• Remind children not to share hats, brushes, or hair ties.

Diet and exercise

No special diet or exercise changes are needed for head lice. A healthy diet supports overall wellbeing.

Mental health and emotional wellbeing

Some people feel embarrassed or frustrated when they get head lice. Remember: it happens to many people and is not a sign of being dirty. If you feel anxious, talk to a trusted friend or health professional. The condition is temporary and treatable.

Prevention

Head lice are hard to prevent completely because they spread so easily. But you can reduce the risk by avoiding head-to-head contact, not sharing hair items, and doing regular checks with a detection comb, especially if there is an outbreak at school.

Vaccines

No vaccine exists for head lice.

Screening programmes

Regular 'wet combing' checks can help find lice early, before they spread to others. Many schools recommend checking children's hair weekly.

Complications

If left untreated

• Intense itching can lead to skin infections from scratching, like impetigo.
• Scratching can cause sores and, rarely, scarring.
• Untreated lice can spread to other people in the household.

Long-term outlook

Head lice are very treatable and do not cause serious health problems. With proper treatment and simple precautions, you can get rid of them completely. Most people recover without any lasting issues.

Find support

International organisations

• World Health Organization (WHO) ↗

Local organisations

• NHS (UK) ↗ · UK
• Centers for Disease Control and Prevention (CDC) ↗ · USA

Helplines

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