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Medical Author:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• Head lice facts
• What are head lice?
• How common is head lice infestation?
• Who is at risk for getting head lice?
• How in the world does a child get head lice?
• What do head lice look like?
• Where are head lice most commonly found?
• What are the signs and symptoms of head lice infestation?
• How is a head lice infestation diagnosed?
• What is the treatment for a head lice infestation (pediculosis)?
• My child has head lice. I don't. Should I treat myself to prevent being infested?
• Should my pets be treated for head lice?
• My child is under 2 years of age and has been diagnosed with head lice. Can I treat my child with prescription or over-the-counter (OTC) drugs?
• What OTC medications are available to treat head lice?
• What is the prescription drug used to treat head lice?
• Are any home remedies effective at getting rid of head lice?
• Which head lice medicine is best for me?
• What are the rules with head lice medicines?
• How can I prevent head lice?
• Should household sprays be used to kill adult lice?
• Should I have a pest-control company spray my house?
• What is the prognosis of a head lice infestation?
• Patient Comments: Head Lice - Treatments
• Patient Comments: Head Lice - Signs and Symptoms
• Patient Comments: Head Lice - Describe Your Experience
• Head Lice Index

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.

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;
• irritability.

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 professional, 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.

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 rewash 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 professional 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. Retreat 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 F; 55 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 F; 55 C) water and then place in bag and leave in freezer for two days.
4. Vacuum the floor and furniture. Do not use fumigant sprays. (They can be toxic if inhaled.)