What is Head Lice? Symptoms, Causes, & Treatment

Head lice are tiny insects that live on your scalp and feed on small amounts of blood from your head. These wingless parasites are about the size of a sesame seed and are incredibly common, especially among school-age children.

Having head lice doesn't mean you're dirty or have poor hygiene. These persistent little creatures can affect anyone, regardless of how clean their hair is. Understanding what they are and how to deal with them can help you handle this situation with confidence.

What are the symptoms of head lice?

The most telling sign of head lice is intense itching on your scalp, neck, and ears. This itching happens because your skin reacts to lice saliva when they bite to feed.

Here are the main symptoms you might notice:

• Persistent itching: This is usually worse behind the ears and at the nape of your neck
• Tickling sensation: You might feel something moving in your hair
• Small red bumps: These appear on your scalp, neck, and shoulders from scratching
• Difficulty sleeping: Lice are most active in the dark, making nighttime particularly uncomfortable
• Irritability: Constant itching can make you feel restless and cranky

You might also notice small red or pink bumps on your scalp from all the scratching. While uncomfortable, these symptoms are your body's normal response to lice bites.

What do head lice and their eggs look like?

Adult lice are tan to grayish-white insects about the size of a sesame seed. They move quickly and can be hard to spot because they avoid light.

Lice eggs, called nits, are easier to find than adult lice. They're tiny oval-shaped capsules that stick firmly to hair shafts close to your scalp. Fresh nits are yellowish or white, while hatched nits appear more translucent.

You'll typically find nits within a quarter-inch of your scalp, especially behind your ears and along your hairline. Unlike dandruff or hair spray residue, nits won't brush out easily because they're glued to individual hair strands.

What causes head lice?

Head lice spread through direct head-to-head contact with someone who already has lice. The lice crawl from one person's hair to another's during close contact.

Common ways lice spread include:

• Playing together: Children often get lice during play, sleepovers, or sports activities
• Sharing personal items: Hats, hair accessories, brushes, or headphones can transfer lice
• Family contact: Hugging, cuddling, or sleeping in the same bed
• School activities: Group photos, reading together, or other close classroom activities

It's important to know that lice can't jump or fly. They can only crawl, which is why direct contact is necessary for transmission. Pets can't get or spread human head lice, so your dog or cat isn't part of this equation.

When should you see a doctor for head lice?

You should see a healthcare provider if over-the-counter treatments haven't worked after two attempts or if you're unsure whether you actually have lice. Getting a proper diagnosis ensures you're treating the right problem.

Seek medical attention if you notice signs of infection from scratching, such as red, tender areas on your scalp, swollen lymph nodes in your neck, or yellow crusting around scratch marks. These symptoms suggest bacteria may have entered through broken skin.

You should also consult a doctor if you have a skin condition like eczema or if you're pregnant or breastfeeding before using any lice treatments. Some medications aren't suitable for these situations.

What are the risk factors for head lice?

Certain situations make it more likely for you to get head lice, though anyone can be affected regardless of age, gender, or cleanliness habits.

The main risk factors include:

• Age: Children between 3-11 years old are most commonly affected
• School attendance: Close contact in classrooms and playgrounds increases exposure
• Gender: Girls get lice slightly more often, possibly due to more frequent head-to-head contact during play
• Household size: Larger families have more opportunities for lice to spread between members
• Group activities: Summer camps, sleepovers, and team sports create close-contact situations

Having longer hair doesn't necessarily increase your risk, but it might make lice slightly easier to spot during checks. Remember that lice actually prefer clean hair because it's easier for them to attach their eggs.

What are the possible complications of head lice?

Most head lice infestations are more annoying than dangerous, but complications can occur if the condition isn't properly managed or if scratching becomes excessive.

Potential complications include:

• Secondary bacterial infections: Scratching can break the skin, allowing bacteria to enter
• Impetigo: A superficial skin infection that causes honey-colored crusts
• Enlarged lymph nodes: Your body's response to infection may cause swollen glands in your neck
• Sleep disruption: Persistent itching can lead to insomnia and daytime fatigue
• Social isolation: Some children may be excluded from activities, affecting their emotional well-being

These complications are relatively rare and usually preventable with proper treatment and care. The key is addressing the lice infestation promptly and avoiding excessive scratching.

How can head lice be prevented?

While you can't completely prevent head lice, you can reduce your risk by avoiding direct head-to-head contact and not sharing personal items that touch your head.

Practical prevention strategies include:

• Avoid sharing: Don't share hats, hair accessories, brushes, or headphones
• Keep belongings separate: Use separate hooks or cubbies for coats and hats at school
• Tie back long hair: Braids or ponytails can reduce contact during group activities
• Regular checks: Look through family members' hair weekly, especially during lice season
• Clean shared spaces: Vacuum furniture and car seats regularly if someone has lice

Teaching children about lice and why they shouldn't share hair accessories helps them understand prevention without creating fear. Remember that even with precautions, lice can still occur, and it's not anyone's fault when they do.

How are head lice diagnosed?

Head lice are diagnosed by finding live lice or viable nits in your hair. The best way to confirm an infestation is through careful visual inspection using good lighting and possibly a magnifying glass.

Your doctor or school nurse will examine your hair systematically, section by section. They'll look for moving lice and check for nits attached close to your scalp, particularly behind your ears and at the nape of your neck.

Sometimes a special fine-toothed comb called a nit comb is used to help detect lice and nits. Wet combing with conditioner can also help identify lice because it slows them down and makes them easier to see.

It's worth noting that finding old, empty nit shells doesn't necessarily mean you have an active infestation. Only live lice or nits close to the scalp indicate current head lice that need treatment.

What is the treatment for head lice?

Head lice treatment involves using medicated shampoos or lotions specifically designed to kill lice and their eggs. Most people start with over-the-counter treatments before considering prescription options.

Common treatment approaches include:

• Permethrin lotion: An over-the-counter treatment that kills lice and some nits
• Pyrethrin shampoo: Another over-the-counter option, though not suitable for people with chrysanthemum allergies
• Wet combing: Using a fine-toothed nit comb with conditioner every few days for several weeks
• Prescription medications: Stronger treatments like malathion or benzyl alcohol for resistant cases

Most treatments require a second application 7-10 days after the first to catch any newly hatched lice. You'll also need to manually remove nits with a nit comb, as no treatment kills 100% of eggs.

It's important to treat all family members who have lice at the same time to prevent reinfection. However, don't treat people who don't have evidence of live lice or viable nits.

How can you manage head lice at home?

Home management focuses on thorough treatment application, careful nit removal, and preventing spread to other family members. The process requires patience and attention to detail.

Key home care steps include:

• Follow treatment instructions exactly: Don't leave products on longer than directed or use them more frequently than recommended
• Comb out nits daily: Use a fine-toothed metal nit comb on damp hair with good lighting
• Wash bedding and clothing: Use hot water and high heat in the dryer for items used in the past two days
• Vacuum thoroughly: Clean furniture, car seats, and carpets where the infested person spent time
• Check family members: Examine everyone's hair carefully and treat those with evidence of lice

You don't need to bag items for weeks or use special sprays throughout your house. Lice can't survive more than 1-2 days away from a human scalp, so focusing on recent contacts is sufficient.

How should you prepare for your doctor appointment?

Before your appointment, avoid using any hair products or treatments that might make it harder to see lice or nits. Come with your hair in its natural state so your doctor can make an accurate assessment.

Prepare to discuss when symptoms started, what treatments you've already tried, and whether other family members or close contacts have similar symptoms. This information helps your doctor determine the best treatment approach.

Bring a list of any medications you're currently taking, especially if you're pregnant or breastfeeding. Some lice treatments aren't recommended in these situations, so your doctor will need to choose alternatives.

Write down any questions you have about treatment, prevention, or when your child can return to school. Having these ready ensures you get all the information you need during your visit.

What's the key takeaway about head lice?

Head lice are a common, treatable condition that doesn't reflect on your cleanliness or parenting. With proper treatment and follow-up, you can eliminate lice completely and prevent their return.

The most important things to remember are to treat the condition promptly, follow treatment instructions carefully, and check all family members. Most cases resolve within 2-3 weeks with appropriate care.

Remember that having lice happens to millions of people every year. Stay calm, be thorough with treatment, and don't let embarrassment prevent you from getting the help you need.