What is Lice? Symptoms, Causes, & Treatment

Lice are tiny insects that live on human hair and feed on blood from your scalp. They're incredibly common, especially among children, and while they can feel embarrassing to deal with, they're not dangerous and don't spread disease.

These wingless parasites are about the size of a sesame seed and can't jump or fly. They spread through direct head-to-head contact, which is why they're so common in schools and daycares where kids play closely together.

What are the symptoms of lice?

The most telling sign of lice is intense itching on your scalp, especially behind your ears and at the back of your neck. This itching happens because you're allergic to lice saliva, and it can take 4-6 weeks to develop if it's your first time having lice.

Here are the key symptoms to watch for, starting with the most common ones:

• Intense scalp itching - Often worse at night when lice are most active
• Red bumps or sores - From scratching the itchy areas
• Tickling sensation - Feeling like something is moving in your hair
• Difficulty sleeping - The itching can be worst at bedtime
• Irritability - Common in children who can't stop scratching

You might also notice small red or pink bumps on your scalp, neck, and shoulders from scratching. These symptoms can make daily life uncomfortable, but remember that lice are treatable and very manageable.

What are the types of lice?

There are three types of lice that affect humans, and each one lives on a different part of your body. Head lice are by far the most common, especially in children and families.

Head lice live exclusively in the hair on your scalp and are what most people think of when they hear "lice." They're grayish-white or tan colored and about the size of a strawberry seed.

Body lice are less common and live in clothing and bedding, only moving to your skin to feed. They're slightly larger than head lice and typically affect people who don't have regular access to clean clothes or bathing facilities.

Pubic lice (sometimes called "crabs") live in coarse hair in the genital area and are usually spread through sexual contact. They're the smallest of the three types and have a crab-like appearance.

What causes lice?

Lice spread through direct contact with someone who already has them. The most common way this happens is head-to-head contact during play, sports, sleepovers, or even quick hugs between friends.

Let's clear up some common misconceptions about how lice spread:

• Direct head contact - The primary way lice move from person to person
• Sharing personal items - Hats, hair ties, brushes, or pillows (though less common)
• Close quarters - Sleeping in the same bed or sitting close together

Here's what's important to know: lice don't jump, fly, or swim. They also don't live on pets, so your dog or cat can't give you lice or catch them from you.

Having lice has nothing to do with cleanliness. These insects actually prefer clean hair because it's easier for them to attach their eggs. Lice are simply very good at what they do - surviving and spreading from person to person.

When to see a doctor for lice?

You should see a healthcare provider if over-the-counter treatments haven't worked after two tries, or if you're unsure whether what you're seeing is actually lice. Sometimes other scalp conditions can look similar, and getting the right diagnosis helps you treat the problem effectively.

Contact your doctor if you notice signs of infection from scratching, such as:

• Red, swollen, or tender areas on the scalp
• Pus or yellow crusting around scratch marks
• Swollen lymph nodes in your neck
• Fever along with scalp irritation

You should also reach out if the itching is so severe that it's affecting sleep or daily activities, or if you're dealing with recurring lice infestations despite treatment.

What are the risk factors for lice?

Certain situations and environments make it more likely that you'll encounter lice. Understanding these risk factors can help you take steps to prevent them, though remember that anyone can get lice regardless of age or cleanliness.

The most common risk factors include:

• Being school-aged (3-11 years old) - Children play closely together and share items frequently
• Having close contact with someone who has lice - Family members, classmates, or friends
• Sharing personal items - Brushes, hats, hair accessories, or bedding
• Participating in group activities - Sports, sleepovers, or camps
• Living in crowded conditions - Dormitories, shelters, or large households

Girls tend to get head lice more often than boys, likely because they often have longer hair and more physical contact during play. However, this doesn't mean boys are immune - they can definitely get lice too.

What are the possible complications of lice?

While lice themselves aren't dangerous, the main complication comes from scratching the itchy bites. Constant scratching can break the skin and lead to bacterial infections that need medical treatment.

Here are the complications to watch for:

• Secondary bacterial infections - From scratching that breaks the skin
• Impetigo - A superficial skin infection with honey-crusted sores
• Cellulitis - A deeper skin infection that can spread (rare but serious)
• Sleep disruption - From intense nighttime itching
• Social stigma - Embarrassment that can affect school or work attendance

In very rare cases, body lice can transmit diseases like typhus, but this is extremely uncommon in developed countries. Head lice, which are the most common type, don't carry or transmit any diseases.

How can lice be prevented?

While you can't completely prevent lice, especially if you have school-aged children, there are practical steps that can reduce your risk. The key is avoiding direct head-to-head contact and not sharing personal items that touch the hair or head.

Here are the most effective prevention strategies:

• Avoid head-to-head contact - During play, sports, or taking photos
• Don't share personal items - Hats, hair ties, brushes, or helmets
• Use separate storage - Keep coats and hats in separate areas at school
• Check regularly - Especially during lice outbreaks at school
• Tie back long hair - Reduces contact during activities

Some people use tea tree oil or other natural repellents, but there's limited scientific evidence that these work. The most reliable prevention is simply being aware and taking practical precautions.

How is lice diagnosed?

Diagnosing lice involves carefully examining the hair and scalp for live lice or their eggs (called nits). The best time to check is in bright light, using a magnifying glass if you have one available.

Here's what to look for during your examination:

• Live lice - Small, grayish-white insects that move quickly
• Nits (eggs) - Tiny, oval-shaped and glued to hair strands
• Location - Check behind ears, at the nape of the neck, and crown of the head
• Movement - Live lice will try to avoid light and move away quickly

Nits can be tricky because they're often mistaken for dandruff or hair spray buildup. The key difference is that nits are firmly attached to the hair shaft and won't brush off easily, while dandruff flakes away.

If you're unsure what you're seeing, your healthcare provider or school nurse can help confirm the diagnosis. They have experience identifying lice and can guide you on the best treatment approach.

What is the treatment for lice?

Treating lice involves using special shampoos or lotions that kill the lice and their eggs, followed by careful combing to remove them from the hair. Most cases can be successfully treated at home with over-the-counter products.

The most common treatment options include:

• Permethrin cream rinse (1%) - Available over-the-counter, kills live lice and some eggs
• Pyrethrin-based shampoos - Natural insecticides that are generally safe for most people
• Dimethicone lotion - Suffocates lice by coating them with silicone
• Wet combing - Using a fine-toothed comb every few days for 2-3 weeks

For stubborn cases, your doctor might prescribe stronger medications like malathion lotion or oral ivermectin. These are typically reserved for cases where over-the-counter treatments haven't worked.

Remember that you'll need to treat all family members who have lice at the same time to prevent reinfection. You'll also need to repeat the treatment in 7-10 days to catch any newly hatched lice.

How to manage lice treatment at home?

Home treatment for lice requires patience and thoroughness, but it's very doable with the right approach. The key is following the product instructions exactly and being diligent about removing nits with a fine-toothed comb.

Here's your step-by-step home treatment plan:

1. Apply the treatment - Follow package directions exactly for timing and application
2. Comb out nits - Use a fine-toothed metal comb while hair is damp
3. Wash items in hot water - Bedding, clothing, and towels at 130°F (54°C)
4. Vacuum thoroughly - Carpets, furniture, and car seats
5. Seal non-washable items - In plastic bags for 2 weeks

The combing step is crucial and often the most time-consuming part. Work in small sections, combing from the scalp to the ends of the hair. Wipe the comb on a white paper towel after each stroke to see what you're removing.

You don't need to use expensive or harsh chemicals throughout your home. Lice can't survive more than 24-48 hours without a human host, so regular cleaning is sufficient.

How should you prepare for your doctor appointment?

If you're seeing a healthcare provider about lice, come prepared with information about what treatments you've already tried and how long you've been dealing with the problem. This helps them recommend the most appropriate next steps.

Before your appointment, gather this information:

• Timeline - When you first noticed symptoms and how long they've persisted
• Previous treatments - What products you've used and how many times
• Family exposure - Who else in your household might be affected
• School or daycare outbreaks - Any known cases in your community
• Symptom severity - How much the itching is affecting daily life

Bring a list of any medications or allergies, especially if you're considering prescription treatments. If possible, don't wash your hair for 24 hours before the appointment so the provider can see the lice or nits more clearly.

What's the key takeaway about lice?

Lice are a common, manageable problem that has nothing to do with cleanliness or personal hygiene. While they're annoying and can cause intense itching, they don't carry diseases and can be effectively treated with the right approach.

The most important things to remember are that lice spread through direct contact, they're incredibly common among children, and they respond well to treatment when you're thorough and patient. Most families deal with lice at some point, so you're definitely not alone in this experience.

With proper treatment and follow-up, you can eliminate lice completely. The key is being systematic about treatment, checking all family members, and following through with the recommended timeline for repeat treatments.