What do head lice look like and what should you look for?

The Head Louse Life Cycle

Nits (Lice Eggs)

Nits are the eggs laid by head lice and form the most reliable indicator of an infestation. They appear as tiny, oval‑shaped structures about 0.8 mm long, roughly the size of a pinhead. The shell is smooth, translucent to white, and often takes on a yellowish hue as it matures. Each nit is attached firmly to a single hair shaft by a cement‑like substance, making it difficult to remove by combing alone.

Detection focuses on the hair base and behind the ears, where lice prefer to lay eggs. When examined under good lighting, nits can be distinguished from dandruff or debris by their firm attachment; a gentle pull on a suspected nit will not dislodge it, whereas flakes will fall away. The presence of a line of nits extending from the scalp toward the hair tip suggests a recent laying, while older nits may appear empty and gray after the embryo hatches.

Key signs to look for:

Oval, white or yellowish bodies glued to hair shafts within ¼ inch of the scalp.
A “capped” appearance where the nit’s top is slightly domed.
Multiple nits aligned in a row along a single hair strand.
Resistance to removal when gently tugged with a fine‑toothed comb.

Prompt identification of nits enables timely treatment and prevents the spread of live lice. Regular inspection, especially after close contact with others, remains the most effective control measure.

Nymphs (Young Lice)

Nymphs, the immature stage of head lice, are smaller than adult insects, measuring about 1 mm in length. Their bodies are translucent to light gray, becoming slightly darker after feeding. Unlike the fully developed, darker brown adults, nymphs lack the pronounced, curved abdomen and the larger, more visible eyes.

When searching for young lice, focus on the following characteristics:

Size: approximately half the length of an adult.
Color: pale, almost invisible against hair shafts.
Mobility: slower movement; they often remain near the scalp where warmth is constant.
Location: clustered close to hair roots, especially behind the ears and at the nape of the neck.
Eggs (nits) nearby: presence of freshly laid, whitish nits indicates recent hatching and the likely presence of nymphs.

Examine hair under bright light, using a fine-toothed comb to separate strands and reveal hidden nymphs. Their subtle appearance requires thorough, systematic inspection to avoid missing early infestations.

Adult Lice

Adult head lice are approximately 2–3 mm long, resembling tiny, flat, cigar‑shaped insects. Their bodies are gray‑brown, sometimes appearing lighter after feeding. Six legs end in claw‑like tarsi that cling tightly to hair shafts. The head bears a pair of antennae, each with five segments, visible under magnification. Adult females are slightly larger than males and carry a single, oval egg (nits) attached to the hair near the scalp.

When inspecting a scalp, look for the following indicators of adult lice:

Live insects moving slowly across hair or crawling on the scalp.
A brownish, translucent body that may become clearer after a blood meal.
Presence of eggs with a shiny, oval shape at a 45‑degree angle to the hair shaft.
Irritation or itching caused by the lice’s saliva, often leading to scratching.
Small, reddish bite marks on the neck, ears, or shoulders.

Detection is most reliable with a fine‑toothed comb on damp, conditioned hair. Separate sections, comb from scalp outward, and examine the comb teeth for lice or nits. A thorough examination should cover the entire head, including behind the ears and at the nape of the neck, where adult lice tend to congregate.

Visual Identification of Head Lice

What Do Nits Look Like?

Nits are the eggs of head lice and have a distinct appearance that differentiates them from normal hair debris. They are oval, measuring about 0.8 mm in length, and resemble tiny, translucent or slightly yellowish beads. The shell is hard and glossy, often appearing white or pale brown when freshly laid, then darkening to a brownish hue as the embryo develops. Nits are firmly attached to the hair shaft, typically within ¼ inch of the scalp, using a strong cement that cannot be removed by brushing alone.

Key visual cues for identifying nits:

Shape: Oval, smooth, and slightly elongated.
Color: Initially white or off‑white; turns brown or gray with age.
Location: Aligned along the hair shaft close to the scalp, especially near the nape, behind the ears, and at the crown.
Attachment: Cemented firmly; attempts to slide a nit along the hair will encounter resistance.
Cluster pattern: Often found in groups of several eggs, forming a line or small cluster.

Distinguishing nits from dandruff or hair fibers is essential. Dandruff flakes are larger, irregular, and easily removed, while hair fibers lack the consistent oval shape and cemented attachment. Inspecting the scalp under good lighting, using a fine-tooth comb, and pulling hair strands gently can reveal nits that are otherwise hidden. Early detection relies on recognizing these specific characteristics.

Size and Shape

Head lice are tiny insects, typically measuring between 1 mm and 3 mm in length. Their bodies are elongated and flattened, allowing them to cling tightly to hair shafts. The adult’s color ranges from light brown to grayish‑white; when they feed, the abdomen may appear slightly engorged and darker.

Key visual cues for size and shape:

Length: about the size of a sesame seed; easily visible only with magnification or close inspection.
Body: oval, dorsoventrally flattened, lacking wings.
Head: small, rounded, with six short legs ending in claw‑like tarsi that grasp hair.
Nymphs: translucent, less than 1 mm, resembling miniature adults.
Eggs (nits): oval, 0.8 mm long, firmly attached to the hair shaft at a 45‑degree angle; the shell is smooth and translucent, becoming more opaque as the embryo develops.

When scanning a scalp, focus on the hair line, behind ears, and the nape of the neck. Look for moving insects of the described dimensions, as well as the characteristic oval nits positioned close to the scalp.

Color

Head lice (Pediculus humanus capitis) are tiny insects, typically 2–4 mm long, whose coloration provides a primary visual cue for detection.

Adult lice: translucent to light brown, often appearing grayish when unfed. After a blood meal, the abdomen becomes engorged and takes on a reddish‑brown hue.
Nymphs (juvenile stages): markedly paler, ranging from off‑white to very light gray, making them harder to spot on dark hair.

The color contrast between lice and hair varies with hair shade. On dark hair, the gray‑brown tones of adults stand out, whereas the near‑transparent nymphs may blend with the shaft. On light hair, the reddish abdomen of a fed adult becomes more noticeable, while the pale nymphs can be obscured.

Observing the scalp directly can reveal lice eggs (nits) that are typically yellow‑white and firmly attached to hair shafts. The combination of adult coloration, post‑feeding redness, and the distinct hue of nits enables accurate identification without reliance on other visual characteristics.

Location on Hair Shaft

Head lice spend most of their life on the hair shaft, preferring areas where the scalp is warm and the hair is dense. The insects cling to strands close to the skin, where they can feed and lay eggs without being dislodged.

Base of the scalp, especially behind the ears
Nape of the neck, where hair meets skin
Crown and top of the head, where hair is thickest
Sideburns and facial hair in children, if present

Adult lice move freely along the shaft but remain within a few centimeters of the scalp. Females embed their eggs (nits) at a 45‑degree angle, cementing them to the hair cuticle about 0.5 cm from the scalp. Nits farther from the scalp are often empty shells, indicating a past infestation rather than an active one.

Effective inspection requires a fine-toothed comb or magnifying lens. Separate hair into small sections, pull each strand taut, and scan from the scalp outward. Focus on the listed zones, noting any live insects, translucent nymphs, or firmly attached, oval nits. Early detection in these locations prevents spread and reduces the need for extensive treatment.

Differentiating Nits from Dandruff or Hair Product Residue

Head lice eggs, or nits, attach firmly to the hair shaft near the scalp. They appear as tiny, oval, translucent or white bodies, typically 0.8 mm long, and remain in a fixed position unless the hair is pulled. The attachment point is a cement‑like substance that resists easy removal; a gentle tug will not dislodge a true nit.

Dandruff consists of loose, flaky skin particles that detach readily from the scalp. Flakes are irregular in shape, range from white to yellowish, and fall off with brushing or shaking. They do not cling to the hair shaft and are easily brushed away.

Hair‑product residue, such as silicone or gel buildup, forms a sticky coating that may cling to strands but lacks the defined oval shape of a nit. Residue often appears as a glossy or matte film and can be removed with a thorough shampoo or clarifying wash.

Key distinguishing features:

Location: Nits sit within 1 cm of the scalp; dandruff and residue appear anywhere along the hair.
Attachment: Nits are glued to the shaft; flakes and residue are loose.
Shape and size: Nits are uniform, oval, and <1 mm; dandruff flakes are irregular and larger; residue is amorphous.
Mobility: Nits remain stationary; dandruff and residue shift with brushing or washing.

A magnifying lens or handheld microscope clarifies these differences. When in doubt, gently pull a suspected nit; a true egg will not separate without breaking the cement, whereas a flake or residue will come off cleanly.

What Do Nymphs Look Like?

Head lice nymphs are immature insects that emerge from eggs after about nine days. They measure roughly 1 mm in length, about half the size of adult lice, and appear translucent or pale gray until they feed. Their bodies are oval, flattened, and lack the pronounced dark brown coloration of mature specimens. Nymphs possess three pairs of legs, each ending in tiny claws adapted for grasping hair shafts.

When searching for nymphs, focus on the following visual indicators:

Small, almost invisible specks near the scalp, especially behind the ears and at the nape of the neck.
Light-colored, mobile dots that move slowly when the hair is disturbed.
Tiny, whitish shells (nits) attached close to the scalp; the presence of nits often signals nearby nymph activity.
Slight itching or tickling sensations that intensify after a few days of infestation.

Differentiating nymphs from adults relies on size, coloration, and movement speed. Adults are darker, larger (2–3 mm), and move more rapidly across hair strands. Nymphs remain near the scalp, feeding frequently and growing rapidly, typically reaching adulthood within a week of their first meal. Recognizing these characteristics enables early detection and prompt treatment.

Size and Color Progression

Head lice are tiny insects, typically measuring 2–3 mm in length when fully mature. Nymphs, the immature stages, are proportionally smaller: first‑instar nymphs are about 1 mm, second‑instar around 1.5 mm, and third‑instar roughly 2 mm. The size difference between stages aids identification when examining hair shafts closely.

Color changes accompany growth. Newly hatched nymphs appear almost translucent, allowing the underlying scalp color to dominate. As they feed and mature, their bodies develop a gray‑brown hue, becoming darker in the final adult stage. Eggs (nits) follow a distinct chromatic progression: freshly laid nits are creamy‑white, gradually turning yellowish as the embryo develops, then darkening to a brownish shade just before hatching. These visual cues—size increments from 1 mm to 3 mm and the shift from translucent to gray‑brown bodies, plus the white‑to‑brown transition of nits—provide reliable markers for detecting infestation.

What Do Adult Head Lice Look Like?

Adult head lice are small, wing‑less insects that survive on the human scalp. Their bodies measure roughly 2–3 mm in length, about the size of a sesame seed. The head is broader than the abdomen, giving a somewhat oval silhouette when viewed from above. Color ranges from light gray to brown, often appearing translucent when the insect is unfed and becoming darker after feeding on blood.

Key visual markers include:

Body shape: flattened, elongated thorax with a wider anterior region.
Eyes: two dark, oval compound eyes positioned on the head.
Antennae: three short segments ending in a blunt tip.
Legs: six legs, each ending in sharp claws adapted for gripping hair shafts.
Egg‑like structures: adult females may be seen near attached nits, which appear as tiny, oval, white or yellowish shells cemented to hair close to the scalp.

Adults cling to hair shafts near the scalp, especially behind the ears, at the nape of the neck, and around the crown. They move slowly, but can crawl quickly when disturbed. Their bodies become more opaque after a blood meal, giving a reddish hue that fades as digestion proceeds.

Recognizing these characteristics enables accurate identification of live lice, distinguishing them from nits or other debris on the hair.

Size

Head lice are tiny insects; their dimensions determine how easily they can be spotted.

Adult females measure roughly 2 mm to 3 mm in length, about the size of a sesame seed.
Adult males are slightly smaller, typically 2 mm long, comparable to a grain of sand.
Nymphs (immature lice) range from 1 mm to 2 mm, growing progressively larger with each molt.
Eggs (nits) are about 0.8 mm long, appearing as tiny, oval shells attached to hair shafts.

Because these measurements fall within the sub‑millimeter to few‑millimeter range, lice may be visible to the naked eye on a light‑colored scalp, but detection often requires close inspection or a magnifying device. Recognizing the specific size of each stage helps differentiate live lice from debris such as dandruff or hair fibers.

Color

Head lice (Pediculus humanus capitis) are small, wingless insects whose bodies typically appear grayish‑brown to tan when viewed with the naked eye. The coloration is uniform across the thorax and abdomen, making live insects difficult to distinguish from hair strands unless examined closely.

Eggs (nits) differ in hue. Freshly laid nits are creamy‑white and cling tightly to the hair shaft. As they mature, the shells become more opaque and may turn yellowish or light brown. After hatching, the empty shells, called nymphal casings, retain a translucent‑white appearance but often darken to a pale gray if they remain attached for weeks.

Key color indicators for detection:

Live lice: gray‑brown, sometimes appearing darker under direct light.
Fresh nits: creamy‑white, smooth, and firmly attached near the scalp.
Mature nits: yellow‑to‑light‑brown, slightly opaque.
Empty shells: translucent‑white, gradually turning gray with age.

When inspecting hair, focus on the base of the scalp where color contrast is most evident; nits are most visible against darker hair, while live lice stand out against lighter strands. Accurate identification relies on recognizing these specific color patterns.

Body Shape and Legs

Head lice are small, wingless insects about 2–4 mm long. Their bodies are flattened laterally, allowing them to move easily through hair shafts. The thorax is broader than the head, creating a tapered appearance toward the abdomen, which is segmented and slightly rounded. Color ranges from light gray to brown, often darkening after a blood meal.

Key features of the legs:

Six legs in three pairs, all attached to the thorax.
Front pair equipped with sharp claws that grasp hair strands.
Middle and rear pairs shorter, lacking claws but aiding in mobility.
Legs are relatively long compared to body size, giving the insect a “spider‑like” stance.
Each leg ends in a small, pointed tip that helps the louse cling to individual hairs.

When inspecting a scalp, look for:

Oval, tan‑brown bodies moving slowly along hair shafts.
Visible claws of the front legs, especially near the base of the head.
Nits (lice eggs) attached at a 45‑degree angle to hair strands, often near the scalp.

These morphological details enable reliable identification of head lice during visual examination.

Movement

Head lice are active parasites; their movement provides a reliable clue for detection. Adult lice crawl rapidly across hair shafts, typically covering a few centimeters per minute. They prefer the warm, moist environment near the scalp and travel in a zig‑zag pattern, often moving upward to reach the hair root where they feed.

When a louse is disturbed, it may drop from the hair and move quickly to a new location, creating a brief, visible motion. The insect’s body is elongated and flattened, allowing it to navigate the narrow space between strands. Nymphs exhibit the same crawling behavior but move more slowly and are less likely to be seen without magnification.

Observable signs of louse movement include:

A sensation of insects crawling on the scalp or in the hair, especially when the head is brushed or shaken.
Small, mobile specks that appear to shift position when the hair is examined from different angles.
Rapid, intermittent jumping of lice from one hair strand to another when the host’s head is tilted or when temperature changes.

Detecting these movements requires close visual inspection, preferably under bright light or with a magnifying device. Regularly combing the hair with a fine-toothed lice comb can expose the insects as they are forced to move, making their presence unmistakable.

Where to Look for Head Lice and Nits

Common Infestation Areas on the Scalp

Head lice are small, wingless insects about the size of a sesame seed, gray‑brown in color, with six legs ending in claw‑like tarsi. Their bodies are flattened, allowing them to move easily through hair shafts. Detection relies on visual identification of live lice, their translucent nymphs (nymphs), and the oval, brown eggs (nits) firmly attached to hair strands.

Infestation concentrates in specific scalp regions where hair is dense and temperature is stable. The most frequent sites include:

The area behind the ears, where hair is thick and less exposed to air.
The occipital region (the back of the head), especially the nape of the neck.
The hairline at the forehead, where hair meets the skin.
The crown, the central top of the scalp, often crowded with hair.
The sideburn area, where hair grows close to the face.

These zones provide optimal conditions for lice to feed, reproduce, and lay nits. Inspecting each area closely with a fine‑toothed comb or magnifying lens increases the likelihood of spotting live insects, immature stages, or attached eggs. Early identification in these common locations enables prompt treatment and prevents further spread.

Behind the Ears

Head lice are tiny, wing‑less insects about the size of a sesame seed (2–3 mm). Their bodies are gray‑brown, flattened, and have six legs ending in claw‑like hooks that cling to hair shafts. Adult lice move quickly, so they may be difficult to see unless the scalp is examined closely. Their eggs, called nits, appear as tiny, oval, white or yellowish shells attached firmly to the hair near the scalp; they are often mistaken for dandruff but cannot be brushed away easily.

When inspecting the area behind the ears, look for the following indicators:

Live lice crawling on the skin or hair at the hairline, especially where hair meets the neck.
Nits adhered to hair shafts within a half‑inch of the skin; they are angled upward and may be visible as a row of glossy specks.
Small, red bite marks or itching spots caused by lice feeding on blood.
Irritated or scaly skin resulting from constant scratching in the region.
A faint, musty odor that can accompany a heavy infestation.

A systematic examination should start at the hairline, run fingers through the hair behind the ears, and separate strands to expose any attached nits. Use a fine‑toothed comb designed for lice detection; a single pass through the area can reveal both adult insects and eggs. Early identification behind the ears is critical because this zone provides a protected environment where lice can multiply unnoticed.

Near the Nape of the Neck

Head lice are tiny, wing‑less insects about the size of a sesame seed (2–4 mm). Their bodies are flattened, grayish‑brown, and translucent when unfed; after feeding they appear darker and more opaque. Six legs end in claw‑like tarsi that cling to hair shafts.

When inspecting the area just above the shoulders—particularly the nape of the neck—look for the following indicators:

Live insects moving slowly across the hair or scalp.
Nits (lice eggs) firmly attached to hair strands within ¼ inch of the scalp; they are oval, white or yellowish, and do not slide easily when the hair is brushed.
Small, reddish‑brown specks of feces, often visible on hair shafts or the skin.
Persistent itching or irritation, especially after a few days of exposure.

Use a fine‑toothed comb on damp hair, pulling the hair taut while moving from the scalp outward toward the nape. Examine the comb after each pass for captured lice or nits. A magnifying lens can aid in distinguishing nits from hair debris. Early detection in this region prevents the spread of infestation throughout the hair.

Along the Hairline

Head lice are small, wingless insects about the size of a sesame seed. Adults measure 2–3 mm, are gray‑brown, and have six legs with claw‑like tarsi that grasp hair shafts. Nymphs (nymphs) appear as translucent versions of adults, becoming darker after feeding. Eggs (nits) are oval, about 0.8 mm long, firmly attached to the hair shaft at a 45‑degree angle.

The hairline is a common site for infestation because lice favor the warm, sheltered environment near the scalp. Visible indicators along this area include:

Live lice crawling near the forehead or temples, often moving quickly when the head is disturbed.
Nits stuck close to the scalp, typically within ¼ inch of the hair root; they appear as tiny, white or yellowish specks.
Small, reddish‑brown bite marks on the skin just behind the hairline, which may be accompanied by mild itching.
Thin, whitish shells that are difficult to remove without a fine‑tooth comb, especially in the frontal fringe.

Inspection should involve parting hair in sections, using a magnifying lens if necessary, and sweeping a fine‑tooth lice comb from the scalp outward along the hairline. Persistent detection of live insects or viable nits confirms the presence of an infestation and warrants treatment.

Tools for Detection

Detecting head‑lice infestations relies on instruments that enhance visibility and accuracy. Direct visual inspection of the scalp and hair provides the baseline, but supplemental tools reduce missed cases.

Fine‑tooth nit comb: metal or plastic teeth spaced 0.2 mm apart; slides through damp hair to capture live lice and eggs.
Handheld magnifier (2–3×): enlarges the head‑lice body (2–4 mm) and nits (0.8 mm) for clearer identification.
Lice detection kits: include a comb, magnifier, and instructional guide; often packaged with a disposable collection tray for laboratory confirmation.
LED scalp lamp: bright, focused light reveals translucent nits attached near the hair shaft base.
Smartphone macro attachment: attaches to the camera, allowing high‑resolution images for remote expert review.

Effective use of these devices follows a consistent routine: wet hair, section into 1‑inch strands, comb from scalp outward, and inspect each pass with magnification. Collected specimens should be examined immediately; live lice move rapidly, while nits appear as oval, cemented shells. Repeating the process three times over a week confirms eradication or identifies residual infestation.

Fine-Toothed Comb

A fine‑toothed comb, often called a lice comb, features a row of metal or plastic teeth spaced 0.2–0.3 mm apart. The close spacing allows the teeth to slide through hair while catching adult lice, nymphs, and nits firmly attached to the shaft.

To use the comb effectively, dampen hair with water or a conditioning spray, then run the comb from scalp to the ends of the hair in a single, steady stroke. After each pass, wipe the teeth on a tissue or rinse them in hot water to remove captured insects. Repeat the process on each section of the scalp, typically for 10–15 minutes per session, and continue every 2–3 days for two weeks to break the life cycle.

Key visual cues the comb reveals include:

Adult lice: tan‑gray bodies, 2–4 mm long, moving quickly across the teeth.
Nymphs: smaller, translucent or pale, 1–2 mm, often found near the base of the hair shaft.
Nits: oval, 0.8 mm, firmly glued to the hair at an angle of 30–45°, appearing as white or yellowish specks.

Regular comb inspections provide a reliable method for confirming infestation, monitoring treatment progress, and preventing re‑infestation.

Magnifying Glass

A magnifying glass provides the visual resolution needed to distinguish live head lice from debris on the scalp. The insects measure 2–3 mm in length, have a flattened, elongated body, and are typically gray‑brown to tan. Their six legs end in claw‑like tarsi that cling to hair shafts. Live lice move actively, often visible as a quick, darting motion when the hair is examined under magnification.

Nits, the eggs, appear as oval, 0.8 mm structures firmly attached to the base of a hair strand. They are translucent at first, becoming opaque and darker as the embryo develops. Nits are positioned within 1 cm of the scalp; any egg farther from the root is likely an empty shell. Adult lice and nymphs can be seen as small, mobile silhouettes against the hair shaft when viewed at 10×–20× magnification.

Key visual cues when using a magnifying glass:

Body length of 2–3 mm, flattened shape, brownish hue
Six clawed legs, visible movement on hair strands
Oval, firmly attached nits within 1 cm of the scalp, changing from translucent to opaque
Absence of mobility in empty nits, indicating they are no longer viable

By focusing the lens on the hairline, behind the ears, and at the nape, observers can reliably confirm the presence of lice and differentiate them from dandruff, hair fibers, or skin flakes. The enhanced clarity reduces false positives and supports prompt, accurate treatment decisions.

Good Lighting

Good lighting is a decisive factor when examining a scalp for live insects or their eggs. Clear, bright illumination reveals the small, translucent bodies of adult pests, which are about the size of a sesame seed, and the oval, whitish nits attached firmly to hair shafts.

Use natural daylight whenever possible; sunlight provides a full spectrum that highlights the contrast between the insect’s dark exoskeleton and the hair.
If indoor inspection is required, select a white LED lamp with a color temperature of 5,000–6,500 K. This range minimizes color distortion and makes the pale nits more visible.
Position the light source at a 45‑degree angle to the head. Direct illumination reduces shadows that can conceal eggs near the scalp.
Employ a magnifying glass or a handheld loupe with built‑in illumination for close‑up inspection of the hair base. The combination of magnification and focused light uncovers nits that are otherwise invisible to the naked eye.
Avoid fluorescent lights with a strong yellow tint; they can blend the nits’ color with the hair, making detection unreliable.

Consistent use of these lighting practices shortens the time needed to locate infestations and increases the accuracy of visual confirmation.

Signs and Symptoms of Head Lice Infestation

Itching and Irritation

Head lice infestations commonly trigger itching and irritation on the scalp. The sensation arises from an allergic reaction to the insect’s saliva, which is injected while feeding on blood. Repeated bites cause localized inflammation, leading to a persistent urge to scratch.

Key indicators that itching is linked to lice include:

Intense scratching that intensifies after a few days of exposure.
Red, raised spots or small papules concentrated around the hairline, behind the ears, and at the nape of the neck.
Presence of fine, white specks (lice eggs) or live insects near the affected areas.

If these signs appear together, especially in a group setting such as a school or daycare, the likelihood of a lice problem increases and prompt examination of the hair and scalp is warranted. Early detection prevents secondary bacterial infection caused by skin damage from excessive scratching.

Scratch Marks and Sores

Scratch marks and sores frequently appear when a person is infested with head‑lice. The insects bite the scalp, injecting saliva that triggers an allergic reaction. The resulting itch leads to repeated scratching, which leaves linear abrasions and small puncture wounds. Continuous irritation can cause erythema, swelling, and, in severe cases, secondary bacterial infection that forms pustules or crusted lesions.

When examining a child or adult for lice, focus on the following signs related to skin trauma:

Red, irritated lines following the direction of hair growth, especially near the hairline, temples, and nape of the neck.
Small, raised bumps or papules that may bleed when scratched.
Pustules or honey‑colored crusts indicating bacterial superinfection.
Scabs or scaly patches where the skin has begun to heal.

These dermatologic manifestations differ from common dandruff, eczema, or psoriasis, which usually present as flaking, scaling, or well‑defined plaques without the characteristic linear scratches. Identifying scratch marks and sores alongside visual confirmation of live lice or viable nits provides a reliable basis for diagnosis and timely treatment.

Sensation of Something Moving on the Scalp

The sensation of movement on the scalp often signals the presence of live insects. When a small, light weight shifts under the hair, the feeling is typically described as a faint tickle or brief flutter that can appear intermittently. This perception differs from the constant itch caused by dry skin or allergic reactions; it is localized, sudden, and may be accompanied by a subtle, prickly pressure.

Key characteristics to differentiate the movement sensation from other scalp conditions include:

Timing – Occurs primarily during periods of inactivity, such as while reading or watching television, when the head remains still.
Location – Concentrated near the hairline, behind the ears, or at the nape, where adult lice commonly reside.
Duration – Lasts only a few seconds per episode; repeated episodes may happen throughout the day.
Accompanying signs – Presence of visible nits attached to hair shafts, red bite marks, or small blood spots on pillows.

To verify the source of the sensation, perform a systematic inspection:

Part the hair into sections of about one inch.
Use a fine-tooth comb to slide from scalp to tip, checking for live insects or their eggs.
Examine the scalp under bright light; live lice appear as translucent, brownish-gray bodies about the size of a sesame seed, moving quickly when disturbed.
Look for nits affixed close to the scalp (within ¼ inch of the hair shaft); these are oval, white or yellowish, and firmly attached.

If the described movement aligns with the listed characteristics and visual inspection reveals lice or nits, immediate treatment is warranted. Absence of these indicators suggests alternative causes, such as dermatological conditions, and may require consultation with a healthcare professional.

Difficulty Sleeping

Head lice are small, wingless insects about the size of a sesame seed. Adults have a gray‑brown, elongated body and six legs that grasp hair shafts. Nymphs look similar but are slightly smaller and lighter in color. Eggs, called nits, appear as tiny, oval, yellow‑white shells firmly attached to the base of each hair strand, usually within a half‑inch of the scalp.

The presence of live lice and nits creates constant scalp irritation. Repeated scratching can cause redness, swelling, and secondary infection, all of which increase discomfort at night. The itching often intensifies in the dark, making it difficult for the host to fall asleep or remain asleep. Disrupted sleep reduces immune response, potentially worsening the infestation.

Signs that a lice problem may be affecting sleep:

Persistent scalp itching, especially after bedtime.
Visible movement of insects on the scalp or behind the ears.
Small, shiny nits attached close to the scalp, difficult to remove with a regular comb.
Red or inflamed patches on the scalp that worsen after night‑time scratching.
Frequent waking, restlessness, or complaints of “head hurting” during the night.

Effective response requires immediate removal of lice and nits, followed by measures to prevent re‑infestation. Use a fine‑toothed lice comb on wet hair, applying a conditioner to ease detangling. Treat the scalp with an approved pediculicide, adhering to the recommended application time. Wash bedding, hats, and personal items in hot water (≥130 °F) and dry on high heat. Repeat the combing process after seven days to capture any newly hatched nits.

Removing the source of irritation restores a calm scalp environment, allowing normal sleep patterns to resume. Continuous monitoring of hair and scalp condition is essential to confirm that the infestation has been fully eradicated.

What to Do After Finding Head Lice

Confirming the Infestation

Head lice infestations are confirmed by locating live insects, viable eggs, or clear evidence of recent feeding. Visual inspection should focus on the scalp, behind the ears, and at the hairline, where lice prefer warm, protected areas.

Key indicators include:

Small, tan‑brown insects moving quickly across the hair shaft.
Nits attached firmly to the hair shaft within ¼ inch of the scalp; viable nits appear glossy and are difficult to slide off a comb.
Small punctate bleeding spots or red bumps caused by bites, often accompanied by itching.
A “cobweb” pattern of nits clumped together, especially near the crown.

Effective confirmation requires a fine‑tooth lice comb. Section hair into 1‑inch strips, run the comb from scalp to tip, and examine the comb teeth after each pass. Repeat the process on both sides of the head, covering all sections. If live lice or firmly attached nits are found, the presence of an infestation is established.

Absence of live insects does not rule out a problem if only nits are present; however, unattached, white, shell‑like nits are likely shed eggs and do not confirm active infestation. Distinguishing viable nits from dandruff or hair products is essential for accurate diagnosis.

Consulting a Healthcare Professional

When you suspect an infestation, a medical professional provides definitive diagnosis and treatment guidance. They can differentiate live lice from nits, identify secondary skin irritation, and assess any allergic response.

Key reasons to seek professional advice:

Confirmation of live insects versus empty shells
Prescription‑strength pediculicides when over‑the‑counter options fail
Evaluation of scalp condition for secondary infection
Recommendations for safe removal techniques and prevention of re‑infestation

During the visit, the clinician will examine the hair near the scalp, using a fine‑toothed comb under magnification. They may request a sample of debris for microscopic review. If treatment is prescribed, the provider will explain dosage, application timing, and necessary follow‑up checks, typically scheduled 7–10 days after the initial therapy to ensure eradication.

If you have young children, a history of allergic reactions, or are pregnant, professional consultation is essential to select appropriate, low‑risk interventions. The clinician can also advise on cleaning personal items, such as bedding and hair accessories, to prevent recurrence.

Treatment Options

Effective management of head‑lice infestations requires a combination of chemical, mechanical, and environmental strategies.

Over‑the‑counter pediculicides containing permethrin (1 %) or pyrethrins with piperonyl butoxide provide rapid knock‑down of active insects. Application follows the product label: a thorough coating of dry hair, a 10‑minute exposure, then rinsing. Resistance to these agents has increased; therefore, a second‑generation formulation such as 0.5 % ivermectin shampoo may be preferred when previous treatments fail.

Prescription options include 1 % malathion, 0.5 % benzyl alcohol, and oral ivermectin (200 µg/kg). These agents target resistant lice and are reserved for confirmed treatment‑failure cases. Dosage and repeat‑treatment intervals are defined by clinical guidelines.

Mechanical removal eliminates both live lice and nits without chemicals. Wet combing with a fine‑toothed nit comb, performed on damp, conditioned hair, removes visible insects. Repeating the process every 2–3 days for at least two weeks ensures coverage of newly hatched nits.

Alternative measures such as dimethicone lotion, which suffocates lice, and essential‑oil blends (e.g., tea‑tree, neem) have demonstrated limited efficacy. Use only when supported by peer‑reviewed data and in conjunction with standard methods.

Environmental control reduces re‑infestation risk. Wash bedding, clothing, and personal items in hot water (≥ 50 °C) or seal them in plastic bags for two weeks. Vacuum carpets and upholstered furniture to remove detached lice and eggs.

Summary of treatment options

OTC pediculicides: permethrin 1 %, pyrethrins + piperonyl butoxide.
Prescription agents: malathion 1 %, benzyl alcohol 0.5 %, oral ivermectin.
Mechanical removal: wet combing with nit comb, repeated every 2–3 days.
Alternative topical agents: dimethicone, evidence‑based essential‑oil formulations.
Environmental decontamination: laundering, sealing, vacuuming.