Head lice (patient information)

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Overview
Head lice are tiny insects that live on the skin covering the top of your head, called the scalp. Lice can be spread by close contact with other people. Head lice may also be found in eyebrows and eyelashes.

What are the symptoms of Head lice?
Symptoms of head lice include: Lice on scalp and clothing may be difficult to see, unless there are a lot of them.
 * Intense itching of the scalp
 * Small, red bumps on the scalp, neck, and shoulders (bumps may become crusty and ooze)
 * Tiny white specks (eggs, or nits) on the bottom of each hair that are hard to get off

What causes Head lice?
Head lice infect hair on the head. Tiny eggs on the hair look like flakes of dandruff. However, instead of flaking off the scalp, they stay put. Head lice can live up to 30 days on a human. Their eggs can live for more than 2 weeks. Head lice spread easily, particularly among school children. Head lice are more common in close, overcrowded living conditions. You can get head lice if you: Having head lice does NOT mean the person has poor hygiene or low social status. Having head lice causes intense itching, but does not lead to serious medical problems. Unlike body lice, head lice never carry or spread diseases.
 * Come in close contact with a person who has lice
 * Touch the clothing or bedding of someone who has lice
 * Share hats, towels, brushes, or combs of someone who has had lice

Who is at highest risk?
You can get head lice if you: Having head lice does NOT mean the person has poor hygiene or low social status. Having head lice causes intense itching, but does not lead to serious medical problems. Unlike body lice, head lice never carry or spread diseases.
 * Come in close contact with a person who has lice
 * Touch the clothing or bedding of someone who has lice
 * Share hats, towels, brushes, or combs of someone who has had lice

When to seek urgent medical care?
Call your health care provider if symptoms continue after home treatment, or if you develop areas of red, tender skin, which could mean a possible infection.

Diagnosis
Head lice can be hard to see. You need to look closely. Use disposable gloves and look at the person's head under a bright light. Full sun or the brightest lights in your home during daylight hours work well. A magnifying glass can help. Part the hair all the way down to the scalp in very small sections, looking both for moving lice and eggs (nits). Look at the entire head this way. Look closely around the top of the neck and ears, the most common locations for eggs. Treatment is recommended if even one egg is found.

Treatment options
Lotions and shampoos containing 1% permethrin (Nix) often work well. They can be bought at the store without a prescription. If these do not work, a doctor can give you a prescription for stronger medicine. Such medicine should be used exactly as directed. Ask your health care provider if you need to treat those who shared a bed or clothing with the person that has had lice.An important part of treatment is removing the eggs (nits). Certain products make the nits easier to remove. Some dishwashing detergents can help dissolve the "glue" that makes the nits stick to the hair shaft. Malathion 0.5% in isopropanol is FDA approved for the treatment of head lice. Apply it to dry hair until the hair and scalp are wet. Leave it on for 12 hours. Malathion may be useful for resistant infections.Treatment can cause significant side effects in children younger than 6 months old, the elderly, and anyone weighing less than 110 lbs (50 kg), especially when the treatment is used repeatedly in a short period of time.
 * To use the medicine shampoo, first rinse and dry the hair.
 * Then apply the medicine to the hair and scalp.
 * After 10 minutes, rinse it off.
 * Check for lice and nits again in 8 to 12 hours. If the lice seem active, talk to your healthcare provider before retreating.
 * You can remove the eggs with a nit comb. Before doing this, rub olive oil in the hair or run the metal comb through beeswax. This helps make the nits easier to remove.
 * Metal combs with very fine teeth are stronger and more effective than plastic nit combs. These metal combs are easier to find in pet stores or on the Internet than in pharmacies.
 * Removing eggs may prevent the lice from returning if the medication fails to kill every one of them.
 * Treat children and adults with lice promptly and thoroughly.
 * Wash all clothes and bed linens in hot water with detergent. This also helps prevent head lice from spreading to others during the short period when head lice can survive off the human body.
 * Repeat combing for nits in 7 - 10 days.

Where to find medical care for Head lice?
Directions to Hospitals Treating Head lice

What to expect (Outlook/Prognosis)?
Lice are usually killed with proper treatment. However, lice may come back, especially if the source is not corrected. For example, a classroom with many infected children can cause kids to repeatedly get lice. When one case is detected in a family or a school or child-care center, every child at that location should be examined for head lice. This can help prevent further spreading.

Possible complications
Some people will develop a secondary skin infection from scratching. Antihistamines can help relieve the itching.

Prevention
Clean clothing and good personal hygiene can lead to prevention of these diseases