How can you tell if you have lice on your head?

Understanding Head Lice

What Are Head Lice?

Life Cycle of Lice

Lice infestations begin when adult females deposit eggs, called nits, on the hair shaft within a millimeter of the scalp. The eggs hatch in 7‑10 days, releasing nymphs that resemble smaller adults. Nymphs undergo three molts over 9‑12 days before reaching reproductive maturity. Fully grown lice live on the scalp for about 30 days, during which each female lays 5‑10 eggs per day. The entire cycle—from egg to reproducing adult—lasts roughly three weeks, allowing rapid population growth if untreated.

The life cycle determines observable signs. Eggs appear as tiny, oval, white or yellowish structures firmly attached to hair near the scalp. Nymphs and adults move quickly, causing itching from saliva injection. Visible lice may be seen crawling on hair or in the ears. A dense concentration of nits, especially when the hair is combed, strongly indicates an active infestation.

Detection relies on visual inspection and tactile cues. To examine a scalp:

Part hair in small sections, starting at the crown and moving outward.
Use a fine-toothed comb, pulling each strand to reveal nits or live insects.
Look for translucent or brownish lice on the comb teeth.
Note persistent itching, especially after washing or exposure to heat.

If any of these indicators are present, the lice life cycle is in progress and immediate treatment is required to interrupt egg development and prevent further spread.

Common Misconceptions

Accurate identification of a head‑lice infestation relies on observable signs rather than assumptions. Misinterpretations often delay treatment and increase spread.

The presence of dandruff proves lice are absent. Dandruff is a scalp condition unrelated to parasites; lice eggs (nits) cling to hair shafts and can coexist with flaky skin.
Itchy scalp alone confirms infestation. Itching may result from eczema, allergic reactions, or dry skin; lice cause localized itching around the neck and behind the ears, not generalized scalp irritation.
Finding a single white speck means no lice. A solitary white particle could be a nite, but without a brown or darker body attached it does not confirm an infestation; thorough inspection is required.
Over‑the‑counter shampoos guarantee eradication. Many products lack pediculicidal agents; only treatments containing permethrin, pyrethrin, or dimethicone are proven effective.
Adult lice are visible to the naked eye at all times. Adult lice are approximately 2–3 mm and may hide under hair layers; a magnifying glass or fine‑tooth comb improves detection.

Correct assessment involves combing wet hair with a fine‑tooth lice comb, inspecting the comb for live insects or nits attached within 1 mm of the scalp, and repeating the process over several days to capture newly hatched lice. Absence of live insects after multiple thorough examinations indicates the scalp is clear.

Recognizing the Signs and Symptoms

Itching and Discomfort

Severity of Itching

Itching intensity is a primary indicator when assessing a possible head‑lice infestation. Mild, occasional irritation often results from dry scalp or allergic reactions, while moderate to severe, persistent scratching points toward active pediculosis. The discomfort typically escalates several days after the first eggs hatch, as nymphs feed repeatedly.

Key characteristics of lice‑related itching:

Occurs primarily behind the ears and at the nape of the neck.
Intensifies in the evening or during periods of inactivity.
Is accompanied by a sensation of movement on the scalp, described as “crawling.”

Unlike dermatitis, lice‑induced itching does not improve with standard moisturizers and may be resistant to over‑the‑counter anti‑itch creams. If the scratching is frequent enough to cause visible redness, excoriations, or secondary infection, the severity suggests a substantial infestation that warrants immediate treatment.

Evaluating the pattern, location, and persistence of itch provides a reliable method for distinguishing lice from other scalp disorders without relying on visual inspection alone. Prompt identification based on these symptoms enables timely intervention and reduces the risk of spread.

Locations of Itching

Itching caused by head‑lice infestations appears in characteristic regions. The most common sites are:

Scalp, especially near the crown and temples
Behind the ears, where lice hide in warm, protected hair
Neck and upper shoulder area, where hair may extend
Hairline and frontal fringe, where nits attach to new growth

The sensation usually intensifies after heat, sweating, or scratching, because lice become more active. It tends to be localized rather than widespread, distinguishing it from allergic dermatitis that often affects the entire scalp. Presence of tiny, movable specks (nits) attached to hair shafts in these areas further confirms the diagnosis.

Visible Lice and Nits

How to Spot Live Lice

Live lice are small, wingless insects that can be seen moving on the scalp or hair shafts. Their bodies measure about 2–3 mm, appear grayish‑brown, and have six legs with distinctive clawed ends. When you examine a head, look for the following indicators:

Active crawling on the scalp, especially near the hairline, behind the ears, and at the nape of the neck.
Rapid, jerky movements; lice do not remain motionless for long when disturbed.
Presence of live insects clinging to individual hairs rather than being fixed to the shaft.
Small, translucent bodies that become darker after feeding on blood.

Visual inspection should be performed under bright lighting. Part the hair in sections as small as one‑inch strips, pulling each section away from the scalp to expose the hair roots. Use a fine‑tooth comb, moving it slowly from the scalp outward; any live lice will be caught in the teeth and may be observed directly. After combing, place the comb on a white surface and examine it closely.

If you feel persistent itching accompanied by a tickling sensation, the likelihood of live lice increases. However, itching alone does not confirm infestation; direct observation remains the definitive method. Regular, systematic checking of the scalp and hair is the most reliable way to identify live lice promptly.

Identifying Nits («Eggs»)

Nits, the oval eggs laid by head‑lice, are the most reliable indicator of an infestation. They attach firmly to individual hair shafts close to the scalp, usually within one to two centimeters of the skin. Their size ranges from 0.8 mm to 1 mm, making them visible to the naked eye as tiny, whitish‑to‑tan specks.

Key characteristics for identification:

Shape: Oval, slightly elongated; not round like dandruff.
Color: Initially translucent or pale yellow; darkens to brown or gray as the embryo develops.
Attachment: Cemented to the hair shaft; attempts to slide them with a fingernail usually fail.
Location: Concentrated behind the ears, at the nape of the neck, and along the hairline; less common on the crown unless the infestation is severe.
Movement: Nits remain immobile; any perceived “wiggling” is usually a hair strand, not an egg.

To confirm presence, part the hair in small sections and examine the base of each strand with a fine‑toothed comb or a magnifying lens. A steady, slow pull of the comb should lift nits from the shaft without breaking the hair. If dozens of cemented specks are observed, the diagnosis is definitive.

In contrast, dandruff flakes are larger, crumbly, and easily dislodged, while seborrheic dermatitis scales are greasy and not attached to individual hairs. Distinguishing these conditions prevents unnecessary treatment and ensures appropriate intervention.

Color and Shape of Nits

Nits, the eggs laid by head‑lice, provide the most reliable visual clue for an infestation. They attach firmly to each hair shaft near the scalp and remain visible for several days after being laid.

Typical colors of nits

Light tan or ivory when freshly deposited; the shell appears translucent.
Dark brown or black after a few days, as the embryo matures and the shell hardens.
Grayish‑white after hatching, resembling a small shell fragment.

Characteristic shapes

Oval to slightly elongated, measuring 0.8 mm – 1.0 mm in length.
Smooth, dome‑shaped surface without visible cracks.
Flattened base that conforms tightly to the hair shaft, often appearing as a “satellite” attached at a 90‑degree angle.

Distinguishing nits from dandruff or hair‑shaft debris relies on these color and shape cues. Dandruff flakes are irregular, easily removable, and lack a firm attachment. Hair casts are cylindrical, slide along the shaft, and differ in texture. Observing the described hue and form of nits confirms the presence of head lice.

Nits vs. Dandruff or Hair Product Residue

Nits are the tiny, oval eggs laid by head‑lice. They measure about 0.8 mm, appear white‑to‑tan, and are firmly glued to the hair shaft within a few millimeters of the scalp. Dandruff flakes are usually larger, powdery, and detach easily when the hair is brushed or washed. Residue from styling products forms sticky, sometimes glittering particles that can cling to hair but lack the consistent oval shape of nits.

Key visual and tactile differences:

Attachment: Nits remain attached even after vigorous combing; dandruff and product buildup fall off.
Location: Nits cluster near the scalp, especially behind the ears and at the nape; dandruff is distributed across the scalp and shoulders.
Shape: Nits are uniformly oval; dandruff is irregular and flaky; product residue may be irregular but often appears as clumps.
Color: Live nits are translucent or slightly yellow; dead nits turn grayish; dandruff is white or gray; product residue matches the product’s color.
Feel: Nits feel hard and immovable; dandruff feels soft and powdery; product residue feels greasy or sticky.

To confirm the presence of lice, use a fine‑toothed lice comb on wet, conditioned hair. Move the comb slowly from scalp outward; each pass should reveal any attached eggs. Absence of the characteristics listed above, combined with a clean comb, indicates that flakes or residue, not lice, are present.

Sores and Infections

Scratch Marks and Scabs

Scratch marks and scabs often appear when a person repeatedly scratches a scalp that is irritated by lice activity. The insects bite the skin to feed on blood, causing tiny, itchy welts. Continuous scratching can break the skin surface, leaving linear or circular abrasions and, eventually, scab formation.

Key indicators related to this symptom include:

Linear or irregular scratches concentrated near the hairline, temples, or nape.
Small, reddish papules that develop into crusted scabs after several days.
Presence of fresh blood or oozing from the edges of the wounds, suggesting ongoing irritation.
Increased scratching intensity during the evening or after a warm shower, when lice are most active.

Distinguishing lice‑induced lesions from other scalp conditions requires a visual examination of the hair shafts. Live or dead lice, nits attached to the base of hair strands, and a “blue‑gray” dot at the nits’ attachment point confirm infestation. In the absence of these findings, other dermatological issues, such as dermatitis or fungal infection, may be responsible for the marks.

Secondary Bacterial Infections

Detecting head‑lice infestation often focuses on visual cues such as live insects, nits attached to hair shafts, or itching caused by bites. However, the presence of lice can create conditions that invite secondary bacterial infections, which may complicate the clinical picture and require separate management.

Lice feed by piercing the scalp, causing microscopic wounds. These breaches allow skin‑resident bacteria—primarily Staphylococcus aureus and Streptococcus pyogenes—to enter deeper tissues. Infection typically manifests within a few days of intense scratching or prolonged irritation.

Common signs of a bacterial complication include:

Red, warm, and swollen areas surrounding bite sites
Pus or clear fluid discharge from lesions
Increased pain or tenderness beyond normal itching
Fever, chills, or malaise in severe cases

If any of these symptoms appear, prompt medical evaluation is essential. Culturing the exudate can identify the causative organism, guiding targeted antibiotic therapy. Empiric treatment often starts with oral agents effective against gram‑positive cocci, such as dicloxacillin or clindamycin, while awaiting culture results.

Preventive measures reduce the risk of infection:

Maintain scalp hygiene; wash hair regularly with mild shampoo
Discourage scratching by using soothing lotions or antihistamines
Treat the lice infestation promptly with approved pediculicides
Clean personal items (combs, hats, bedding) with hot water or disinfectant

Monitoring the scalp after lice eradication helps detect early bacterial involvement. Persistent redness or pus formation warrants immediate attention to prevent spread and possible complications such as cellulitis or abscess formation.

How to Perform a Head Check

Tools You Will Need

Fine-Toothed Comb

The fine‑toothed comb is the most reliable mechanical method for confirming the presence of head lice. Its dense teeth, spaced 0.2–0.3 mm apart, capture both adult insects and their eggs during a single pass.

To use the comb effectively, follow these steps:

Wet the hair thoroughly and apply a liberal amount of conditioner to reduce tangling.
Start at the scalp, placing the comb as close to the skin as possible.
Pull the comb slowly toward the hair tip, ensuring each tooth contacts the hair shaft.
After each pass, wipe the teeth on a white tissue or rinse them in water to reveal any captured specimens.
Repeat the process on all sections of the head, especially behind the ears and at the nape of the neck.

Examination of the comb after each stroke determines the outcome:

Live lice appear as brown, mobile insects; they may be seen moving on the teeth.
Viable eggs (nits) are oval, firmly attached to the hair shaft and often visible as white or yellowish specks.
Empty shells (nits that have hatched) are translucent and can be distinguished from viable eggs by their lack of attachment.

A single thorough combing session may miss early infestations; repeat examinations every 2–3 days for a week to ensure accurate detection. If live lice or viable nits are found, immediate treatment is warranted.

Good Lighting

Good lighting is essential for detecting lice because it reveals the tiny, translucent bodies and nits that blend with hair. Bright, white illumination eliminates shadows that can hide insects, allowing the examiner to see the head’s surface clearly.

Effective lighting should be:

Direct, not diffused, to create contrast between lice and hair.
White or daylight‑balanced (5000–6500 K) to render true colors.
Sufficiently bright (at least 500 lux) to magnify details without glare.

When inspecting a scalp under proper lighting, follow these steps:

Position a lamp or flashlight close to the hair, holding it at a 45‑degree angle to reduce glare.
Separate sections of hair with a fine‑toothed comb, moving the comb slowly while the light shines on each strand.
Examine each section for live lice (brown, crab‑shaped) and nits (oval, attached near the scalp).
Record any findings; repeat the process on all regions, especially behind ears and at the nape.

Consistent use of bright, white light combined with systematic combing provides a reliable method for confirming the presence of head lice.

Step-by-Step Inspection Process

Sectioning the Hair

Sectioning the hair creates manageable portions that expose the scalp and individual strands, making it easier to spot lice and nits. By separating the hair into small sections, you eliminate the visual barrier created by dense or long hair, allowing a thorough examination with a fine-toothed comb or magnifying lens.

To section effectively:

Divide the hair into 1‑ to 2‑inch sections using a clean comb or hair clips.
Secure each section with a clip before moving to the next area.
Start at the crown, where infestations commonly begin, and work outward toward the temples and nape.
Comb each section slowly, pulling the comb through from scalp to tip; inspect the comb after each pass for live insects or oval, white‑to‑brown eggs attached to the hair shaft.
Repeat the process on the entire scalp, ensuring no area is missed.

Consistent sectioning during each inspection increases detection accuracy and reduces the likelihood of overlooking hidden lice. Regular practice, combined with proper treatment, helps confirm whether an infestation is present and monitors progress during eradication.

Focusing on Key Areas

When examining a scalp for infestation, concentrate on the regions where lice most often attach. These include the base of the hair near the neck, the area behind the ears, the crown, and the hairline at the forehead. Focused inspection of these zones increases the likelihood of detecting both adult insects and their eggs.

Visual cues are limited to three reliable indicators: the presence of live insects moving quickly across the hair, small oval nits firmly attached to hair shafts within a half‑centimeter of the scalp, and persistent itching caused by bite reactions. Nits located farther from the scalp are usually shed eggs and not evidence of an active infestation.

Effective detection relies on proper tools and conditions. Use a fine‑toothed comb designed for lice, work through damp hair under bright natural light or a magnifying lamp, and examine each strand systematically. After each pass, wipe the comb on a white surface to reveal any captured lice or nits.

If any of the described signs appear in the examined zones, the presence of head lice should be considered confirmed, and appropriate treatment measures must follow.

Behind the Ears

The region behind the ears frequently harbors the first signs of infestation because lice prefer warm, sheltered spots.

When inspecting this area, look for three indicators:

Small, oval‑shaped eggs firmly attached to hair shafts, typically yellow‑white or brown.
Live insects about the size of a sesame seed, moving quickly when the scalp is disturbed.
Irritation such as redness, itching, or tiny bite marks on the skin.

To conduct a reliable examination, follow these steps:

Separate the hair near the ear with a fine‑toothed comb or a disposable brush.
Pull the hair away from the scalp to expose the skin surface.
Scan the hair and skin with a magnifying lens, moving from the hairline outward to the area behind the ear.
Repeat the process on both sides, using a bright light source to enhance visibility.

If any of the listed signs are present, isolate the affected individual, wash clothing and bedding at high temperature, and begin an appropriate treatment regimen according to medical guidance.

Nape of the Neck

The nape of the neck is a common site for early lice detection because hair density and warmth create a favorable environment for eggs and nymphs. Visual inspection should begin at the base of the skull, moving outward along the hairline. Look for live insects, which appear as small, brownish specks about the size of a sesame seed, and for translucent, oval-shaped eggs (nits) attached firmly to hair shafts.

Key indicators at the nape:

Nits positioned within ¼ inch of the scalp; loose or easily removable eggs suggest contamination rather than infestation.
Live lice moving quickly when the hair is brushed or when the scalp is disturbed.
Red, irritated skin or small, raised bumps caused by scratching.

Effective examination technique:

Part the hair in sections, exposing the skin and hair roots.
Use a fine-toothed lice comb, pulling the comb from the scalp outward in a steady motion.
After each pass, wipe the comb on a white tissue to reveal any captured insects or nits.
Repeat the process on both sides of the neck, ensuring thorough coverage of the nape area.

If any of the described signs are present, immediate treatment and a repeat inspection after 7‑10 days are recommended to confirm eradication.

What to Do If You Find Something

If you spot moving insects or tiny white specks attached to hair shafts, act immediately. First, verify the finding by using a fine-toothed comb on a well‑lit area; live parasites will move, while nits remain firmly attached near the scalp. Once confirmed, begin treatment without delay.

Apply an FDA‑approved pediculicide according to the product label, covering the entire scalp and hair length.
Rinse after the recommended exposure time, then repeat the application after seven days to eradicate any newly hatched insects.
Comb the hair with a nit‑comb every 2–3 days for two weeks, removing dead lice and nits each session.
Wash all recently worn clothing, bedding, and towels in hot water (≥130 °F) and dry on high heat; items that cannot be laundered should be sealed in plastic bags for two weeks.
Vacuum carpets, upholstered furniture, and vehicle seats to eliminate stray eggs.
Notify close contacts—family members, classmates, caregivers—so they can inspect and treat if necessary.
Schedule a follow‑up inspection after treatment to ensure no survivors remain; repeat the combing process for an additional week if any are found.

Prompt, systematic action eliminates the infestation and prevents re‑contamination.

Who Is at Risk?

Common Transmission Methods

Head-to-Head Contact

Head‑to‑head contact is the most common mechanism by which lice spread from one person to another. When two scalps touch, adult lice or nymphs can transfer directly, bypassing clothing or other barriers. This transmission route explains why activities such as sharing helmets, scarves, or close‑range play increase the risk of infestation.

If a person has been involved in frequent head contact, look for the following indicators:

Small, white or brown specks attached to hair shafts, often near the scalp; these are lice eggs (nits) that appear firmly glued.
Live insects moving quickly across the hair, especially behind the ears or at the nape of the neck.
Persistent itching that intensifies several hours after contact, caused by an allergic reaction to lice saliva.
Red or irritated patches on the scalp, sometimes accompanied by tiny sores from scratching.

Detecting an infestation promptly after a bout of close contact reduces further spread. Examine the hair under bright light, using a fine‑toothed comb to separate strands and reveal hidden lice. If any of the signs above are present, initiate treatment and inform anyone else who may have shared the same head‑to‑head exposure.

Sharing Personal Items

Sharing personal items such as combs, hats, hairbrushes, headphones, and pillowcases creates a direct pathway for head‑lice transmission. When these objects pass from one person to another, viable nits or adult lice can cling to the fibers and be transferred to a new host without any visible contact.

Key personal items to keep separate:

Combs and brushes
Hats, caps, scarves, and headbands
Earphones and earbuds
Hair accessories (clips, barrettes)
Bedding and pillowcases

Detecting an infestation relies on observable signs rather than speculation. Look for the following indicators:

Persistent itching, especially behind the ears and at the nape of the neck, caused by allergic reactions to lice saliva.
Live lice crawling on the scalp or hair shafts; they move quickly and may drop when the hair is brushed.
Nits firmly attached to hair strands within a quarter inch of the scalp; they appear as tiny, oval, white or yellowish specks and cannot be removed by simple brushing.

If any of these signs appear, isolate and launder all shared items in hot water (minimum 130 °F) and dry on high heat. Inspect personal belongings before reuse, and consider using a fine‑toothed lice comb on dry hair to confirm the presence or absence of nits. Prompt identification and strict separation of personal items reduce the risk of further spread.

Risk Factors and Demographics

Children in Schools and Daycares

Detecting head‑lice infestations among school‑age children and daycare attendees is essential for preventing rapid spread in close‑contact environments. Early identification relies on observable clues and systematic inspection.

Typical indications include:

Small, white or tan eggs (nits) attached firmly to hair shafts within a half‑inch of the scalp.
Live insects moving quickly when the hair is brushed or disturbed.
Persistent itching, especially behind ears or at the nape of the neck.
Red, irritated patches on the scalp or neck.

A thorough examination involves parting the hair in sections as close to the scalp as possible, using a fine‑toothed comb under bright light. Each comb pass should be inspected for live lice or nits; repeating the process several times improves accuracy. If the child reports recent itching, the inspection should focus on the areas most commonly affected.

When a possible case is identified, staff must isolate the child briefly, notify parents or guardians, and follow the institution’s protocol for treatment and notification of other families. Documentation of findings, including photographs of nits when permissible, supports consistent response and helps track any outbreak within the facility.

Close-Contact Activities

Close‑contact activities such as team sports, group dancing, or shared sleeping arrangements create opportunities for head‑to‑head contact, which is the primary transmission route for head lice. When a child or adult participates in these activities, the risk of infestation rises sharply, making regular scalp inspection essential.

After engaging in any activity that involves direct contact with another person’s hair, examine the scalp for the following indicators:

Small, mobile insects about the size of a sesame seed moving among hair shafts.
Light‑colored or dark brown oval eggs (nits) attached firmly to the base of hair strands, typically within a half‑inch of the scalp.
Persistent itching, especially behind the ears or at the nape of the neck, that does not subside with typical shampooing.
Tiny white or yellowish fecal spots on hair or clothing, visible when hair is brushed.

Prompt detection following close‑contact events reduces the likelihood of spreading the infestation to others and allows immediate treatment. Regular checks after such activities are a practical preventive measure.

Next Steps After Discovery

Confirming an Infestation

Detecting a head‑lice infestation requires a systematic visual examination. The primary indicators are live insects and their eggs (nits) attached to hair shafts.

Live lice: Small, tan or gray insects about the size of a sesame seed. They move quickly when the scalp is disturbed.
Nits: Oval, firm, and usually yellow‑white. They are cemented to the hair close to the scalp, typically within ¼ inch of the skin.

A thorough inspection should include the following steps:

Prepare the environment – Work in a well‑lit area; natural daylight or a bright lamp reduces visual errors.
Separate hair – Use a fine‑tooth nit comb or a wide‑tooth comb to part the hair into sections, exposing the scalp.
Examine the base of each strand – Look for nits attached at a 45‑degree angle to the hair shaft; nits lying flat are likely shed shells, not active eggs.
Check typical sites – Focus on the crown, behind the ears, neck line, and near the hairline, where lice prefer to congregate.
Observe movement – Gently lift a strand; if a live louse scuttles away, the infestation is confirmed.

Additional clues include persistent scalp itching, especially after a few days of exposure, and the sensation of a “tickling” feeling on the scalp. Absence of these signs does not rule out an early infestation; repeat the inspection after 48 hours if suspicion remains.

Confirming the presence of both live lice and viable nits constitutes definitive evidence of an infestation, prompting immediate treatment and environmental decontamination.

Seeking Professional Advice

Professional consultation should be considered when visual inspection yields uncertainty or when symptoms persist despite over‑the‑counter attempts. A qualified clinician or trained lice‑removal specialist can confirm infestation with greater certainty than a layperson’s examination.

Signs that merit expert evaluation include:

Persistent itching accompanied by visible nits attached to hair shafts near the scalp.
Small, mobile insects observed moving quickly across the scalp or clothing.
Re‑occurring symptoms after initial treatment, suggesting resistance or reinfestation.

During an appointment, the practitioner will use a fine‑toothed lice comb, magnification devices, and, if necessary, a handheld microscope to examine hair strands and scalp skin. The assessment may involve:

Systematic sectioning of hair to locate live lice and viable eggs.
Documentation of infestation density to guide treatment intensity.
Discussion of potential secondary skin irritation or infection.

A professional diagnosis offers several advantages: precise identification eliminates guesswork, prescription‑strength pediculicides or non‑chemical treatments can be applied safely, and a structured follow‑up schedule reduces the risk of recurrence. Additionally, clinicians can advise on environmental decontamination measures for bedding, clothing, and personal items.

When selecting a provider, verify credentials such as board certification in dermatology or certification from a recognized lice‑removal program. Confirm that the practice accepts your insurance plan or offers transparent out‑of‑pocket pricing. Confidential handling of personal health information should be standard practice.

Treatment Options Overview

Lice infestations require prompt and effective intervention. Treatment choices fall into three categories: chemical agents, mechanical removal, and environmental measures.

Over‑the‑counter pediculicides such as permethrin 1 % lotion or pyrethrin‑based products are applied to dry hair, left for the recommended time, then rinsed. Follow‑up applications after 7–10 days eliminate newly hatched nymphs.
Prescription medications include malathion 0.5 % lotion, benzyl alcohol 5 % lotion, and ivermectin 0.5 % lotion. These options are reserved for resistant cases or younger children where OTC options are unsuitable.
Manual removal employs a fine‑toothed nit comb on wet, conditioned hair. Repeated combing every 2–3 days for two weeks eradicates live insects and eggs without chemicals.

Alternative remedies—such as tea tree oil, neem oil, or dimethicone‑based lotions—lack consistent regulatory approval but may be considered when conventional agents are contraindicated.

Environmental control reduces re‑infestation risk. Wash bedding, hats, and clothing in hot water (≥ 130 °F/54 °C) and dry on high heat for at least 20 minutes. Non‑washable items can be sealed in plastic bags for 48 hours to starve lice. Vacuum carpets and upholstered furniture, and avoid sharing personal items.

Effective management combines one or more of these strategies, tailored to the individual’s age, health status, and resistance patterns. Regular inspection after treatment confirms success and prevents recurrence.