How can one check for lice on themselves?

Understanding Head Lice

What Are Head Lice?

Life Cycle of a Louse

The life cycle of a louse determines when and where the parasite can be seen during a personal inspection. An adult female attaches her eggs to hair shafts close to the scalp. Each egg, called a nit, is firmly cemented and remains immobile for approximately 7–10 days. After hatching, the emerging nymph resembles a miniature adult but lacks full reproductive capacity. The nymph undergoes three successive molts, each lasting about 3–4 days, before reaching sexual maturity. An adult louse lives on the host for 30–35 days, during which it feeds on blood several times a day and produces new eggs.

Understanding these stages aids detection:

Egg (nit): Oval, white or yellowish, firmly attached near the scalp; visible to the naked eye or with a magnifying lens.
1st‑3rd nymph stages: Small, translucent; may be mistaken for hair debris but can be identified by their movement.
Adult: Six legs, grayish‑brown, mobile; often found near the base of hair shafts.

Because eggs are immobile and attached close to the skin, they remain in place throughout the incubation period. Regular combing of damp hair with a fine-toothed lice comb reveals both nymphs and adults, while a careful visual scan of the scalp and hair roots exposes nits. Detecting the life cycle phases early prevents the population from advancing to the reproductive adult stage, reducing the risk of a full infestation.

Common Misconceptions About Lice

Self‑inspection for lice is often clouded by inaccurate beliefs that impede early detection and effective treatment.

Common misconceptions include:

Lice are visible to the naked eye at all times. In reality, lice hide in hair shafts and may be missed without systematic combing.
Only children can have lice. Adults can host lice, especially when sharing personal items or living in close quarters.
A single nymph confirms an infestation. A solitary immature louse can be a stray; a full assessment requires searching for multiple stages.
Lice disappear after a short shower. Wetting hair does not kill lice; they cling to strands and survive routine washing.
Pet animals transmit human lice. Human head lice are species‑specific and cannot be transferred from dogs or cats.

Accurate detection relies on a fine‑toothed lice comb used on dry hair, performed in a well‑lit area. The comb should be drawn from scalp to tip in small sections, repeated several times. After each pass, examine the comb for live insects or viable nits attached within 1 mm of the scalp.

Misconceptions that lice are only a childhood problem or that a single nymph indicates a full outbreak often lead to delayed treatment. Recognizing that lice can affect any age group and that a thorough search is required eliminates false security and supports prompt eradication.

Preparing for a Self-Examination

Necessary Tools and Materials

Proper Lighting

Proper illumination is critical when examining hair and scalp for lice. Insufficient light conceals nits and adult insects, leading to missed detections.

Ideal light sources include direct daylight, high‑intensity white LED lamps, and adjustable desk lamps with a color temperature of 5,000–6,500 K. Light should be bright, uniform, and free of shadows. Position the source at a 45‑degree angle to the scalp to reveal the translucent shells that cling to hair shafts.

When performing the inspection:

Use a fine‑toothed lice comb on wet, conditioned hair.
Hold the comb under the light source, keeping the head steady.
Examine each section for the characteristic oval nits attached close to the scalp.
Repeat the process in multiple lighting conditions if any doubt remains.

Supplementary magnification, such as a handheld magnifier (10×–20×), enhances visibility of small nits. Consistent use of proper lighting reduces false negatives and improves detection accuracy.

Magnifying Glass

A magnifying glass is an essential tool for personal lice inspection. Its enlarged view reveals nits, lice eggs, and adult insects that are otherwise invisible to the naked eye.

Choose a lens with 5×–10× magnification; higher power provides clearer detail on hair shafts.
Hold the glass 1–2 cm from the scalp, positioning it over the hair parting or behind the ears.
Examine each strand from root to tip, looking for oval, cement‑attached nits and the darker, mobile lice.
Use a fine‑toothed comb in conjunction with the magnifier to separate hair and improve visibility.
Repeat the process on the entire head, focusing on warm, moist areas such as the neckline and behind the ears.

A quality magnifying glass features a non‑distorting, flat optical surface and a comfortable grip to maintain steady focus. When combined with systematic combing, it enables accurate detection and reduces the risk of missed infestations.

Fine-Toothed Comb («Nit Comb»)

The fine‑toothed nit comb is the most reliable instrument for self‑inspection of head lice. Its densely spaced teeth separate lice and nits from hair shafts, allowing visual confirmation without magnification.

To conduct an effective examination, follow these steps:

Wash hair with a regular shampoo and rinse thoroughly. Dry hair completely; moisture can cause the comb to slip.
Section hair into sections of 2–3 cm using clips or hair ties. Work from the scalp outward, moving the comb slowly through each strand.
After each pass, wipe the comb on a white tissue or paper towel. Examine the debris for live insects (brown or gray bodies) and attached eggs (oval, yellow‑white, firmly attached to the hair shaft within 1 mm of the scalp).
Dispose of collected material by flushing it down the toilet or sealing it in a plastic bag. Clean the comb with hot, soapy water and allow it to dry before reuse.

Key characteristics of an effective nit comb include:

Teeth spaced no more than 0.2 mm apart, sufficient to capture eggs attached close to the scalp.
Stainless‑steel or durable plastic construction to resist bending and ensure consistent tension.
A handle that permits firm grip while applying gentle pressure, preventing hair breakage.

Regular use—once or twice weekly after suspected exposure—reduces the likelihood of unnoticed infestations. Combining the comb with a thorough visual check of the scalp and neck enhances detection accuracy.

Hair Clips or Ties

Hair clips and ties serve as practical tools when examining one’s own scalp for lice. A clip can secure a section of hair, exposing the roots and allowing a clear view of the skin. An elastic tie can pull hair away from the neck and ears, creating space for a thorough inspection.

Choose a small, smooth clip that grips without damaging hair.
Part the hair into 1‑ to 2‑inch sections; secure each with a clip before inspection.
Hold the clip open with one hand, pull the hair taut, and use a magnifying lens or a fine‑tooth comb to scan the scalp.
Move the clip along the hair line, checking behind ears, at the nape, and around the crown.
After each section, release the clip, examine the hair shaft, and look for live nits or adult lice.
Dispose of or wash the clip and any ties in hot water (≥130 °F) after the check to prevent re‑infestation.

Using clips and ties minimizes hair movement, reduces missed spots, and streamlines the self‑examination process.

White Towel or Cloth

A plain white towel or cloth offers a high‑contrast background that makes lice and their eggs easier to see. The lack of color eliminates visual interference, allowing the observer to spot the tiny, translucent nits and the darker bodies of adult lice against the bright surface.

Before beginning, ensure the fabric is clean, dry, and free of lint. Lay it on a stable, flat surface under strong, natural or artificial light. The white color maximizes visibility while the smooth texture prevents hair from snagging.

Part the hair into sections no wider than one inch.
Place each section directly onto the towel, spreading the strands flat.
Run a fine‑toothed comb or fingertips through the hair, moving from scalp outward.
After each pass, lift the hair and examine the towel surface for moving insects or attached eggs.
Use a magnifying glass if necessary to confirm doubtful spots.
Discard or launder the towel after the inspection to avoid cross‑contamination.

Repeat the procedure weekly during an outbreak, and combine it with a systematic combing method for comprehensive detection. The simplicity and affordability of a white towel make it a reliable tool for personal lice surveillance.

Step-by-Step Self-Examination Process

Sectioning the Hair

Starting Point

The first action in a self‑examination for lice is to create a suitable environment. Choose a well‑lit area, preferably with natural light, and lay a clean towel or disposable sheet on a flat surface. Have a fine‑toothed comb, a magnifying glass, and a container for any specimens ready before beginning.

Proceed with the inspection as follows:

Dampen the hair with lukewarm water; wet hair loosens nits and improves visibility.
Separate the hair into small sections, securing each with a clip or elastic band.
Run the fine‑toothed comb from the scalp outward, moving slowly to capture any lice or attached eggs.
Examine the comb after each pass using the magnifying glass; look for live insects (approximately 2–3 mm, gray‑brown) and oval, white or yellowish nits attached close to the scalp.
Repeat the process on all sections, including behind the ears, at the nape, and around the crown, where infestations concentrate.

After completing the combing, wipe the towel or sheet with a disposable wipe and discard any captured specimens in a sealed bag. This systematic start ensures thorough detection and minimizes the chance of overlooking hidden parasites.

Systematic Approach

A systematic self‑inspection for lice begins with preparation. Gather a fine‑tooth lice comb, a magnifying device if available, white paper towels, and a well‑lit space. Remove clothing that could conceal parasites and secure hair in a plain, damp towel to reduce movement.

The inspection proceeds in ordered stages:

Section hair – Divide the scalp into quadrants (front, crown, sides, back). Work one quadrant at a time to avoid missed areas.
Apply comb – Starting at the scalp, pull the comb through each strand from root to tip. After each pass, wipe the comb on a paper towel to capture any nits or insects.
Examine output – Observe the collected material under magnification. Live lice appear as small, brownish insects; nits are oval, firmly attached to hair shafts.
Document findings – Record the presence, quantity, and location of any specimens. Photographs can aid future comparison.
Repeat – Perform the entire process after 7–10 days to detect newly hatched lice, as early stages may have been missed initially.

Consistent adherence to this sequence, combined with thorough lighting and careful combing, maximizes detection accuracy while minimizing false negatives.

Visual Inspection

Checking the Scalp

Detecting lice on oneself begins with proper preparation. Use a fine‑tooth comb, a bright light source, and a clean, flat surface such as a countertop. Remove any hair products that could obscure the hair shaft. Separate the hair into manageable sections by pinching small portions between the fingers.

Part the hair close to the scalp, starting at the nape of the neck and moving forward.
Slide the comb through each section from the roots to the tips in a single, slow motion.
After each pass, wipe the comb on a white tissue or paper towel to reveal any attached insects or nits.
Examine the tissue for live lice (small, tan to gray insects, about the size of a sesame seed) and nits (oval, brownish, firmly attached to the hair shaft within ¼ inch of the scalp).

Repeat the process on the entire head, giving extra attention to the behind‑ear region, the occipital area, and the crown, where infestations most often concentrate. A thorough inspection typically requires 5–10 minutes per person.

If live lice are found, rinse the comb in hot, soapy water and repeat the combing process after 24 hours to capture newly hatched nymphs. If only nits are present, continue daily combing for a week to ensure any hatching lice are removed before they can reproduce.

Document the findings by noting the number of insects observed and the locations of nits. This record assists in evaluating treatment effectiveness and determining whether additional measures, such as laundering bedding or applying a pediculicide, are necessary.

Examining Hair Strands

Detecting lice on oneself begins with a systematic inspection of each hair strand. The process requires a fine-toothed comb, adequate lighting, and a clean surface for collecting debris.

Wet the hair thoroughly; moisture immobilizes lice and makes nits more visible.
Apply a small amount of conditioner to reduce tangles and allow the comb to glide smoothly.
Starting at the scalp, pull a section of hair away from the head and run the comb from root to tip in a single, steady motion.
After each pass, wipe the comb on a white tissue or rinse under running water to reveal any attached organisms.
Examine the tissue or water for live insects (approximately 2–3 mm in length, grayish‑brown) and for nits (oval, cemented to the shaft, often appearing as tiny yellow‑white specks close to the scalp).
Repeat the procedure on all sections, paying special attention to behind the ears, the nape of the neck, and the crown—areas where lice preferentially reside.

If any lice or nits are found, isolate the affected strands, repeat the combing process for at least ten minutes to remove remaining specimens, and wash the hair with an approved treatment. Continue daily examinations for one to two weeks to confirm eradication.

Key Areas to Focus On

Inspect the scalp under bright, natural light. Separate sections of hair with a fine‑tooth comb, moving from the scalp outward. Examine each strand for live insects, translucent nits, or brownish shells attached within ¼ inch of the hair shaft.

Focus on the following areas:

Crown and occipital region, where lice concentrate.
Behind the ears and at the hairline, common attachment sites.
Neck and shoulders, especially in children who rest their heads on pillows.
Any recently washed or newly cut hair, as nits may be hidden in short lengths.

Use a magnifying lens if available to verify doubtful spots. Conduct the inspection on a clean, dry head; moisture can obscure nits. Repeat the process after 7–10 days to catch newly hatched lice that were previously unnoticed. Maintain a dedicated comb, disinfected after each use, to prevent cross‑contamination.

Using the Nit Comb

Combing Technique

The combing method provides a direct way to detect head‑lice infestations without assistance. Begin by selecting a metal nit comb with teeth spaced 0.2 mm apart; plastic variants may miss nits. Wet the hair thoroughly with conditioner or a detangling spray, then divide it into manageable sections of about two inches. Starting at the scalp, draw the comb through each section from root to tip in a slow, steady motion, ensuring the teeth reach the skin. After each pass, wipe the comb on a white tissue or rinse it in hot water to expose any captured lice or eggs. Repeat the process for every section, revisiting areas where hair is dense or where previous passes revealed debris.

Key points for effective self‑inspection:

Perform the procedure in a well‑lit environment to see small insects.
Conduct the check at least twice a week during an outbreak.
Examine the comb after each stroke; live lice move quickly, while nits appear as tiny, oval, brownish shells attached to hair shafts.
Dispose of captured lice by sealing them in a plastic bag; destroy nits by soaking the comb in boiling water for ten minutes.

Consistent use of this technique, combined with thorough cleaning of personal items such as hats and pillowcases, confirms the presence or absence of infestation and supports timely treatment decisions.

Wiping the Comb

Using a fine-toothed lice comb is a reliable way to detect infestations. The comb must be run through dry hair first, then through wet hair treated with a conditioner to reduce tangles and improve visibility of eggs and nymphs.

Separate hair into small sections (about 2‑3 cm wide).
Starting at the scalp, pull the comb through each section from root to tip in a single, steady motion.
After each pass, wipe the teeth on a white paper towel or tissue to expose any captured organisms.
Examine the towel for live lice, nymphs, or nits attached to the comb.
Rinse the comb in hot, soapy water, then dry before the next section.

Repeat the process across the entire head, paying special attention to the nape, behind the ears, and the crown. Finding live insects confirms an active infestation; spotting only empty shells (nits) indicates a past or low‑level presence. Immediate treatment should follow any positive result.

What to Look For on the Comb

When checking for head‑lice, the comb becomes the primary diagnostic tool. After each stroke, inspect the teeth for specific indicators.

Live adult insects – oval, tan to gray, about the size of a sesame seed; may move quickly when disturbed.
Nymphs – smaller, translucent versions of adults; often clustered near the base of a hair shaft.
Nits (eggs) – oval, about 0.8 mm long, white or yellow; firmly cemented to the hair shaft within ¼ inch of the scalp.
Empty shells – cracked or translucent nits that have already hatched; their presence confirms an active infestation.
Blood or scalp debris – specks of dark red or brown material adhering to the comb; a sign that lice have been feeding.

Effective inspection follows a consistent method: dampen hair, apply conditioner, run a fine‑tooth (nit) comb from scalp outward, and repeat every few centimeters. After each pass, place the comb on a white surface and examine each tooth for the items listed above. Detecting any of these elements warrants immediate treatment and a repeat combing schedule to ensure eradication.

Identifying Signs of Lice Infestation

Distinguishing Lice from Dandruff or Debris

Characteristics of Live Lice

Live lice are small, wing‑less insects that survive only on human blood. An adult head louse measures 2–3 mm in length, is elongated, and has a gray‑to‑brown body that becomes slightly darker after a blood meal. The head is rounded, equipped with six legs that end in claw‑like tarsi, allowing the parasite to cling tightly to hair shafts. Lice move quickly in a jerky, hopping motion; they can traverse a few centimeters per minute but rarely drop from the scalp because of their strong grip.

Key observable traits include:

Size and shape: Visible to the naked eye as a moving speck; larger than a grain of sand but smaller than a flea.
Color variation: Light gray when unfed, turning reddish‑brown after feeding.
Movement pattern: Rapid, erratic crawling over the scalp and behind the ears; rarely remains stationary for long.
Attachment points: Prefer the base of hair shafts near the scalp, especially behind the ears, at the nape, and along the hairline.
Eggs (nits): Oval, 0.8 mm long, firmly cemented to the hair shaft; appear as white or yellowish pinheads and are often mistaken for dandruff, but unlike debris they cannot be brushed away easily.

Recognizing these characteristics during a self‑inspection enables accurate detection of live lice and distinguishes them from shed skins, dandruff, or other debris.

Characteristics of Nits («Lice Eggs»)

Nits, the eggs of head‑lice, present distinct physical traits that enable reliable identification during a personal inspection. They are oval, measuring approximately 0.8 mm in length and 0.3 mm in width, which makes them visible to the naked eye under adequate lighting. The shells are translucent to pale yellow when freshly laid, darkening to amber or brown as the embryo matures. A key diagnostic feature is the firm attachment to a single hair shaft; a nit is glued near the scalp, typically within ¼ inch of the root, and will not be dislodged by gentle pulling. The attachment point often appears as a tiny, white or yellowish, cigar‑shaped object that lies at an angle to the hair, contrasting with the hair’s natural direction.

Distinguishing nits from dandruff or hair‑fiber debris relies on several criteria:

Location: Nits remain close to the scalp; dandruff flakes fall away from the hair.
Mobility: Nits are immobile; dandruff can be brushed off.
Surface texture: Nits have a smooth, glossy coating; dandruff appears flaky and matte.
Color shift: Nits change color over time; dandruff does not undergo a predictable darkening.

During a self‑examination, use a fine‑toothed lice comb on wet, conditioned hair, working from the scalp outward. After each pass, inspect the comb teeth on a white surface; any attached oval objects matching the description above indicate the presence of nits. A magnifying lens (10×) can improve detection of early‑stage eggs, which may appear almost colorless. Removing nits requires careful mechanical extraction; chemical treatments alone do not dissolve the cement that secures the egg to the hair shaft. Regular inspection, performed every two to three days, ensures early detection before hatching occurs, reducing the risk of infestation spread.

Characteristics of Empty Egg Casings

Empty egg casings, commonly called nits, are the most reliable visual indicator of an infestation. They are oval, measuring 0.8 mm × 0.4 mm, and have a smooth, translucent to whitish appearance. The shell is hard and resistant to removal, remaining attached to the hair shaft even after the embryo has hatched.

Key characteristics include:

Attachment point: Cemented within 1 mm of the scalp, usually on the base of the hair shaft. This proximity causes the casing to lie flat against the skin, making it difficult to slide along the hair.
Color change: Fresh nits appear pale yellow; older, empty casings turn opaque or grayish as the shell thickens and the interior dries.
Shape: Uniformly oval with a slightly pointed end where the operculum (opening) was located. The opposite end often shows a small, rounded scar from the emerging nymph.
Texture: Rigid and brittle; applying gentle pressure with a fingernail will not crush the shell, but a slight flex can reveal a hollow interior.

When inspecting one’s own head, locate these features by parting hair close to the scalp and using a fine-tooth comb. Examine the hair in bright, natural light or with a magnifying lens. The presence of multiple empty casings, especially in clusters near the nape, behind the ears, or at the hairline, confirms that lice were present recently, even if live insects are no longer visible.

Other Symptoms and Indicators

Itching and Irritation

Itching and irritation are the most immediate indicators that a head‑lice infestation may be present. The sensation arises from the saliva injected by feeding nymphs, which triggers a localized allergic response. Persistent scratching often creates secondary skin lesions, making the scalp more vulnerable to infection.

When inspecting oneself, follow these precise actions:

Part the hair in sections as small as one centimeter; use a fine‑tooth lice comb on each part.
Observe the scalp for redness, raised bumps, or small puncture marks where nymphs have fed.
Look for tiny white or yellowish specks (nits) attached firmly to hair shafts within two centimeters of the scalp; these are often mistaken for dandruff but do not flake off easily.
Note any areas where the skin feels sore or inflamed after scratching; such zones may harbor hidden lice.

If itching intensifies after a brief period of exposure to another person’s hair, consider the possibility of a recent transmission. Immediate visual confirmation, combined with the described symptoms, provides reliable evidence of an infestation and guides the need for treatment.

Red Bumps or Sores

Red bumps or sores on the scalp often indicate an active lice infestation. The irritation results from the bite of a nymph or an allergic reaction to saliva deposited during feeding. When performing a personal inspection for lice, focus on these skin changes as a primary clue.

During the examination, part the hair close to the scalp with a fine-toothed comb. Observe any areas where the skin appears inflamed, raised, or covered with tiny, blood‑stained spots. These lesions usually cluster around the nape of the neck, behind the ears, and at the hairline. If the bumps are accompanied by a crawling sensation, the likelihood of lice presence increases.

Key points for accurate detection:

Use a bright light to enhance visibility of scalp irritation.
Run the comb slowly from the roots to the tips, cleaning the teeth after each pass.
Examine the comb for live insects, translucent nymphs, or dark brown eggs (nits) attached to hair shafts.
Record the location and severity of any lesions; multiple sites suggest a widespread infestation.

Distinguishing lice‑related sores from other dermatological conditions is essential. Contact dermatitis, fungal infections, and psoriasis can also produce red lesions, but they typically lack the characteristic itching triggered by lice bites and do not accompany visible nits. If uncertainty remains, consult a healthcare professional for microscopic analysis or appropriate treatment.

Swollen Lymph Nodes

When inspecting one’s own scalp for lice, attention to swollen lymph nodes can provide valuable clinical insight. Enlarged lymph glands in the neck or behind the ears often signal a secondary bacterial infection, an allergic response to bites, or a systemic reaction to prolonged infestation. Recognizing this sign alongside the presence of live insects or nits helps differentiate simple pediculosis from more complex health concerns that may require medical intervention.

A systematic self‑examination should include:

Part the hair into small sections using a fine‑toothed comb; inspect each strand for live lice, nits attached to the hair shaft, and any signs of scratching.
Observe the scalp for redness, crusting, or lesions that could indicate secondary infection.
Palpate the cervical and occipital lymph nodes; note any tenderness, firmness, or swelling beyond normal size.
Record findings: number of live lice, density of nits, and presence of lymphadenopathy.

If swollen lymph nodes are detected, especially when accompanied by pain, fever, or extensive scalp irritation, seek professional evaluation promptly. Early treatment of bacterial complications reduces the risk of further tissue damage and accelerates resolution of the lice infestation.

Next Steps After Finding Lice

Confirming the Infestation

Detecting a lice infestation requires a systematic visual and tactile examination. Begin by separating the hair into small sections, using a fine-toothed comb or a specialized lice detection comb. Run the comb from scalp to tip, wiping each pass on a white surface such as paper or a towel. Visible nits (oval, white or tan eggs) attached firmly to hair shafts, especially within a quarter‑inch of the scalp, indicate an active infestation. Live lice appear as brown, mobile insects that move quickly when disturbed.

Key indicators to confirm infestation:

Live insects observed moving on the scalp or hair.
Nits firmly attached to hair strands, not easily removed by a gentle pull.
Presence of brown or black fecal spots (fecal pellets) on hair shafts or clothing.
Persistent itching, especially after washing, suggesting a reaction to bites.

If any of these signs are found, repeat the combing process after 24–48 hours to verify persistence, as newly hatched lice may appear. A thorough inspection of the entire head, including behind the ears and at the nape, ensures no area is overlooked.

Seeking Professional Advice

Professional consultation provides reliable identification of head‑lice infestations. Dermatologists, pediatricians, and certified lice‑removal specialists possess magnifying equipment and trained expertise that surpasses visual inspection alone.

When arranging an appointment, gather the following items: a recent photograph of the scalp, any previously used over‑the‑counter treatments, and a list of current medications. Present these details promptly to enable accurate assessment.

Typical clinical procedure includes:

Examination of hair and scalp under magnification.
Collection of suspected nits for microscopic verification.
Discussion of treatment options, including prescription shampoos, oral medication, or mechanical removal.

Choosing a provider involves verifying credentials, confirming experience with pediatric cases if applicable, and reviewing patient feedback. Insurance coverage often extends to dermatologist visits; some community health centers offer low‑cost services without insurance.

Follow‑up appointments confirm eradication and address reinfestation risk. If lice persist after initial treatment, the professional may adjust the regimen or recommend environmental decontamination measures.

Treatment Options Overview

Effective treatment after confirming an infestation requires a clear plan. Over‑the‑counter (OTC) products dominate the market, but prescription options exist for resistant cases.

Permethrin 1 % lotion – applied to damp hair, left for 10 minutes, then rinsed; repeat after 7–10 days to kill newly hatched nits.
Pyrethrin‑based shampoos – combined with piperonyl‑butoxide to enhance penetration; follow manufacturer’s timing instructions, usually a 10‑minute exposure.
Spinosad 0.9 % lotion – single application, no repeat needed for most strains; effective against permethrin‑resistant lice.
Ivermectin 0.5 % lotion – applied to dry hair, left for 10 minutes; suitable for children over 6 months and for cases unresponsive to other agents.
Malathion 0.5 % liquid – requires thorough saturation of hair and scalp; leave for 8‑12 hours before washing; reserved for multi‑drug‑resistant infestations.
Prescription oral ivermectin – single dose of 200 µg/kg; used when topical treatments fail or compliance is low.

Adjunct measures support chemical therapy:

Fine‑toothed lice comb – comb hair while wet and conditioned; repeat every 2–3 days for two weeks to remove live lice and viable nits.
Heat treatment – use a dryer on low heat for 10 minutes to kill lice on items that cannot be washed; avoid damaging heat‑sensitive fabrics.
Environmental decontamination – wash bedding, clothing, and personal items in hot water (≥ 50 °C) or seal in plastic bags for two weeks; vacuum carpets and upholstery to eliminate stray insects.

Selecting a regimen depends on age, allergy history, and resistance patterns. Consultation with a healthcare professional ensures appropriate dosage and monitoring of adverse reactions.