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November 25, 2009
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Head Lice (cont.)

Where are head lice most commonly found?

Head lice are most frequently located on the scalp behind the ears and near the neckline at the back of the neck. Head lice hold on to hair with hook-like claws that are found at the end of each of their six legs. Head lice are rarely found on the body, eyelashes, or eyebrows.

What are the signs and symptoms of head lice infestation?

The signs and symptoms are

  • a tickling feeling of something moving in the hair;
  • itching (caused by the an allergic reaction to the bites);
  • sores on the head (caused by scratching);
  • these sores on the head can sometimes become infected; and
  • irritability (a very nonspecific thing, to be sure).

How is a head lice infestation diagnosed?

Head lice can be detected by looking closely through the hair and scalp for nits, nymphs, or adults. Locating a nymph or adult may be difficult; there are usually only a few of them, and they can move quickly from searching fingers. However, the presence of nits close to the scalp confirms that a person is infested. If the nits are located more than ¼ inch from the scalp, the infestation is probably an old one. If you are not sure whether or not a person has head lice, the diagnosis should be made by a health-care provider, school nurse, or a professional from the local health department or agricultural extension service. The nits of head lice are easily visible with a microscope.

How is a head lice infestation (pediculosis) treated?

For effective elimination of head lice, the infested individual, family members that are also infested, and the home must all be treated.

Treatment of the individual and the infected family members:

Over-the-counter (OTC) or prescription medications are used to treat the affected people and their families. Follow these treatment steps:

  1. Remove all clothing.
  2. Apply lice medicine, also called pediculicide, according to the label instructions. If your child has extra long hair, you may need to use a second bottle. WARNING: Do not use a cream rinse or combination shampoo/conditioner before using lice medicine. Do not re-wash hair for one to two days after treatment.
  3. Have the infested person put on clean clothing after treatment.
  4. If some live lice are still found eight to 12 hours after treatment, but are moving more slowly than before, do not retreat. Comb dead and remaining live lice out of the hair. The medicine sometimes takes longer to kill the lice.
  5. If, eight to 12 hours after treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. See your health-care provider for a different medication and follow their treatment instructions.
  6. Nit (head lice egg) combs, often found in lice medicine packages should be used to remove nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective.
  7. After the initial treatment, check, comb, and remove nits and lice from hair every two to three days.
  8. Re-treat in seven to 10 days.
  9. Check all treated people for two to three weeks until you are sure all lice and nits are gone.

Treating the house:

Treating the whole house is a laborious but important task. Follow these steps:

  1. Machine wash all washable clothing and bed linens that the infested person touched during the two days before treatment (to kill the lice and nits). Use the hot water cycle (130 degrees F; 55 degrees C) to wash clothes. Dry laundry using the hot cycle for at least 20 minutes.
  2. Dry clean clothing that is not washable (coats, hats, scarves, etc.), or store all clothing, stuffed animals, comforters, etc., that cannot be washed or dry cleaned into a plastic bag and seal it for two weeks.
  3. Soak combs and brushes for one hour in rubbing alcohol, Lysol, or wash with soap and hot (130 degrees F; 55 degrees C) water.
  4. Vacuum the floor and furniture. Do not use fumigant sprays. (They can be toxic if inhaled.)


Next: My child has head lice. I don't. Should I treat myself to prevent being infested? »

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