What should be done when lice are found on the head

Initial Steps Upon Discovery

Confirming the Presence of Lice

Visual Inspection

When lice are detected on a scalp, the first decisive action is a thorough visual examination. This step confirms the presence, determines the infestation level, and guides subsequent treatment.

Use a fine‑toothed comb designed for lice detection. Place the comb on a well‑lit surface; a magnifying mirror or bright natural light improves visibility.
Part the hair in small sections, starting at the crown and moving outward. Run the comb from the scalp to the tip of each strand, wiping the teeth after each pass.
Inspect the comb for live insects, nymphs, and viable eggs (nits) attached to the hair shaft within 1 mm of the scalp. Record the number of findings to assess severity.
Examine the entire head, including behind the ears, the nape, and the hairline, where lice tend to congregate.
If possible, repeat the inspection after a short interval (15–20 minutes) to verify that all insects have been captured.

A meticulous visual inspection eliminates guesswork, provides an accurate count of parasites, and establishes a baseline for monitoring treatment effectiveness. Immediate documentation and repeat checks ensure that any remaining lice are identified promptly, reducing the risk of re‑infestation.

Combing for Nits and Lice

Combing remains the most reliable method for eliminating live insects and their eggs from the scalp. A fine‑toothed nit comb, preferably stainless steel, should be used on dry hair. Apply a conditioner or a specialized detangling spray to reduce friction and allow the comb to glide smoothly.

Section hair into 1‑inch strips, starting at the crown and moving outward.
Place the comb at the scalp, pull it through the hair to the ends in a single, steady motion.
After each pass, wipe the comb on a white tissue to expose any captured nits; discard visible eggs.
Repeat the process on each section until no live insects or eggs are observed.
Rinse the scalp and wash the comb with hot, soapy water after each use.

Repeat the entire routine every 2–3 days for two weeks to intercept newly hatched lice before they mature. Maintain a clean environment by washing bedding, hats, and brushes in hot water (≥130 °F) and vacuuming upholstered furniture. Regular inspection of the scalp, especially after treatment, confirms complete eradication.

Immediate Actions

Notifying Close Contacts

When a head‑lice infestation is identified, informing individuals who have had recent close contact is essential to contain the spread. Prompt communication allows others to inspect themselves, begin treatment, and prevent further transmission.

Notify parents, guardians, or caregivers of anyone who shares a classroom, daycare, or household. Provide the date of detection, the steps already taken, and clear instructions for checking hair and scalp. Encourage the use of a fine‑toothed comb and appropriate over‑the‑counter or prescription products.

Advise close contacts to:

Examine hair and scalp daily for at least two weeks.
Wash and dry clothing, bedding, and personal items on high heat.
Avoid sharing hats, hairbrushes, or headphones until the infestation is resolved.

Document the notification, including the recipients, method (e.g., email, phone call, written notice), and the date. Retain records for reference in case additional cases arise.

Isolating Contaminated Items

When head lice are detected, any objects that have contacted the hair must be separated from clean items to prevent re‑infestation. Place these items in a designated area that is inaccessible to other household members until they have been treated.

Clothing, hats, scarves, and hair accessories: seal in a plastic bag, then launder at 130 °F (54 °C) or dry‑clean. If washing is not possible, store sealed for two weeks, a period sufficient for lice to die without a host.
Bedding, pillowcases, and towels: wash on the same temperature setting or place in a sealed container for two weeks.
Combs, brushes, and hair clips: soak in hot water (at least 130 °F) for ten minutes, then rinse and dry thoroughly.
Personal items such as helmets, wigs, or headbands: isolate in a sealed bag and treat according to manufacturer guidelines, typically involving heat or chemical disinfection.

After treatment, inspect each item before returning it to regular use. Maintaining strict separation during the decontamination phase eliminates the primary pathway for lice to spread within the environment.

Treatment Options and Procedures

Over-the-Counter Treatments

Pyrethrin-based Products

Pyrethrin-based products are the most widely used chemical agents for eliminating head‑lice infestations. They are derived from chrysanthemum flowers and formulated as shampoos, lotions, or sprays that can be applied directly to the scalp.

The active compounds disrupt the nervous system of lice, causing rapid paralysis and death. Their rapid action reduces the need for prolonged exposure and limits the chance of re‑infestation during treatment.

Application procedure

Wet the hair thoroughly with warm water.
Apply the recommended amount of product, ensuring coverage from the scalp to the tips of all hair strands.
Leave the preparation on the hair for the time specified on the label, typically 10 minutes.
Rinse completely with water; avoid using conditioner or other hair products until the next wash.
Comb the hair with a fine‑toothed lice comb while still damp to remove dead insects and nits.

Safety precautions include: testing a small skin area 24 hours before full application to detect possible allergic reactions; avoiding contact with eyes and mucous membranes; keeping the product out of reach of children; and following age restrictions indicated on the packaging. Pregnant or nursing individuals should consult a healthcare professional before use.

After treatment, repeat the process after 7–10 days to eradicate any newly hatched lice that survived the initial application. Regular inspection of the scalp and immediate retreat with a non‑pyrethrin option, such as a silicone‑based lotion, helps prevent resistance development.

Permethrin-based Products

Permethrin‑based formulations are the most widely recommended first‑line agents for eliminating head‑lice infestations. The active ingredient, a synthetic pyrethroid, disrupts the nervous system of lice, leading to rapid paralysis and death while sparing human skin at recommended concentrations.

The product is supplied as a 1 % lotion, cream rinse, or spray. Application follows a strict protocol to ensure complete coverage and to minimize re‑infestation.

Apply to dry hair, saturating the scalp and all strands down to the roots.
Leave the preparation on for the time specified on the label, typically 10 minutes.
Rinse thoroughly with warm water; do not shampoo before treatment.
Comb wet hair with a fine‑toothed nit comb to remove dead insects and nits.
Repeat the entire process after 7–10 days to target any newly hatched lice.

Additional steps reduce the likelihood of recurrence:

Wash clothing, bedding, and personal items in hot water (≥ 130 °F) or seal them in airtight bags for two weeks.
Vacuum upholstered furniture and car seats.
Instruct all household members to avoid head‑to‑head contact until treatment is complete.

Permethrin is approved for use in children over two months of age. Adverse reactions are rare but may include mild scalp irritation or redness. Persistent infestations after two treatment cycles may indicate resistance; in such cases, consult a healthcare professional for alternative agents such as ivermectin or malathion.

Dimethicone-based Products

When a head‑lice infestation is confirmed, dimethicone‑based formulations provide an effective, non‑neurotoxic option. Dimethicone is a silicone polymer that coats each louse and its eggs, blocking the respiratory spiracles and causing rapid immobilisation without chemical poisoning.

Application proceeds as follows:

Apply the product to dry hair, ensuring full coverage from scalp to tips.
Massage gently to distribute the silicone film evenly.
Leave the preparation on for the time specified by the manufacturer (typically 10–15 minutes).
Use a fine‑toothed nit comb to remove dead insects and nits.
Rinse hair thoroughly with warm water.
Repeat the treatment after 7–10 days to eliminate any newly hatched lice.

Safety profile is favorable: dimethicone is inert, does not penetrate the skin, and is approved for use on children over two months. Avoid contact with eyes; rinse immediately if irritation occurs.

Key benefits include:

No reported resistance among lice populations.
Minimal scalp irritation compared with traditional insecticides.
Simple administration without prescription.

To prevent re‑infestation, wash bedding and clothing in hot water, vacuum upholstered furniture, and inspect close contacts, treating them with the same dimethicone product if necessary. Consistent adherence to the protocol eliminates the infestation and minimizes the risk of recurrence.

Prescription Treatments

Ivermectin Lotion

Ivermectin lotion is a topical antiparasitic agent approved for the treatment of head‑lice infestations. The active ingredient, ivermectin, binds to glutamate‑gated chloride channels in the parasite’s nervous system, causing paralysis and death of the lice and their eggs.

When an infestation is detected, the following protocol applies:

Apply the lotion to dry hair, ensuring thorough coverage from scalp to the tips of the hair shafts.
Leave the product on the scalp for the time specified in the manufacturer’s instructions, typically 10 minutes.
Rinse thoroughly with water; do not use shampoo or conditioner for at least 12 hours after treatment.
Repeat the application after 7 days to eliminate any newly hatched lice that survived the first dose.

Clinical studies report cure rates above 90 % when the two‑dose regimen is followed correctly. Ivermectin lotion is effective against lice resistant to pyrethrin or permethrin, making it a valuable alternative when conventional treatments fail.

Safety considerations include:

Avoid use on children under 15 kg or on pregnant or lactating individuals without medical guidance.
Do not apply to broken or inflamed skin; wash off any excess product that contacts the eyes.
Monitor for mild skin irritation, which generally resolves without intervention.

Ivermectin lotion provides a single‑application, resistance‑proof solution for head‑lice management, fitting within a comprehensive approach that also recommends regular combing with a fine‑toothed lice comb and washing of personal items.

Malathion Lotion

Malathion lotion is a prescription‑strength pediculicide used to eradicate head lice after detection. The formulation contains 0.5 % malathion, an organophosphate insecticide that immobilizes lice by inhibiting cholinesterase activity. Application follows a precise protocol to maximize effectiveness and minimize irritation.

First, wash the scalp with a mild shampoo and towel‑dry. Apply a generous layer of lotion, ensuring coverage of the entire hair shaft and scalp. Leave the product on for eight hours, typically overnight, then rinse thoroughly with warm water. Repeat the treatment after seven days to eliminate any newly hatched nymphs that survived the initial dose.

Key safety considerations include:

Verify prescription and contraindications; avoid use in children under six months or in individuals with known malathion hypersensitivity.
Perform a patch test on a small skin area 30 minutes before full application to detect adverse reactions.
Do not combine with other topical insecticides, as synergistic toxicity may occur.
Keep the product away from eyes, mouth, and broken skin; wash hands after handling.

Effectiveness rates reported in clinical trials exceed 90 % when the regimen is followed correctly. Resistance to malathion remains low compared to pyrethroid agents, making it a reliable option when other treatments fail.

When lice are identified, immediate steps should include:

Confirm infestation by visual inspection of live insects or viable nits within 1 cm of the scalp.
Isolate personal items (combs, hats, bedding) and wash them at ≥60 °C or seal in plastic bags for two weeks.
Initiate treatment with malathion lotion according to the outlined procedure.
Conduct a follow‑up examination after the second application to ensure complete eradication.

Malathion lotion provides a scientifically validated method for addressing head‑lice outbreaks, provided that dosage instructions, safety guidelines, and follow‑up measures are strictly observed.

Spinosad Topical Suspension

Spinosad topical suspension is a prescription‑only, leave‑on treatment formulated for head‑lice infestations. The active ingredient, spinosad, is a bacterial‑derived compound that disrupts the nervous system of lice, leading to rapid mortality.

The product is applied to dry hair, left in place for the recommended duration, and then rinsed off. Instructions are as follows:

Part hair into sections of 1‑2 cm; apply the suspension evenly, ensuring coverage of the scalp and all hair shafts.
Keep the medication on the scalp for 10 minutes; do not exceed the time limit.
Rinse thoroughly with lukewarm water; avoid shampoo or conditioner for at least 24 hours.
Repeat the application after 7 days to eliminate any newly hatched nymphs.

Clinical trials report a single‑application cure rate above 90 % when the repeat dose is administered. Spinosad retains activity against lice strains resistant to pyrethroids and other common insecticides.

Adverse effects are limited to mild scalp irritation, itching, or erythema. Contraindications include known hypersensitivity to spinosad or any formulation component. Use with caution in children under 6 months; safety in this group has not been established.

After treatment, remove dead lice and eggs with a fine‑toothed comb, wash bedding, hats, and personal items in hot water, and vacuum upholstered surfaces. If live lice are observed after the second application, consult a healthcare professional for alternative therapy.

Non-Chemical Methods

Wet-Combing Method

When lice are detected on a scalp, the wet‑combing technique offers a reliable, chemical‑free solution. The method removes live insects and eggs by physically separating them from hair fibers.

Required items include a fine‑toothed nit comb, a wide‑toothed detangling comb, a bowl of warm water mixed with a small amount of conditioner, and a towel. The conditioner softens hair, allowing the nit comb to glide smoothly and capture parasites.

Saturate the hair with the conditioner‑water mixture; keep strands wet throughout the process.
Starting at the scalp, run the wide‑toothed comb to detangle and eliminate tangles.
Switch to the nit comb, pulling it through each section from root to tip in a single, steady stroke.
After each pass, rinse the comb in the water bowl to remove captured lice and nits.
Repeat the combing sequence on every section of the head, ensuring no area is missed.
Rinse the hair thoroughly and towel‑dry.

Perform the procedure every 3–4 days for at least two weeks, covering the typical hatching cycle of lice eggs. Re‑inspection after each session confirms removal; any remaining nits require additional passes.

Avoid sharing combs, hats, or bedding during treatment. Wash clothing, towels, and pillowcases in hot water (≥ 130 °F) and dry on high heat to prevent reinfestation. Consistent application of wet‑combing, combined with strict hygiene measures, eliminates the infestation without resorting to pesticide‑based products.

Suffocation Treatments

Suffocation treatments aim to block the respiratory system of head‑lice and their eggs, forcing them to die without chemical insecticides. The method relies on covering the hair and scalp with a substance that prevents the insects from accessing air.

Apply a thin layer of mineral oil, baby oil, or petroleum jelly to dry hair, ensuring coverage from scalp to hair tips.
Massage gently for 30 seconds to distribute the product evenly.
Cover the head with a plastic cap or cling‑film to maintain occlusion.
Leave the occlusive layer in place for 8–12 hours, preferably overnight.
After the exposure period, remove the cap, comb the hair with a fine‑toothed lice comb, and discard nits and dead insects.
Wash hair with a mild shampoo to eliminate residual oil; repeat the process after 7 days if any live lice are observed.

Key considerations:

Do not use suffocation agents on infants younger than 6 months or on individuals with skin conditions that may react to oil.
Avoid excessive amounts of oil to prevent staining of clothing and bedding.
Ensure the occlusive cover is airtight; gaps allow lice to breathe and reduce efficacy.

Suffocation treatments provide a non‑chemical option for eliminating head‑lice, suitable for families seeking alternative approaches or for individuals with sensitivities to conventional pediculicides. Regular inspection and prompt re‑treatment are essential to confirm complete eradication.

Post-Treatment Care

Follow-up Inspections

When lice are discovered, the treatment plan must be followed by systematic re‑examinations to confirm eradication and prevent reinfestation. The first inspection should occur 7–10 days after the initial application of a pediculicide, because nymphs emerging from eggs become detectable at this stage. During this visit, examine the scalp, hair shafts, and behind the ears with a fine‑toothed comb, recording any live insects or viable nits within 1 cm of the hair root. If any are found, repeat the treatment according to product guidelines and schedule another check after 5 days.

Subsequent inspections follow a consistent timetable:

Day 7–10: Initial post‑treatment review; verify absence of live lice.
Day 14: Second assessment; ensure no new hatchlings appear.
Day 21: Final check; confirm complete removal of nits and lice.

Each inspection should be documented, noting the number of lice and nits observed, the condition of the scalp, and any adverse reactions to treatment. If the final review still reveals viable insects, a comprehensive retreatment and possible environmental decontamination (washing bedding, vacuuming furniture) become necessary. Consistent follow‑up eliminates residual populations and reduces the risk of recurrence.

Re-treatment Schedule

When lice are detected, an initial medicated shampoo or lotion must be applied according to the product’s instructions. After the first application, a second dose is essential to eliminate newly hatched nymphs that survived the initial exposure.

Day 0: Apply treatment, leave on scalp for the recommended duration, then rinse thoroughly. Comb hair with a fine-toothed lice comb to remove live insects and eggs.
Day 7 ± 1: Repeat the entire process. This timing corresponds to the average hatching period, ensuring any surviving nymphs are eradicated.
Day 14 ± 2 (optional): Perform a final treatment if live lice are observed during the Day 7 check. Otherwise, a single additional combing session suffices.

During the interval between applications, wash bedding, clothing, and personal items in hot water (≥ 130 °F) or seal them in plastic bags for two weeks. Continue daily combing for at least five days after the second treatment to verify total removal. If live lice persist after the optional third dose, consult a healthcare professional for alternative therapy.

Preventing Reinfestation

Environmental Cleaning

Washing Linens and Clothing

When head lice are detected, laundering personal items prevents re‑infestation. Heat destroys both adult insects and their eggs, eliminating a common source of recurrence.

Wash all bedding, pillowcases, and towels in water at ≥ 130 °F (54 °C) for at least 10 minutes.
Dry on high heat for a minimum of 20 minutes; low‑temperature drying does not guarantee viability loss.
Separate clothing worn by the affected person; launder in hot water and tumble dry on high heat.
For items that cannot withstand heat, seal in a plastic bag for two weeks, the period required for eggs to hatch.
Clean hairbrushes, combs, and hats by soaking in hot water (≥ 130 °F) for 10 minutes, then air‑dry.

Prompt, thorough washing removes residual lice and nits, supporting successful eradication of the infestation.

Vacuuming and Cleaning Surfaces

When head lice are detected, thorough environmental cleaning reduces the chance of re‑infestation. Vacuuming removes live insects, eggs, and shed skin from fabrics and floor surfaces.

Use a high‑efficiency vacuum with a motorized brush attachment.
Vacuum carpets, upholstered furniture, and floor mats for at least 10 minutes, focusing on seams and crevices where lice may hide.
Immediately discard the vacuum bag or seal the canister in a plastic bag and place it in a sealed container for 48 hours before disposal.
Clean hard surfaces—tables, countertops, and toys—with a disinfectant solution containing at least 0.5 % hydrogen peroxide or a commercial lice‑kill spray. Allow the solution to remain on the surface for the contact time recommended by the manufacturer.
Wash removable covers, pillowcases, and clothing in hot water (≥130 °F/54 °C) and dry on high heat for 30 minutes. Items that cannot be laundered should be sealed in a plastic bag for two weeks.

Consistent application of these measures eliminates residual lice and nits, supporting the overall treatment plan.

Sealing Non-Washable Items

When an infestation of head lice is confirmed, the response must include both direct treatment of the scalp and protection of surrounding objects. Items that cannot be washed—such as certain hats, scarves, hair accessories, or plush toys—require isolation to stop lice from migrating back to the hair.

Place each non‑washable item in a sealed plastic bag that closes airtight.
Remove excess air, then seal the bag with a heat‑activated clip or zip lock.
Store the sealed bag in a cool, dry location for at least two weeks, the typical lifespan of a louse without a host.
After the isolation period, inspect the items for live insects before reintroducing them to the environment.

If immediate disposal is impractical, repeat the sealing process after the first two‑week interval to ensure any newly hatched lice are captured. This method eliminates a common source of re‑infestation without damaging delicate materials.

Personal Hygiene and Habits

Avoiding Head-to-Head Contact

When a head infestation is identified, preventing direct hair contact becomes a primary control measure. Lice migrate by crawling from one scalp to another, making any face‑to‑face or shoulder‑to‑shoulder interaction a high‑risk vector.

Practical steps to eliminate head‑to‑head transmission:

Keep hair tied back, braided, or covered with a snugly fitting cap during close‑contact activities.
Prohibit sharing of hats, helmets, scarves, hairbrushes, combs, and other personal grooming tools.
Arrange separate sleeping spaces; avoid laying heads on the same pillow or blanket.
Supervise playtime and sports practices to ensure children do not rest heads on each other’s shoulders or backs.
Educate caregivers and teachers about the need for physical separation during group activities.

Consistent application of these precautions reduces re‑infestation rates and supports the effectiveness of any subsequent treatment regimen.

Not Sharing Personal Items

When lice are identified on a scalp, the priority is to eliminate the parasites and block routes of re‑infestation. A proven preventive action is to keep all personal items that touch hair or skin separate from those of others.

Combs, brushes, and hair‑care tools
Hats, caps, scarves, and headbands
Pillowcases, sheets, and blankets
Towels, washcloths, and hair‑drying cloths
Earphones, headphones, and sports helmets

Each of these objects can harbor live lice or viable eggs. Using only one’s own items eliminates a common transmission pathway and supports successful eradication of the infestation.

Ongoing Vigilance

Regular Head Checks

Regular head inspections are a cornerstone of effective lice management. Early detection limits spread, reduces the number of treatments required, and prevents secondary skin irritation.

Perform inspections systematically. Part the hair in sections of approximately two inches, using a fine-toothed comb or a dedicated lice detection comb. Examine the scalp and hair shafts for live insects, viable eggs (nits), or empty shells. Pay special attention to the nape, behind the ears, and the crown, where lice commonly congregate.

Guidelines for inspection frequency:

Daily checks during an active outbreak, preferably in the morning before styling.
Every three to four days for households with a recent case, extending to weekly for a month after the last confirmed nits are removed.
Biweekly checks for schools, daycare centers, or families with a history of recurrent infestations.

Responsibility should be shared. Parents or guardians conduct examinations on children, while individuals with long hair or those in close-contact environments perform self‑checks or enlist a peer. Trained personnel, such as school nurses, may verify results in institutional settings.

Tools and preparation:

Lice detection combs made of stainless steel or fine plastic.
Good lighting; a handheld lamp or bright natural light improves visibility.
A clean, dry surface for the comb to glide without excess hair product interference.
Optional magnifying glass for detailed observation.

Documentation aids follow‑up. Record the date, findings, and any treatment applied. Consistent logs reveal patterns, confirm eradication, and support communication with healthcare providers or school officials.

By integrating disciplined, regular scalp examinations into daily routines, the likelihood of unnoticed infestations diminishes, and control measures become more targeted and efficient.

Educating Family Members

When a head‑lice infestation is detected, every household member must understand the facts and responsibilities to prevent spread and ensure effective treatment.

First, provide clear information about lice biology: they are insects that live on hair shafts, lay eggs (nits) attached to the strand, and cannot survive more than 24 hours off a human host. Emphasize that lice are not a sign of poor hygiene and that anyone can become infested.

Second, outline the actions each person should take:

Inspect hair daily for live insects and nits using a fine‑tooth comb on a well‑lit surface.
Avoid sharing personal items such as combs, hats, pillows, and headphones.
Wash clothing, bedding, and towels used within the previous 48 hours in hot water (≥130 °F) and dry on high heat.
Isolate non‑washable items in a sealed plastic bag for two weeks.
Follow the prescribed treatment regimen precisely, repeating the application according to the product instructions (typically 7–10 days after the first dose).

Third, assign roles within the family:

One adult coordinates treatment purchases, schedules follow‑up checks, and documents findings.
All members report any signs of reinfestation immediately.
Parents supervise children’s combing sessions and verify that no nits remain after treatment.

Finally, reinforce the educational message regularly. Conduct brief reviews after each treatment cycle, answer questions, and distribute printed or digital resources that summarize the protocol. Consistent, factual communication reduces anxiety, eliminates misconceptions, and speeds the eradication of lice from the household.