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Head Lice - Itchy Just Thinking About It

Created: September 1, 2017
Updated: July 23, 2022
leadlice next to a match head and penny to show size
This blog content is provided for informational purposes only, and is not intended as a substitute for professional medical advice, diagnosis, or treatment.


While head lice, also called pediculosis capitis, is not necessarily dangerous to us, there is some physical discomfort associated with having these little parasites on us and there is a significant amount of social stigma associated with having an infestation.  Having lice is about as close to having "cooties" as many people, particularly children experience.

Head lice occur throughout the world and affect individuals of all social and economic backgrounds, particularly children.  Females seem to be more affected than boys, and white children more affected than black children.

Getting Them

Lice are transmitted by direct contact with the head of a person infected with them.  This is the primary method of getting them. There is some suggestion that it is possible to transfer lice through sharing combs, brushes, hairdryers, hats, and towels.  But this method of transfer is felt to be rare.  Socially there is a lot of unnecessary fear about being near someone with lice.  One thing is known for sure:  lice do NOT jump, fly, or travel on pets between people.

How They Make You Feel?

Did I hear the word "itchy" pop into your head?  Even writing this post increased my itch level.  But it is true that the most common symptom is itching, also known as pruritus.  This itching is from an allergic reaction to the saliva of the lice during their feeding. Additionally, from the itching, people may scratch themselves so much that they cause little cuts in the skin.  And rarely, some bacteria from the skin can get under the skin either from the feeding of the lice or from scratches on the skin.  This can lead to small zit-like pustules cropping up often from staph bacteria or it can lead to a spreading red and warm-to-touch skin infection.

How Do We Find Them?

Lice should be considered in anyone with a very itchy scalp, particularly in children.  Seeing scratches around the back of the ears and neck should also make you wonder if lice could be to blame.

The actual diagnosis is generally made by simply inspecting the scalp closely and finding nits, which are the eggs at the base of the hair shaft, or actual lice.  Inspection is best done with a fine tooth nit comb through hair that has been moistened, often with conditioner.  This wet-combing technique in one study has been shown to detect lice about 90% of the time compared to only about 30% of the time with simply looking through the hair.  If one member of the household is found to be infested, all other members should be examined to determine if they are too.


  • Apply a lubricant like hair conditioner to the hair
  • Brush or comb the hair to remove tangles
  • Use the fine-toothed nit comb starting at the top of the head and draw it firmly but slowly downward through the hair
  • Examine for lice and nits after each pass through the hair
  • Comb the entire head
  • Repeat the above combing twice.

How Do We Get Rid of the Lice?

Treatment of pediculosis capitis or head lice is recommended once the diagnosis is made.  However, it is recommended that the diagnosis is actually made before starting treatment.  Particularly when it is known that there are one or more cases of head lice going around a school, there is a tendency to assume that every kid that scratches their head has it.  But there are potential side effects to some of the treatments, so it is best to confirm the diagnosis before submitting someone to the treatment.


  • Pyrethroids(pyrethrins, permethrin - These mediations are well tolerated and inexpensive.  There is however, evidence of increasing resistance to them.  Over the counter examples of these are Nix and Rid.   They are used by saturating dry hair with them and leaving on the hair for 10 minutes before rinsing off with water.  A repeat application is recommended on day 9.
  • Malathion - Prescription only.  More effective than pyrethroids but also more expensive.  Additional caution needs to be maintained because it is flammable.  The smell also isn't the most pleasant and it can be irritating to the eyes.  It is applied to dry hair and left in place for 8 - 12 hours before washing off with a regular shampoo.
  • Benzyl Alcohol - Prescription only.  This lotion suffocates the lice.  It works about as well as pyrethroids.  It is only recommended for patients older than 6 months as it contains alcohol.  The side effects include irritation to skin and eyes as well as some numbness at the site of application.  Apply the lotion to dry hair and rinse after 10 minutes with a repeat treatment in 7 days.
  • Spinosad - Prescription only.  Designed to affect the nervous system of lice, it is used by completely covering the initially dry scalp and hair with it.  Let is sit for 10 minutes and then completely rinse it out with warm water.  If live lice are found in 1 week it can be repeated.  Similar to benzyl alcohol, it should only be used in children 6 months and older.  Skin irritation is the most common side effect.
  • Ivermectin - Prescription only.  Available as both a lotion and a pill.  It also affects the nervous system of lice.  The use of lotion is the same as many of the others.  Apply, wait 10 minutes, and rinse.  The pill is taken as a one time dose.  Usually a single use is enough but may be repeated if unsuccessful.  Safety of the lotion in children under 6 months old and safety of the pill in young children and pregnant women has not been determined.  Common side effects are eye and skin irritation, skin dryness, and a burning sensation on application.
  • Wet combing - Manually attempting to remove all lice and nits is an option.  It certainly is without the potential side effects of medical treatment.  But the success rate is also lower.  To maximize success, this needs to be repeated every 3-4 days for at least two weeks.  It can take time to go through long and thick hair which makes this a time consuming but all natural potential fix.
  • Other - Several home treatments have been tried such as olive oil, butter, and petroleum jelly with the hope of suffocating the lice.  Evidence that these methods actually work is lacking and there is one study that suggested this is not an effective treatment.  Gasoline and kerosene treatments are reported but are also NOT recommended.

What about Clothing and Bedding?

It is unlikely that any of the lice can survive off of their human host for more than 2 days.  But it reasonable to wash clothing and bedding used by the person with head lice in hot water and/or drying these articles in a high-heat dryer.  An alternative method is to store them in a sealed plastic bag for up to two weeks(although as stated above, they generally cannot last more than 2 days once off the scalp).  Spraying the entire room or home with a liquid lice treatment is not recommended.

When Can Children Return to School?

Children should NOT be excluded from school due to the presence of head lice.  Children should be treated as soon as possible after the lice are found, but they may remain in school with the caveat of avoiding direct head-to-head contact and not sharing articles of clothing that go on the head or around the neck like hats and scarves.

Here is a link to more information about this recommendation from the Centers for Disease Control and backed up by the American Academy of Pediatrics and the National Association of School Nurses.

How Can We Get More Information?

As you can tell, many of the treatments require a prescription.  At Care on Location, while it may be difficult for us to definitively make the diagnosis over the video connection, we certainly can help prescribe one of the several treatment options if you have already made the diagnosis and over-the-counter treatment has failed.  We are also more than happy to answer any questions you may have regarding head lice.

Use the button below to get seen by one of our experienced medical providers who has treated this condition a multitude of times

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