What should you do if you have lice on your head?

Identifying Head Lice Infestation

Recognizing the Symptoms

Itching and Scalp Irritation

Head lice infestations frequently trigger itching and scalp irritation due to the insects’ saliva and the mechanical action of nits attached to hair shafts. The sensation results from an allergic response; repeated scratching can damage the skin, create secondary bacterial infections, and prolong discomfort.

Effective management begins with eliminating the parasites. Apply a licensed pediculicide according to the product label, then comb the hair with a fine-toothed nit comb while the hair remains damp. Remove all visible nits and adult lice; repeat the procedure after seven to ten days to capture any newly hatched insects.

To control itching while treatment proceeds, consider the following measures:

Wash the scalp with a mild, fragrance‑free shampoo to reduce residual irritants.
Apply a topical antihistamine cream or a corticosteroid lotion prescribed by a healthcare professional to lessen inflammation.
Use a cool compress on affected areas for a few minutes, several times daily, to provide temporary relief.
Avoid hair products containing alcohol or strong fragrances, which can exacerbate irritation.

Maintain strict hygiene to prevent reinfestation and secondary infection. Launder bedding, clothing, and personal items in hot water (minimum 130 °F/54 °C) and dry on high heat. Seal non‑washable items in sealed plastic bags for two weeks, the typical lifespan of lice off the host. Inspect close contacts regularly; treat anyone who shows signs of infestation promptly.

If itching persists beyond the treatment cycle, seek medical evaluation to rule out dermatitis, allergic reactions, or bacterial infection that may require additional therapy.

Visible Nits and Lice

Visible nits and lice are the primary indicators that an infestation exists. Nits appear as tiny, oval, yellow‑white or brownish objects firmly attached to the hair shaft, usually within a quarter of an inch from the scalp. Live lice are small, wingless insects about the size of a sesame seed, moving quickly and often visible on the scalp or in the hair. Their presence confirms the need for immediate treatment.

To address the problem effectively, follow these steps:

Confirm identification – Examine the hair under bright light or a magnifying lens. Nits that are firmly glued and cannot be slid easily indicate a current infestation; loose nits may be remnants of a past one.
Select an appropriate pediculicide – Choose a product approved by health authorities, apply according to the label, and ensure thorough coverage of the scalp and hair to the length of the hair.
Comb out nits – Use a fine‑toothed nit comb on wet, conditioned hair. Start at the scalp and work toward the ends, cleaning the comb after each pass. Repeat the combing process for at least 48 hours to remove newly hatched lice and any remaining nits.
Repeat treatment – Apply a second dose of the pediculicide 7–10 days after the first application to eliminate any lice that survived the initial treatment cycle.
Sanitize personal items – Wash clothing, bedding, and towels in hot water (≥ 130 °F) or seal them in plastic bags for two weeks. Vacuum carpets and upholstered furniture to remove stray hairs that may contain nits.
Monitor for recurrence – Inspect the scalp daily for the next two weeks. Any new lice or nits require immediate repeat of the treatment protocol.

Accurate detection of nits and live lice, combined with systematic chemical and mechanical removal, eliminates the infestation and prevents re‑infestation.

Confirming the Diagnosis

Wet Combing Method

Wet combing eliminates head‑lice without chemicals by physically removing insects and their eggs. Begin by washing hair with a regular shampoo, then apply a generous amount of a thick conditioner to keep strands slippery. Use a fine‑toothed lice comb, preferably stainless steel, and work on damp hair; the moisture prevents the comb from snagging.

Start at the scalp, draw the comb through each section from root to tip in a slow, steady motion. After each pass, wipe the comb on a white tissue or rinse it in a bowl of water, inspecting for live lice or nits. Repeat the process on the same section until no insects appear, then move to the next area. Complete the entire head, ensuring the comb reaches the nape and behind the ears.

Perform the routine every 2–3 days for two weeks, then weekly for an additional two weeks to catch any newly hatched lice. Dispose of collected insects by sealing them in a plastic bag and discarding it in an outdoor trash bin. Wash the comb in hot, soapy water after each session; replace it if teeth become worn.

Additional measures enhance effectiveness:

Trim long hair to reduce combing time.
Launder bedding, hats, and scarves in hot water (≥60 °C) and dry on high heat.
Vacuum floors and upholstered furniture to remove stray nits.

When applied consistently, wet combing provides a reliable, non‑toxic solution for eliminating head‑lice infestations.

Magnification Tools

Magnification tools enhance the ability to locate and remove lice and their eggs. A handheld magnifying glass with 2‑3× power provides enough enlargement to see live insects on the scalp. Optical loupes, typically offering 5‑10× magnification, allow detailed inspection of hair shafts and nits attached close to the skin. Digital microscopes connected to a computer or smartphone display images at 20‑100×, facilitating documentation and precise removal.

When using any magnifier, follow these steps:

Clean the device with a lint‑free cloth and an alcohol wipe before each session.
Position the light source directly above the scalp to eliminate shadows.
Examine each section of hair, starting at the crown and moving outward.
Identify live lice by their movement; distinguish nits by their oval shape and firm attachment to the hair strand.
Use fine‑toothed combs in conjunction with the magnifier to extract insects, pulling gently from the scalp toward the tip.

Digital microscopes also enable tracking treatment progress. Capture images before treatment, after each application of pediculicide, and at the end of the recommended two‑week period. Comparing photos confirms the disappearance of live lice and verifies that no viable nits remain.

Selecting the appropriate magnification tool depends on the user’s comfort and the severity of infestation. Hand lenses suit quick checks, loupes support thorough examinations, and digital microscopes provide the highest detail for persistent cases. Proper cleaning, adequate lighting, and systematic inspection maximize effectiveness in managing head‑lice problems.

Treatment Options for Head Lice

Over-the-Counter Treatments

Pyrethrin-Based Products

When lice are detected on the scalp, a rapid, effective treatment is essential to prevent spread and re‑infestation. Pyrethrin‑based products constitute a primary option for immediate eradication.

These formulations combine natural pyrethrins extracted from chrysanthemum flowers with a synergist, typically piperonyl butoxide, to enhance toxicity to lice while remaining safe for human use. The active compounds target the nervous system of the insects, causing rapid paralysis and death.

Key characteristics of pyrethrin treatments:

Fast action: Lice typically die within minutes of contact.
Broad coverage: Sprays, lotions, and shampoos reach hair shafts and skin.
Low resistance: Pyrethrins remain effective despite widespread use of other insecticides.

Application guidelines:

Apply the product to dry hair, saturating the scalp and strands from roots to tips.
Leave the preparation on for the time specified on the label, usually 10 – 15 minutes.
Rinse thoroughly with warm water.
Comb the hair with a fine‑toothed lice comb to remove dead insects and eggs.
Repeat the treatment after 7 – 10 days to eliminate any newly hatched nymphs.

Precautions:

Verify the product is approved for the user’s age group; some formulations are unsuitable for children under two years.
Avoid contact with eyes; rinse immediately if exposure occurs.
Do not use on broken skin or irritated scalp to prevent irritation.

Incorporating pyrethrin treatment into a comprehensive lice‑management plan—cleaning bedding, clothing, and personal items—maximizes the likelihood of complete eradication and reduces the risk of recurrence.

Permethrin-Based Products

Permethrin‑based products are the first‑line topical agents for eliminating head‑lice infestations. The active ingredient, permethrin 1 % (often marketed as a lotion or shampoo), disrupts the nervous system of lice, leading to rapid death while sparing human skin.

Apply the product to dry hair, ensuring thorough coverage from scalp to tips.
Leave the formulation on for the time specified in the label, typically 10 minutes.
Rinse thoroughly with warm water; avoid shampooing for at least 24 hours afterward.
Comb the hair with a fine‑toothed nit comb to remove dead insects and eggs.
Repeat the treatment after 7–10 days to eradicate any newly hatched nymphs that survived the first application.

Safety considerations include avoiding use on children under two months, on individuals with known permethrin hypersensitivity, and on heavily damaged scalp skin. Resistance to permethrin remains low in most regions, but documented cases require alternative agents such as ivermectin or spinosad.

After treatment, wash bedding, hats, brushes, and personal items in hot water (≥ 130 °F) or seal them in a plastic bag for two weeks to prevent re‑infestation. Continue weekly inspections for at least one month to confirm complete eradication.

Dimethicone-Based Products

When lice are found on the scalp, the first priority is to eliminate the insects and their eggs. Dimethicone‑based formulations provide a mechanical mode of action: the silicone oil penetrates the exoskeleton of lice and nits, causing dehydration and loss of grip without relying on neurotoxic chemicals. This property reduces the risk of resistance development that is common with traditional insecticides.

Application guidelines:

Apply the product to dry hair, ensuring full coverage from scalp to tips.
Massage gently for 5–10 minutes to allow the oil to coat each strand.
Leave the formulation on for the time specified by the manufacturer, typically 10–15 minutes.
Rinse thoroughly with warm water; do not use harsh shampoos immediately after treatment.

After rinsing, use a fine‑toothed lice comb to remove dead insects and nits. Comb the hair in sections, wiping the comb after each pass. Repeat the combing process for at least 48 hours, then conduct a second treatment 7–10 days later to capture any newly hatched lice.

Safety considerations:

Dimethicone is classified as low‑toxicity; it is not absorbed through the skin in significant amounts.
Products are suitable for children over six months, provided there are no known silicone allergies.
Avoid contact with eyes; flush with water if exposure occurs.

When integrated with thorough combing and environmental cleaning (washing bedding, hats, and personal items at ≥ 60 °C), dimethicone‑based treatments achieve high eradication rates and minimize the need for repeated chemical applications.

Prescription Treatments

Malathion Lotion

Malathion lotion is a prescription‑strength pediculicide used to eliminate head‑lice infestations. The formulation contains 0.5 % malathion, an organophosphate insecticide that paralyzes lice by inhibiting acetylcholinesterase.

Application begins with thorough combing of wet hair using a fine‑toothed lice comb to remove adult lice and nits. After rinsing, the scalp and hair are dried until damp but not wet. The lotion is poured onto the scalp, massaged into the hair, and left for the recommended eight‑hour period, typically overnight. During this time, the hair should remain uncovered and the individual should avoid contact with water.

Following the exposure interval, the lotion is rinsed out with warm water and mild shampoo. A second treatment is usually scheduled seven days later to target any newly hatched lice that survived the initial application. Repeating the combing process after each treatment helps verify eradication.

Safety considerations include:

Avoiding use on children under two years of age or on individuals with known hypersensitivity to malathion.
Wearing gloves during application to reduce skin absorption.
Keeping the product away from eyes, mouth, and open wounds.
Consulting a healthcare professional if irritation, rash, or respiratory symptoms develop.

Malathion lotion remains effective when applied according to the prescribed schedule, combined with meticulous mechanical removal of nits, and supported by environmental measures such as washing bedding and personal items in hot water.

Ivermectin Lotion

If lice are found on the scalp, Ivermectin Lotion can serve as an alternative treatment. The product contains the antiparasitic agent ivermectin, formulated for topical use. Applied to dry hair and scalp, the lotion penetrates the insect’s nervous system, leading to paralysis and death of both lice and nits.

Typical usage involves the following steps:

Wash hair with a mild shampoo and towel‑dry without rinsing.
Apply the prescribed amount of lotion evenly over the entire scalp and hair length.
Leave the product on for the duration specified by the prescribing professional, usually 10–12 minutes.
Rinse thoroughly with water, then comb with a fine‑toothed lice comb to remove dead insects and debris.
Repeat the application after 7–10 days to eliminate any newly hatched lice.

Clinical data indicate a cure rate of 80–90 % after the second application, comparable to conventional pediculicides. Ivermectin Lotion is approved for other parasitic infections; its use for head lice is off‑label, requiring a medical prescription. Safety considerations include:

Avoiding application to broken skin or irritated scalp.
Not using on children under the age recommended by the prescriber.
Monitoring for rare skin reactions such as redness or itching.

When standard over‑the‑counter shampoos fail or resistance to common insecticides is suspected, Ivermectin Lotion offers a viable option. Consultation with a healthcare professional ensures appropriate dosage, confirms suitability, and provides guidance on complementary measures such as washing bedding and personal items.

Spinosad Topical Suspension

Spinosad topical suspension is a prescription medication specifically formulated to eliminate head‑lice infestations. The active ingredient, spinosad, attacks the nervous system of lice, causing rapid paralysis and death, while remaining safe for use on the scalp and hair. It is approved for individuals six months of age and older, providing a single‑application solution that does not require a repeat dose.

When lice are present, follow these steps with spinosad:

Apply a generous amount of the suspension to dry hair, ensuring coverage from scalp to tips.
Massage the product into the hair for at least 10 seconds to guarantee contact with all lice and nits.
Leave the medication on for the recommended 10‑minute period; no rinsing is needed during this time.
Remove excess product with a towel or comb, then wash hair with regular shampoo.
Use a fine‑toothed comb to extract any remaining nits, repeating the process for 7‑10 days if live lice reappear.

Spinosad’s high efficacy (over 99 % kill rate) and lack of resistance reports make it a reliable choice for immediate eradication of head‑lice populations.

Non-Chemical Removal Methods

Wet Combing with a Fine-Toothed Comb

Wet combing with a fine‑toothed comb provides a chemical‑free way to eliminate head‑lice and their eggs. The technique relies on a saturated hair shaft, which immobilizes insects and allows the comb to capture them without breakage.

Begin by washing the scalp with a regular shampoo, then apply a generous amount of conditioner or a specialized wet‑combing solution. Keep the hair thoroughly wet; dry strands make it difficult for the comb to glide and increase the risk of tearing.

Procedure

Separate hair into sections 1–2 inches wide.
Starting at the scalp, pull the comb through each section slowly, using steady pressure.
After each pass, wipe the comb on a white paper towel to visualize captured lice or nits.
Repeat the process for every section, covering the entire head at least twice.
Rinse the hair, then repeat the combing session after 7–10 days to address any newly hatched insects.

After the final session, wash all clothing, bedding, and personal items in hot water (≥ 130 °F) or seal them in a plastic bag for two weeks. Regularly inspect the scalp for a week to confirm eradication.

Suffocation Methods (e.g., petroleum jelly, olive oil)

When head‑lice infestations occur, suffocation agents such as petroleum jelly and olive oil can be employed to immobilize nymphs and adult insects before mechanical removal.

Apply a thin, even layer of the chosen oil to the entire scalp, ensuring coverage of hair shafts and the skin at the hairline. Allow the product to remain for 30–60 minutes; the coating blocks the insects’ respiratory spiracles, causing them to die or become immobile. After the waiting period, use a fine‑toothed lice comb to extract dead or weakened lice and nits. Rinse the hair thoroughly with warm water and a mild shampoo to remove residual oil.

Key considerations

Effectiveness – suffocation works best on live lice; eggs (nits) remain viable and must be removed manually.
Contact time – insufficient exposure reduces mortality; adhere to the recommended duration.
Skin tolerance – petroleum jelly may cause irritation in sensitive individuals; test a small area before full application.
Residue – oil can attract dirt and make hair greasy; thorough washing is essential.
Combination therapy – pairing suffocation with combing improves overall eradication rates.

Step‑by‑step protocol

Separate hair into manageable sections.
Apply petroleum jelly or olive oil, covering each section completely.
Cover the head with a shower cap to maintain humidity and prevent oil loss.
Wait 30–60 minutes.
Remove the cap, comb out lice and nits with a fine lice comb, wiping the comb after each pass.
Wash hair with shampoo, repeat combing if any lice remain.
Repeat the process after 7–10 days to address newly hatched insects.

Suffocation methods provide a non‑chemical option for lice control, but success depends on diligent application and thorough mechanical removal.

Preventing Reinfestation and Spreading

Treating the Environment

Washing Linens and Clothing

Lice eggs and nymphs can remain viable on bedding, towels, and clothing, so thorough laundering is essential to stop re‑infestation.

Wash all items that have contacted the scalp in hot water of at least 130 °F (54 °C) for a minimum of 10 minutes. Use a regular detergent; adding a small amount of vinegar or a lice‑specific additive does not improve efficacy. After washing, dry on high heat for at least 30 minutes, or tumble‑dry on the hottest setting. Heat kills both adult lice and their eggs.

Separate contaminated fabrics from untreated laundry.
Place them in the washing machine; set temperature ≥130 °F (54 °C).
Run a full wash cycle of at least 10 minutes.
Transfer immediately to a dryer; select the highest heat setting for a minimum of 30 minutes.
Store any items that cannot be washed (e.g., delicate fabrics) in a sealed plastic bag for two weeks, the period required for eggs to hatch and die without a host.

Repeat the process after seven days to capture any lice that may have survived the first wash. Following these steps eliminates the risk of re‑colonization from linens and clothing.

Vacuuming Furniture and Floors

When lice are detected on a scalp, removing them from the environment is essential to prevent re‑infestation. Vacuuming furniture and floors eliminates hatched nits and mobile insects that have fallen off the hair.

Begin by selecting a vacuum equipped with a high‑efficiency filter. Run the appliance over upholstered chairs, sofas, and cushions, focusing on seams and crevices where lice may hide. Extend the cleaning to mattresses, pillows, and headboards, using the hose attachment for tighter areas.

Next, treat hard‑surface floors. Move rugs and carpets aside, then vacuum the exposed floor thoroughly. Pay special attention to baseboards, under furniture, and any cracks in flooring material.

After vacuuming, seal the vacuum bag or empty the canister into a plastic bag, close it tightly, and discard it outside the home. This step prevents any captured lice from escaping back into the living space.

Key actions:

Use a vacuum with a HEPA or equivalent filter.
Clean all upholstered surfaces, including cushions and seams.
Vacuum mattresses, pillows, and headboards with a hose attachment.
Thoroughly vacuum hard floors, rugs, and baseboards.
Seal and dispose of the vacuum contents immediately.

Implementing these steps reduces the likelihood that surviving lice or nits will re‑attach to hair, supporting the overall treatment plan.

Sealing Non-Washable Items

When a head infestation is confirmed, items that cannot be laundered must be isolated to prevent reinfestation.

Place each non‑washable object—such as hats, scarves, hair accessories, plush toys, or decorative pillows—into a resealable plastic bag. Seal the bag tightly, removing as much air as possible.

Keep sealed bags at room temperature for at least 48 hours.
After 48 hours, inspect the items; if live lice are still present, repeat the sealing cycle.
For items that cannot tolerate prolonged confinement, consider encasing them in a vacuum‑sealed bag for 24 hours, then repeat.

If the item is disposable, discard it in a sealed trash bag to eliminate any risk of re‑contamination.

Store sealed bags away from sleeping areas until the infestation is fully resolved. This approach limits the spread of parasites while preserving items that cannot be washed.

Notifying Close Contacts

Family Members

When a family member discovers head lice, prompt, coordinated action prevents spread throughout the household. The affected individual should begin treatment immediately, following the product’s instructions precisely and repeating the application as directed to eradicate both live insects and newly hatched nits.

All other household members must be examined without delay. Use a fine-tooth comb on dry hair, section by section, to detect any lice or viable eggs. If any are found, start the same treatment regimen used for the primary case. Even without visible signs, a prophylactic single treatment reduces the risk of unnoticed infestation.

Key steps for the entire family:

Wash all bedding, pillowcases, and towels in hot water (minimum 130 °F) and dry on high heat.
Seal non‑washable items (hats, scarves, hair accessories) in a sealed plastic bag for two weeks.
Vacuum carpets, upholstered furniture, and car seats; discard vacuum bags afterward.
Clean combs, brushes, and hair accessories by soaking them in hot water for at least ten minutes.
Schedule a follow‑up inspection after seven days to confirm eradication.

Maintain regular checks for at least four weeks, as lice eggs can hatch beyond the initial treatment window. Consistent vigilance eliminates re‑infestation and protects all family members.

School and Daycare Contacts

When head lice are identified, immediate communication with the educational or childcare facility is required. Failure to inform the institution can lead to further spread among children and staff.

Contact the school or daycare office as soon as possible. Provide the date of detection, the number of affected individuals, and the treatment plan being used.
Supply written confirmation of treatment completion, including the date the final application was performed and any follow‑up steps recommended by a medical professional.
Request that the facility distribute a brief notice to other parents, outlining the situation, recommended actions for their children, and the timeline for any additional screening.
Ask the administration to arrange a thorough inspection of the premises, focusing on shared items such as hats, hair accessories, and upholstered furniture.
Confirm that the institution will enforce policies on personal belongings, ensuring that items are not shared and that affected children remain at home until treatment is verified as successful.

Prompt notification enables the organization to implement preventive measures, schedule cleaning, and reduce the risk of additional infestations.

Regular Checks and Maintenance

Weekly Scalp Examinations

Regularly checking the scalp helps identify a lice infestation at the earliest stage, reducing the need for extensive treatment. Perform a focused examination once a week, preferably after a shower when hair is damp and easier to part.

Part the hair into sections of about two inches.
Use a fine-toothed lice comb, moving from the scalp outward.
Inspect the comb after each pass; look for live insects, eggs (nits), or brown specks attached to hair shafts.
Record any findings in a simple log to track changes over time.
If live lice or nits are detected, begin an appropriate treatment protocol immediately and repeat the examination after 48 hours to confirm eradication.

Consistent weekly inspections create a reliable baseline, allowing rapid response to any resurgence and preventing widespread contamination among household members.

Continued Combing

Continued combing is essential after the first application of a lice‑killing product. The process removes surviving nits and any newly hatched insects, preventing re‑infestation.

Use a fine‑toothed, lice‑comb on damp, conditioned hair. Starting at the scalp, pull the comb through each section from root to tip, then wipe the teeth with a tissue and rinse them in hot water. Repeat the passage at least three times per section to ensure that hidden nits are captured.

Perform the combing routine every 2–3 days for two weeks. After each session:

Rinse the comb in boiling water for 10 seconds.
Inspect the hair for live lice or viable nits.
Discard any found nits and continue treatment if live lice remain.

Maintain the schedule even if no insects are visible; residual eggs can hatch within a week and will be eliminated by the next combing session. This systematic approach, combined with proper hygiene of personal items, secures complete eradication.