Head Lice: Care Instructions

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Head lice in hair on head, with close-up of louse and eggs (nits)


Head lice are tiny bugs that can live in your hair and on your head. Live lice are tan to grayish white. They're about the size of a sesame seed. It may be easiest to find them at the base of the scalp, at the bottom of the neck, and behind the ears. When you have lice, all people living in your home need to be carefully checked and then treated.

Lice eggs (nits) may be easier to see than live lice. They look like tiny yellow or white dots attached to the hair, close to the scalp. Nits can look like dandruff. But you can't pick them off with your fingernail or brush them away.

Lice aren't dangerous. They don't spread disease or have anything to do with how clean someone is. The lice may make your head itch.

Lice won't go away without treatment. You can treat lice and their eggs with prescription or over-the-counter medicines. After treatment, your skin may still itch for a week or more. This is because of your body's reaction to the lice.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • Use an over-the-counter medicine to kill lice. It's important to use any medicine correctly and to choose a medicine that is safe. Talk to your doctor or pharmacist if you have questions.
  • Do not shampoo or condition your hair before you use the medicine. It's best to wait 1 to 2 days after you use the medicine before washing your hair.
  • Check your scalp for live, active lice 12 hours after treatment. If you find some, talk to your doctor. You may need a different type of treatment.
  • Follow the directions carefully. Some medicines should only be used once. Others require a 2nd treatment 7 to 9 days after the first treatment.
  • Wet combing may help remove lice and nits. Use a comb with teeth that are close together. A flea comb that's made for dogs and cats will also work. Wet the hair. Comb all of the hair very carefully. Combing needs to be done over and over.
  • Try not to scratch. It may help to use an over-the-counter cream or calamine lotion to calm the itching. If the itching is really bad, ask the doctor about an over-the-counter antihistamine. Read and follow all instructions on the label.
  • Try not to share anything that comes into contact with hair. For example, don't share hair bands, barrettes, towels, hats, combs, or brushes. Teach your children not to share anything that comes into contact with hair if they have lice.
  • You don't need to spend a lot of time or money deep cleaning your home. But it is a good idea to:
    • Soak hairbrushes, combs, barrettes, and other items for 10 minutes in hot water (at least 130°F).
    • Vacuum carpets, mattresses, couches, and other fabric-covered furniture.
    • Machine-wash clothes, bedding, towels, and hats in hot water (at least 130°F). Dry them in a hot dryer. If you don't have access to a washing machine, instead you can store these items in a sealed plastic bag for 14 days.

When should you call for help?

Call your doctor now or seek immediate medical care if:

  • You have signs of a skin infection, such as:
    • Increased pain, swelling, warmth, and redness.
    • Red streaks coming from an area of the scalp.
    • Pus draining from the area.
    • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You see live lice or new nits after you have followed the directions for your medicine.
  • Anyone else in your family has lice.
  • You do not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.