What are lice?

Girl scratching head Lice are tiny insects that can infest the skin anywhere on the body, causing intense itching. While highly contagious, lice cannot jump or fly; they are spread from person to person by close body contact, shared clothing, and items like hats and hairbrushes.

There are three types of human lice:

  • Head lice
  • Body lice
  • Pubic lice

Facts about lice

Head lice:

  • Head lice is seen most in school-aged children and those in childcare centers.
  • The main manifestation is intense itching of the scalp.
  • Live lice can be seen on the hair, behind the ears, and on the neck. The eggs, or nits as they are commonly called, can be found tightly attached to the hair shaft, closest to the scalp.

Body lice:

  • Body lice is rarely seen in children. It is most common in people with poor hygiene.
  • Unlike head lice, body lice live on clothing and bedding; improved hygiene and washing clothes will usually eliminate body lice. Body lice can cause severe nighttime itching.

Pubic lice:

  • Pubic lice is very contagious and can be transmitted through sexual contact or by contaminated items, such as towels and clothes.
  • Pubic lice generally affects pubic hair, but can also cause infections on the chest, abdomen, thighs and eyebrows. Itching of the affected area is a common symptom of pubic lice.

How are lice diagnosed?

In most cases, head lice can be diagnosed at home by a parent. To check your child’s head for lice, you should start by sitting them in a brightly lit room. Part their hair so you can take a close look at their scalp. Spotting live lice can be difficult because they’re fast and avoid light. However, it is important to find the adult lice to confirm active infestation and/or treatment failure.

Lice eggs (or nits) are easily visible to the naked eye and appear as small white or yellow-brown spots that are firmly attached to the hair shaft, near the scalp. The easiest places to spot the nits is at the hairline on the neck or behind the ears. You can also wet your child’s hair, then run a fine-toothed comb through the hair, wipe the comb on a wet paper towel, and carefully examine the towel for lice or nits.

Treatment for lice

The best way to treat head lice is with a medication that’s designed specifically for the treatment of lice. There are several over-the-counter products available, as well as some by prescription. It’s important to talk to your child’s doctor before beginning any treatment for head lice.

In most cases, your child’s doctor will recommend an over-the-counter option to start. Application of a medicated cream rinse or shampoo, known as permethrin (Nix®) or pyrethrin (RID®), are available at most drug and grocery stores, are least expensive and usually effective treatment for lice. Specific instructions, as well as age considerations, need to be followed to minimize reinfection and treatment failures. Additionally, you may need to repeat the treatment to completely get rid of lice but be sure to check with your child’s pediatrician again before beginning a second or third course.

Prescription head lice treatments include malathion and ivermectin. Both are highly effective, but malathion is highly flammable, malodorous and contraindicated for children younger than age 2; ivermectin can be cost-prohibitive.

Due to toxicity, lindane shampoo is no longer recommended as a first line treatment for lice and should be avoided in patients with skin disorders or open sores.

Once a treatment is determined, the following steps should be performed:

  • Nits need to be removed from the hair with a fine-tooth comb.
  • Combs and brushes should be soaked in hot water with the shampoo for at least 15 minutes.
  • Children can return to school or day care the day following their first treatment for head lice according to updated recommendations from the American Academy of Pediatrics.
  • Check all other household members closely to see if anyone else needs to be treated.
  • Wash all bedding and any clothing the child has used during the three days prior to lice being found in hot water (130° F or 54° C) and dry them on high heat.
  • Seal items that cannot be washed in a plastic bag for two weeks to ensure all lice and nits are dead.

Reviewed by Chun H. Yin, MD, FAAP, Naline Lai, MD, FAAP, Julie Kardos, MD, FAAP

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