by Jennifer Hellwig, MS, RD
Head lice (lice is plural, louse is singular) are tiny insect-like animals called arthropods that may live on the head and cause itching. Head lice may also live in the eyebrows, eyelashes, and beard. However, some infestations in these areas are from a related species called crab lice (pubic lice).
Head lice is spread by personal contact and by sharing combs, brushes, hats, and other personal items.
This condition is more common in young children.
Factors that may increase the chances of lice:
Some people with head lice do not have any symptoms.
When symptoms do occur, they may include:
You will be asked about your symptoms and medical history. A physical exam will be done. Your head and scalp will be examined for lice and lice eggs (nits).
Do not self-diagnose and self-treat head lice. Some treatments can cause irritation and should only be used by people who have the infestation.
Treating head lice involves removing eggs and killing lice so that they cannot continue to lay eggs. Treatment may be difficult. In some regions, lice have become resistant to many commonly used medications. Some experts recommend that treatment be given only when live adult lice are seen.
Most cases of head lice can be treated with over-the-counter preparations. However, there is increasing resistance to the medications permethrin and pyrethrin in the US. There are other treatments that may be effective, such as herbal remedies that contain coconut oil and anise.
Prescription creams or lotions may be prescribed to treat head lice. These include benzyl alcohol lotion, ivermectin lotion, and malathion lotion.
In certain cases, your doctor may prescribe lindane. Lindane is neurotoxic and carries a black box warning. Follow the instructions carefully. It should only be prescribed to those who are unable to take other medications or who have not responded to them. According to the US Food & Drug Administration’s warning, rare but serious side effects include seizure and death. Those especially susceptible are infants, the elderly, children and adults weighing under 110 pounds, and individuals with other skin conditions. Lindane is toxic and should not be overused. People are given small amounts (1-2 ounces) of the shampoo or lotion and instructed to apply a thin layer and not to reapply.
Lice are common, especially in children. To help prevent outbreaks of head lice:
Centers for Disease Control and Prevention
Nemours Kids Health
Caring for Kids—Canadian Paediatric Society
Head lice. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/contagious-skin-diseases/head-lice. Accessed January 29, 2021.
Head lice. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T116514/Head-lice . Accessed January 29, 2021.
Lindane. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T233229/Lindane . Accessed January 29, 2021.
Parasites—lice—head lice. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/parasites/lice/head. Accessed January 29, 2021.
11/26/2012 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116514/Head-lice : Pariser D, Meinking T, Bell M, et al. Topical 0.5% ivermectin lotion for treatment of head lice. N Engl J Med. 2012;367(18):1687-1693.
Last reviewed March 2020 by EBSCO Medical Review Board David L. Horn, MD, FACP
Last Updated: 1/29/2021
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