Lice are tiny insects that live on
humans and feed on blood. When a large number of lice live and multiply on a
person, it is called an infestation.
Three different kinds of lice
live on humans:
Lice spread easily
from one person to another through close contact or through shared clothing or
personal items (such as hats or hairbrushes). A louse cannot jump or
The most common symptom of
lice is itching. There are different symptoms, depending on which type of lice
Frequent scratching can cause a skin infection. In the
most severe cases of head lice, hair may fall out, and the skin may get darker
in the areas infested with lice.
A doctor can
usually tell if you have lice by looking closely for live lice or eggs in your
hair. The doctor may also comb through your hair with a fine-toothed comb to help detect lice. He or she may look at the lice or eggs under a microscope.
Your doctor can also find pubic lice and body lice by
looking closely at your body or your clothing.
Lice won't go away on their own. Be sure to do all you can to treat lice and to prevent the spread of lice.
The most common
treatment is an
over-the-counter or prescription cream, lotion, or
shampoo. You put it on the skin or scalp to kill the lice and eggs. In some
cases, you may need treatment a second time to make sure that all the eggs are
dead. If two or more treatments don't work, your doctor may prescribe a different medicine.
It's also important to wash clothing and
bedding in hot water to help get rid of lice.
Some people continue to have itching for 7 to 10 days after the
lice and eggs have been killed. Steroid creams or calamine lotion can relieve
the itching. If you have severe itching, you can try
antihistamine pills. But don't give antihistamines to
your child unless you've checked with the doctor first.
Learning about lice:
Lice are very
easily spread, usually through close personal contact. Lice infestation may be
caused by any of the three types of lice:
Lice are spread from human to human. Pets don't get head lice and can't spread them to humans.
Itching, the most common symptom of all
lice infestation, is caused by an
allergic reaction. Lice bite the skin to feed on a
person's blood. The saliva from these bites causes the allergic reaction and
Itching may not occur right away, depending on a
person's sensitivity and history of lice infestation. The first time a person
is infested with lice, it may take several weeks or months for itching to
start or to be noticed. In a repeat case of lice, a person may begin to itch
within 2 days of infestation because the
immune system reacts more quickly when exposure has
Some people become very sensitive to lice
bites and have unbearable itching. Others build up tolerance to the bites and
have little or no itching, even with repeated infestations.
addition to itching, symptoms of lice infestation vary depending on which type
of lice is present.
Head lice and their eggs (nits) can be
seen on hair, the nape of the neck, and behind the ears. They can vary in color
from white to brown to dark gray. The eggs are tiny round or oval shapes that
are tightly attached to the hair near the scalp and do not slide up and down on
Frequent scratching may cause broken skin or sores to
form on the scalp. The damaged skin may weep clear fluid or crust over, and it
may become infected. In response to infection, the
lymph nodes behind the ears and in the neck may become tender and
pubic lice infestation may cause itching around the genitals as well as the
anus, armpits, eyelashes, and other body areas with hair. Pubic lice bites may
cause small, flat, blue-gray marks (maculae cerulea) that look like bruises on the torso,
thighs, or upper arms. The marks may last for several months, even after all
lice have been killed. Pubic lice, like head lice, can be seen on shafts of
Pubic lice that infest the eyelashes and eyelids may cause
irritation and crusting in those areas. The lice may be visible near the base
Pubic lice tends to be spread by sexual contact. If you or your teen has pubic lice, you may also have some other sexually
transmitted infection (STI). Symptoms of STIs can include itching, tingling,
burning, or pain of the genitals. For more information about STIs, see the
Exposure to Sexually Transmitted Infections.
Itchy sores from
body lice usually develop in the armpits, around the waist, and along the
trunk where seams of clothes press against the skin. The lice and eggs are
generally not seen on the skin but may be found in the seams of the person's
Other conditions, such as dandruff or
scabies, can cause symptoms similar to those of a lice
Lice will not go away without treatment. If the initial treatment does not kill all of
the eggs (nits), a follow-up treatment may be required 7 to 10 days later to
kill the newly hatched
lice. Itching may last for 7 to 10 days even after
After treatment, dead eggs may remain in the
person's hair until they are removed. Some schools have a policy of not
allowing children to return to school until they are free of eggs.
If your child has lice, report it to your child's day care provider or
school so that other children can be checked.
Some children and parents think about or feel lice crawling even after the lice problem is gone. If you or your child feels like symptoms are lasting or feels troubled after the lice problem is gone, talk to your doctor.
Frequent scratching can cause mild
complications such as skin infections. In severe cases, hair may fall out. Some
people may develop thickened, darkened skin in areas that are infested with
lice over a long period.
Things that increase the
risk of getting
If you suspect
lice infestation (pediculosis), you can try an
over-the-counter lice medicine or visit your doctor to
double-check your symptoms. Call a doctor if:
Lice will not go away without proper treatment.
Even if they don't bother you much, lice can be spread to other household
members, sex partners, or other people you have close personal contact
with. If you think you have lice, try an over-the-counter lice medicine or call a
If you need help
treating a lice problem, contact any of the following:
pharmacist can answer your questions about medicines
that treat lice.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
To find out if your child has lice, the doctor will do a close
visual exam to look for live
lice or their eggs (nits) on the hair. The doctor may
also use a fine-toothed comb to help detect lice. He or she may need to look at the lice or eggs under a microscope to confirm the diagnosis.
Lice will not
go away without proper treatment. Treatment should begin as soon as symptoms of
lice are noticed or when live lice and eggs (nits) are seen on the person's
body or in clothing. Specific treatment depends on the type of lice
Children with head lice can return to school or
day care after their first treatment. Some schools have a "no nits" policy in which the child can go back to school or day care only after eggs have
been removed. "No nits" policies are discouraged by medical experts. Most doctors agree that a child should be allowed to return
to class after proper treatment and should be urged to avoid close head-to-head
contact with other students. Confidentiality should be maintained so as not to
embarrass a child who has head lice.
Itching may continue even
after all lice are destroyed. This happens because of a lingering
allergic reaction to their bites. Over-the-counter
cortisone (corticosteroid) creams or calamine lotion may help.
For severe itching,
antihistamine medicines (such as Benadryl) or
stronger, prescription-strength corticosteroid creams may be needed. Don't give
antihistamines to your child unless you've checked with the doctor first. And
don't use cortisone cream for longer than 7 days without talking with your
doctor. Do not use the cream on children younger than age 2 unless your doctor
tells you to. And don't use it in the rectal or vaginal area in children
younger than age 12 unless you've checked with the doctor first.
Who should be treated?
Treatment is not likely to work if:
Head lice are easily spread among children because kids commonly share hats, combs, and other items. If you or your child has head lice, you can help prevent others from getting it if you avoid head-to-head (hair-to-hair) contact during activities inside the home and outside the home.
Also, don't share clothing, bedding, hair brushes and accessories, pillows, stuffed animals, or towels. Frequently examining the scalps of your school-age children may help you
discover and treat lice before they spread to the rest of your family. Avoiding
prolonged close contact with a person who has lice will also reduce your
Pubic lice are spread primarily among people who have
many sex partners. Reducing the number of sex partners you have may help reduce
your risk of getting pubic lice.
Body lice may be
prevented by bathing regularly and changing clothes daily. Body lice live on
clothing, not on the body. Washing clothing in hot water [130°F (54.44°C) or higher] will usually kill
adult lice and prevent eggs from hatching. Body lice that are on the skin
usually go away on their own with daily bathing and wearing clothes that are
not contaminated. Medicines to kill body lice are usually not needed.
To help control the spread of lice, you can also clean combs, brushes, clothing, and other personal items to kill lice and their eggs.
There are both
over-the-counter medicines and prescription products
to treat head
lice and pubic lice. Most products come as a shampoo, creme rinse, or
lotion (topical treatment) that is applied to the affected areas, left on for a
period of time, and then rinsed off. Doctors sometimes prescribe a pill to treat lice when two or more approved topical medicines have not
If lice infest the eyelashes, your doctor may prescribe an eye ointment for you.
Because body lice live in clothing, not on the body, medicines are generally not needed unless the person is severely
infested. The most common way to kill body lice and eggs is to wash clothing
and bedding in hot water [130°F (54.5°C) or higher] in a washing machine.
Over-the-counter (OTC) medicines that are recommended for head or pubic lice include:2
There are other OTC products for lice, but not all of them have good evidence that their benefits outweigh the side effects and other risks. Check the product label. Be sure to follow the directions about proper use and safety. And talk to your doctor or pharmacist about whether these products are safe for young children.
Prescription medicines that are recommended for head or pubic lice include:2
If these OTC or prescription medicines aren't working, your doctor may prescribe a different medicine to help get rid of lice. These include ivermectin (Sklice or Stromectol), permethrin 5% (Elimite), and spinosad (Natroba). In rare cases, lindane may be prescribed. But lindane is falling out of favor because of the potential for serious nervous system side effects. The American Academy of Pediatrics no longer recommends lindane as a treatment for head lice.
Antihistamines (both prescription and nonprescription)
can help relieve the itching that often occurs with lice. These medicines may cause
drowsiness. Don't give antihistamines to your child unless you've checked with
the doctor first.
If there is a serious skin infection,
antibiotics may be needed.
It is not necessary to remove
lice eggs from hair after treatment with topical medicines, but some people
may wish to remove them for cosmetic reasons.
Most products used
to treat lice may cause side effects if they are not used properly. Never use a
product more than two times (with less than 7 days between uses) without first
consulting a doctor.
There is some concern that lice are becoming
resistant to (can no longer be killed by) permethrin or other medicine used to
treat lice infestations. It is also possible that lice may persist after
treatment because the medicine was not used properly or because the person was
reinfected by someone else who was still infected with lice.
Wet combing is an option for infants who can't use lice medicines.
Some people try other treatments (such as using petroleum jelly or olive oil to smother lice). But there is not strong evidence that other treatments such as these work well or are safe to treat lice.
Head-shaving helps get rid of
lice. But this method can cause distress to the person whose head is shaved. After cutting or shaving the hair, put the hair
into a garbage bag right away and seal it so that lice cannot spread to other
areas in your home.
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CitationsHill N, et al. (2005). Single blind, randomized, comparative study of the Bug Buster kit and over-the-counter prediculicide treatments against head lice in the United Kingdom. BMJ, 331(7513): 384–387.Drugs for parasitic infections (2010). Treatment Guidelines From The Medical Letter, 8(Suppl): e1–e20.Other Works ConsultedAmerican Academy of Pediatrics (2009). Pediculosis capitis (head lice), pediculosis corporis (body lice), pediculosis pubis (pubic lice, crab lice). In LK Pickering et al., eds., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 495–499. Elk Grove Village, IL: American Academy of Pediatrics.Burgess I (2011). Head lice, search date June 2010. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.Diaz JH (2010). Lice (pediculosis). In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 2, pp. 3629–3632. Philadelphia: Churchill Livingstone Elsevier.Drutz JE (2009). Arthropods. In RD Feigin et al., eds., Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 3033–3039. Philadelphia: Saunders Elsevier.Elston D (2011). Infestations. In EG Nabel, ed., ACP Medicine, section 4, chap. 8. Hamilton, ON: BC Decker.Frankowski BL, et al. (2010). Clinical report: Head lice. Pediatrics, 126(2): 392–403.Gupta A, Levitt JO (2010). Pediculosis. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 536–539. Edinburgh: Saunders Elsevier.Habif TP (2010). Infestations and bites. In Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 5th ed., pp. 581–634. Edinburgh: Mosby Elsevier.Habif TP, et al. (2011). Infestations and bites. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 334–365. Edinburgh: Saunders.Morelli JG (2011). Arthropod bites and infestations. In RM Kleigman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 2317–2322. Philadelphia: Saunders.Spinosad (Natroba) topical suspension for head lice (2011). Medical Letter on Drugs and Therapeutics, 53(1367): 50–51.Stone SP, et al. (2008). Scabies, other mites, and pediculosis. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 2, pp. 2029–2037. New York: McGraw-Hill.
August 30, 2012
John Pope, MD - Pediatrics & Susan C. Kim, MD - Pediatrics
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