The first sign of head lice often is an itchy scalp and irritation near the ears and neck. If your child has these symptoms, check closely for lice. You can treat lice at home with over-the-counter options, daily combing, head checks and avoiding direct contact. Follow these tips to help your family nix the nits and prevent head lice from spreading.

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If you or your children find yourself with lice, don’t panic. Treat lice at home or with help.

Diagnose by carefully combing through hair

The best way to diagnose lice is to identify a live nymph (hatched egg) or adult louse.

The American Academy of Pediatrics recommends examining wet hair. Carefully comb through the hair with a fine-toothed comb (a nit comb) from the scalp to the end of the hair. Using a lubricant, such as oil or conditioner, may help slow down the movement of the bug.

Nits are lice eggs. They’re small, oval, white and attached to individual strands of hair. Unlike dandruff flakes, nits don’t easily fall off the hair. It takes a fine-tooth comb or your fingers to remove nits.

You can identify and diagnose them at an appointment with a health care provider, or at home.

“Appointments are easy and painless. I examine the scalp very thoroughly, looking for adult lice and nits. Nits look like tiny, one millimeter, gray-white specks. They usually are well-adhered to the hair shaft, usually within one centimeter from the scalp,” said Melissa Koopmann, dermatology physician assistant with Marshfield Clinic Health System. “Special attention is paid to the area behind the ears, as well as the back of the scalp and hairline.”

Treat lice at home with over-the-counter products

If you have lice, you may notice a tickling feeling of something moving in your hair, itching, redness or small scabs in the scalp, due to scratching.

“There are products available that are typically applied to dry hair, for 10 minutes, and then rinsed out and combed through with a nit comb,” Koopmann said.

Over-the-counter products available include:

• Nix® or RID® (with active ingredient Permethrin, 1%)
• Sklice (with active ingredient Ivermectin, 0.5%). Sklice does not require nit combing.

“Due to the high-resistance of over-the-counter treatments, I typically recommend repeating the treatment in eight to 10 days,” Koopmann said.

If these treatments aren’t effective, there are prescription-strength treatment options available. These include topical products – like Elimite and Ovide lotion – and oral Ivermectin.

“While you can diagnose and treat at home, I would recommend seeing a provider if you or your child is not noticing relief within one to two applications of over-the-counter therapy,” Koopmann said. “An appointment is needed sooner if severe redness or itching occurs.”

Stop head lice from spreading

They typically don’t live more than a day off a human scalp. However, it’s good to take precautions to clean items that the affected person has used over the previous couple days.

“If lice is found on someone, make sure to wash and dry clothing or linens that were used in the two days prior to treatment,” Koopmann said. “Soak combs or brushes in hot water, at least 130 degrees Fahrenheit, for five minutes.”

Check all family members daily if someone in your household has lice. Avoid direct contact with the person who has lice, and don’t share bedding, hats, combs or brushes. Once you think they are gone, check for stragglers weekly for two or three weeks.

Head lice are very common. Anyone can be affected, and it doesn’t mean you’re dirty. Remind your kids not to use someone else’s hat, comb or brush at school. Check your child’s hair daily if a classmate has lice.

If over-the-counter treatments don’t work, or your child is younger than 2, call his or her pediatrician.

Besides using drugstore or prescription treatments, remove nits and lice with a fine-tooth comb every day and wash them down the drain. An easy way to do this is to wet your child’s hair, apply conditioner and comb through sections of hair from root to tip.

For help with head lice, talk to a Marshfield Clinic Health System provider.

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