Head lice are diagnosed by sight. Spread the hair apart and look for tiny specks. Most likely you’ll see nits (lice eggs), which are the tiny white-yellow-tan specks attached to the individual hair.

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Lice! The very word sends chills down the spines of any parent. My mother, a registered nurse who worked in elementary schools, suffered from pediculophobia, which is a fear of ice. The words “head lice” caused her scalp to itch, and we children were never allowed to try on hats at stores or share hats with friends for fear of picking up head lice. As it turns out, she may have been overreacting just a tad—although there are way more head-lice treatments now than there were a few decades ago. But head lice are surely not a thing of the past. According to the American Academy of Pediatrics, six to 12 million school-age children get head lice each year.

While head lice are a year-round problem, the number of cases seems to peak when the kids go back to school in the fall and again in January, says Patricia Brown, M.D., a dermatologist at the Food and Drug Administration (FDA).

Head-Lice Transmission

Lice cannot fly or hop. They crawl. So, it takes close contact to transmit head lice from person to person, which is why children are major players in their spread and why head lice can infiltrate an entire family quickly. Kids and families spend a lot of time near one another, making head-to-head lice contact easy.

Mom wasn’t entirely wrong about head lice and hats, however. Although the CDC says methods of transmission other than head-to-head are “uncommon”—possibly because lice only live a day or two without food (human blood) and nits (microscopic lice eggs) cannot hatch if away from the warmth of the human scalp—it is possible to get head lice from hats and more, if the timing is right. Head lice can be transferred via items like shared:

• Carpeting
• Clothing
• Furniture
• Hair brushes and combs
• Stuffed animals
• Towels and blankets

It’s important to understand that lice do not discriminate. They are equal-opportunity pests, regardless of race, income, religion, or housekeeping ability. Anyone can get head lice, no matter how “clean” they are (or aren’t). While three different species of lice can infect people, only the body louse transmits disease (see sidebar).

Symptoms of Head Lice

If you or your child have head lice, the first symptom is usually an itchy scalp, most often behind the ears and/or at hairline at the back of the neck.  The itching is an allergic reaction to head lice saliva, which is transmitted when they bite.

Head lice are diagnosed by sight. Spread the hair apart and look for tiny specks. Most likely you’ll see nits (lice eggs), which are the tiny white-yellow-tan specks attached to the individual hair. Nits look a lot like dandruff, but they’re glued to the hair shaft. Adult head lice are harder to see because not only are they small, but they’re fast and move away from light, explains the American Academy of Pediatrics.

The U.S. National Library of Medicine says additional symptoms of head lice include:

• Tickling feeling in the hair.
• Sores from scratching. Sometimes the sores can become infected with bacteria.
• Trouble sleeping, because head lice are most active in the dark.

Treatment

Only the body louse is known to spread disease, so antibiotics are not normally needed with head lice, unless a bite or area that has been scratched becomes infected.  Use only FDA-approved lice-removal products (see chart). Research does not support the use of home remedies, such as mayonnaise, olive oil, or similar substances, to “suffocate” head lice. It should go without saying that kerosene and gasoline should never be used, as they are both harmful to the person and flammable.

Pediculosis (the medical term for head lice and body lice) and pthiriasis (pubic lice) can be treated with medications and housecleaning/delousing.  “Many head-lice products are not for use in children under the age of 2, so read the label carefully before using a product to make sure it is safe to use on your child,” Brown says.  To be certain, you should consult your pediatrician or a pharmacist for specific recommendations. These are strong chemicals. If elderly people are involved in the head-lice invasion, consult their primary care physicians before treatment.

Products that kill lice are called pediculicides. If possible, you should choose one that is also ovicidal (meaning it kills eggs, too). If not, you will have to retreat with the pediculicide to kill newly hatched head lice.

Anyone with an active head-lice infestation should be treated, obviously, as well as household members and other close contacts. Many experts advise that if you think someone could be infested, treat them.

Always follow label instructions and never mix products. Apply the product only to the scalp and the hair attached to the scalp. Use exactly as directed. Do not use extra product unless directed by your health-care provider.

After rinsing the product from the hair and scalp use a “nit comb” (available at a pharmacy) to remove dead head lice and nits. (Note: A pet flea comb may work as well.) Use the nit comb every day for two to three weeks to ensure all head lice and nits are removed.

While it’s not always necessary to do housecleaning when you find evidence of head lice, it is often recommended. There is that 24- to 48-hour period where hungry head lice can survive not on a host scalp. That means wash anything washable in hot water. Hot-air drying is also useful to kill head lice.

Lice and eggs can be killed if exposed to temperatures 128.3°F or more for a minimum of five minutes. You can soak things that cannot be put in the washer-dryer in lice-killing product for five minutes. If an item is not washable, it may be sealed in an air-tight plastic bag for two weeks to ensure any head lice are killed.

If active head lice are still present several days after treatment, you will need to re-treat the area. If head lice return after two treatments with a topical product, do not try the product again. Consult your health-care provider, as there may be a resistance problem going on or a treatment error.

FDA-Approved Medications for Lice

For related reading, please visit these posts:

• Does Your Child Have Lice? Don’t Panic! Natural Lice Treatment Is Safe and Effective
• Natural Lice Treatment Calendar
• Lyme Disease: Prevention Is Key
• Tick-Bite Tale from the ER: “Doctor, There’s a Seed Attached to Me!”
• Tick-Borne Diseases: 12 Types to Beware
• Ignore Lyme Disease Symptoms and You Could Risk Severe Complications