Lice are tiny, wingless insects that feed on human blood. Lice spread from person to person through close contact and by sharing belongings.

There are three types of lice:

• Head lice found on the scalp. They’re easiest to see at the nape of the neck and over the ears.
• Body lice that live in clothing and bedding and move onto the skin to feed. Body lice most often affect people who aren’t able to bathe or wash clothing often, such as homeless people.
• Pubic lice, also called crabs, that occur on the skin and hair of the pubic area. Less often, they may be found on coarse body hair, such as chest hair, eyebrows or eyelashes.

Unless treated properly, lice can become a recurring problem.

Symptoms

Head lice

Common signs and symptoms of lice include:

• Intense itching on the scalp, body or in the genital area.
• A tickling feeling from movement of hair.
• The presence of lice on your scalp, body, clothing, or pubic or other body hair. Adult lice may be about the size of a sesame seed or slightly larger.
• Lice eggs (nits) on hair shafts. Nits may be difficult to see because they’re very tiny. They’re easiest to spot around the ears and the nape of the neck. Nits can be mistaken for dandruff, but unlike dandruff, they can’t be easily brushed out of hair.
• Sores on the scalp, neck and shoulders. Scratching can lead to small red bumps that can sometimes get infected with bacteria.
• Bite marks, especially around the waist, groin, upper thighs and pubic area.

How do you treat head lice?

Treatment for head lice includes using over-the-counter medicated or prescription shampoos, lotions or creams that eliminate head lice. Over-the-counter medicated shampoos contain a substance called pyrethrin or permethrin that kill lice and nits.

Lice and nits attach to the strands of your hair and can be hard to remove unless you use a fine-toothed comb to loosen them. After using a comb or brush, soak the comb in hot water for 10 minutes.

Make sure you follow the directions on over-the-counter medicines. The treatment is only successful if you follow the instructions on how to apply the treatment, how long you should leave it in your hair and how often you should repeat the treatment.

Treating resistant “super lice”

Over the years, some lice (called “super lice”) evolved so that the over-the-counter treatments don’t effectively kill the lice. Powerful prescription drugs are available that can eliminate super lice with one dose.

Talk with your healthcare provider if the first treatment for your head lice isn’t working. They’ll make a recommendation if treatment for super lice is necessary.

How do I get rid of head lice with shampoo?

Follow these steps to get rid of head lice with an over-the-counter medicated or prescription shampoo:

• Read the instructions on the treatment label.
• Apply treatment to your scalp and rub the product throughout the hair on your head. Don’t apply the product to other hair on your body.
• Follow the treatment’s recommended instructions for how long you should leave the treatment on your hair before rinsing it out.
• After rinsing the treatment out of your hair, use a fine-tooth comb to remove dead lice and nits.
• Reapply the treatment as advised by the treatment’s instructions or your healthcare provider.

It takes several treatments to completely remove lice and nits from your hair. It could take up to three weeks to get rid of all lice and nits.

Make sure all members of your household check and receive treatment for head lice if one member of your household has head lice, as lice easily spread from person to person.

How can I prevent head lice?

The best prevention is to not share combs, brushes, towels or hats with others and to avoid physical contact with someone who has lice. It also helps to examine and treat all members of your household who have contact with a person with lice.

Take time to teach your children about head lice and advise them to:

• Avoid head-to-head contact when playing.
• Not share hats or items that they put on their head with others.

If someone in your household has head lice, you can prevent the spread of head lice by:

• Washing clothes, bedding and fabrics with hot water and dry them with a hot cycle in the dryer. If there are items like a hat or stuffed animals that you can’t wash or dry, seal those items in a plastic bag for two weeks.
• Soaking hairbrushes and combs in hot water for up to 10 minutes after use.
• Vacuuming areas of your home and around furniture where a person with head lice might have sat or played.

What can I expect if I have head lice?

Head lice is a temporary irritation that effectively goes away with treatment of a medicated shampoo, lotion or cream. It may take several treatments to completely get rid of head lice, so be sure to follow instructions on the treatment’s packaging or as advised by your healthcare provider.

Head lice can’t spread disease, but they can make your scalp itchy. Frequent itching could break the skin on your scalp, which could lead to infections. If your child has lice and can’t stop scratching, contact your healthcare provider for additional treatment options to prevent them from damaging the skin on their scalp.

How long does head lice last?

With effective treatment, head lice will completely go away after two to three weeks. The duration is dependent on how many lice made a home in your hair. Make sure you follow the instructions on your medicated shampoo, lotion or cream to get rid of lice quickly. Lice can live up to 30 days or longer on your head if left untreated.

When can my child go back to school after having head lice?

Children who have head lice don’t have to stay home from school. But as head lice spread from close contact, it’s important to tell the school, daycare center or your child’s babysitter if your child has head lice. Remind your child to avoid making head-to-head contact with other children during playtime.

Other parents must be made aware of a confirmed head lice case so that they can check and treat their children as needed.

LIVING WITH

How do I take care of myself?

Symptoms of head lice can create disturbances in your sleep pattern and cause excessive itching and discomfort. Treat head lice at the first sign with over-the-counter medicated shampoo, lotion or cream and follow the instructions to make sure it’s effective. If you notice your head lice get worse and don’t go away with over-the-counter treatment, talk with your healthcare provider about stronger prescription treatment.

Lice don’t always go away after one treatment and it could take a couple of weeks to completely get rid of them. Following the treatment’s instructions leads to the best outcome.

When should I see my healthcare provider?

Call your health care provider if over-the-counter treatments fail to work or if there are signs of an infection. Signs of infection include:

• Fever.
• Sores that won’t heal on your head.
• Pain or tenderness on your head.
• Redness or swelling on your scalp.

What questions should I ask my doctor?

• What type of treatment do you recommend for my head lice?
• What do I do if the head lice don’t go away after treatment?
• Do I have super lice?
• Do I need a doctor’s note to send my child to school if they have head lice?

FREQUENTLY ASKED QUESTIONS

Do home remedies make head lice go away?

There isn’t any scientific evidence that at-home remedies, like using salt or other food products like olive oil or mayonnaise, get rid of head lice. The only recommended treatment for head lice is over-the-counter medicated or prescription shampoos, lotions or creams.

Is head lice the result of poor hygiene?

No, infestation with head lice doesn’t occur because someone has poor hygiene. Head lice spread from person to person during close contact or from sharing items that touch a person’s hair who has head lice. Anyone can get head lice regardless of hygiene.

A note from Cleveland Clinic

Hearing that your child has head lice can be a stressful experience. As children are in close contact with each other in school and daycare, head lice easily spread. It also means that there’s a chance other members of your household could get head lice as well. Make sure you follow the treatment as recommended by the instructions on the treatment product or from your healthcare provider and educate your family on head lice to prevent others from getting and spreading it. Following instructions and repeating treatment as necessary eliminates head lice quickly and effectively.