Head Lice

Overview

Head lice are tiny insects that feed on blood from the human scalp. They usually spread through direct transfer from the hair of one person to the hair of another and are most common among children. Having head lice isn't a sign of poor personal hygiene or an unclean living environment. Nonprescription and prescription medications can help treat head lice. Common symptoms include itching on the scalp, neck, and ears, which is an allergic reaction to louse bites.

Understanding the disease

Symptoms

The symptoms of head lice may include itching on the scalp, neck, and ears, as well as sores on the scalp, neck, and shoulders due to scratching. Other symptoms may include lice and their eggs (nits) on the hair shafts, which may be difficult to spot as they are small, avoid light, and move quickly. It's important to note that improved hygiene alone will not remove an infestation of head lice. If you suspect that you or your child has head lice, it's best to see a health care provider for proper diagnosis and treatment.

Risk Factors

The risk factors for developing head lice include direct head-to-head contact and being in close proximity with others, such as in child care facilities and schools. Head lice are most common among children in preschool through elementary school in the United States. The insects can also spread through personal items like hats, scarves, brushes, combs, and headphones that have been in contact with an infested person.

Development

Head lice go through three stages in their life cycle: eggs, nymphs, and adults. The female louse lays eggs, called nits, which hatch after 6 to 9 days. The nymphs, or immature forms, mature into adults after 9 to 12 days. Adult lice can live for 3 to 4 weeks, and the female lays 6 to 10 eggs per day during that time.

Assessment and Diagnosis

Triage

You should see a health care provider if you suspect head lice, especially if you or your child are experiencing symptoms such as itching on the scalp, neck, and ears. The health care provider can confirm the presence of head lice and provide guidance on appropriate treatment options. Note that it's common for children to be treated for head lice even if they don't actually have them, so it's important to consult a health care provider for accurate diagnosis and treatment advice.

Diagnosis

The diagnosis of head lice is typically done by a health care provider or pediatrician. The provider will examine your child's scalp and look for a live nymph or adult louse to determine if head lice are present. To make the examination easier, the hair is lubricated with hair conditioner or another product. If no live louse is found during the initial examination, the provider may repeat the exam at a second appointment. Another way to diagnose head lice is by identifying nits in the hair. Nits are examined under a specialized light or a microscope to determine if they are living or not.

Management and Treatment

Complications

Potential complications of head lice include:

1. Secondary infections: Excessive scratching and biting from lice can cause skin irritation, which may lead to secondary infections.
2. Sores on the scalp, neck, and shoulders: Persistent scratching can result in small, red bumps on the affected areas, which may become infected if scratching continues.

Prevention

Head lice can be difficult to prevent, especially among children in childcare facilities and schools who have close contact with each other. However, you can take some precautions to minimize the risk of getting head lice:

1. Avoid head-to-head contact: Teach children to avoid direct head-to-head contact with other children, as head lice spread primarily through close contact.
2. Don't share personal items: Discourage the sharing of combs, brushes, hats, scarves, and other personal items that come in contact with the hair.
3. Regularly check for lice: Regularly inspect your child's hair for lice and eggs, especially if they have recently been in contact with other children who have head lice.
4. Hang clothes separately: To minimize the risk of spreading lice through clothing, hang your child's clothes on a separate hook or in a separate bag.
5. Clean bedding and clothing: Wash bedding, pillows, and clothing worn in the 2-3 days prior to the start of the itching in hot water and dry on a high heat setting. This will help to kill any lice or eggs that may be present. While these measures can help to reduce the risk of head lice, it is important to remember that head lice can still occur even with the most diligent prevention efforts. If your child does get head lice, prompt treatment with appropriate medication can help to alleviate the issue.

Treatment

Nonprescription and prescription medications can help treat head lice. Some common treatments include:

1. Over-the-counter (OTC) medications: These medications contain active ingredients such as permethrin, pyrethrin, or a combination of both. They are applied to the hair and scalp, killing the lice and their eggs. Follow the instructions on the packaging carefully.
2. Prescription medications: In some cases, a healthcare professional may prescribe stronger medications if OTC treatments are not effective. Additionally, some people use home or natural remedies to treat head lice, but there is little clinical evidence to support their effectiveness. Always consult a healthcare provider before using alternative treatments, as they may not be safe or as effective as medications. Remember to follow the instructions provided with the treatment, and check with a healthcare professional if you have any concerns or if the treatment doesn't seem to be working.

Preparing for medical consultation

To prepare for an appointment for head lice, you should see your family's health care provider or pediatrician. Before the appointment, make a list that answers questions such as:

• How long have you had head lice?
• What symptoms are you experiencing?
• How did you become infested?
• Have you shared items like combs, hats, or pillows with others?
• What treatments have you tried?
• Do you have any chronic health problems? Your health care provider will examine your child's scalp, look for live nymphs or adult lice, and check for nits. They may also use a specialized light or microscope to determine if the nits are alive. They will likely recommend a medication to treat head lice and may provide instructions for a recommended treatment schedule.