Lice - Diagnosis and treatment (2023)


During an exam, a health care provider may use a magnifying lens to look for lice. The provider may also use a special light, called a Wood's light, to check for nits. This light makes the nits easier to spot by making them look pale blue.

Head lice

A health care provider may diagnose head lice after finding a live young or adult louse in the person's hair or on the scalp, or after seeing one or more nits on hair shafts found within 1/4 inch (6 millimeters) of the scalp.

Body lice

A health care provider may diagnose body lice if they find eggs or crawling lice in clothing seams or on bedding. You can see a body louse on skin if it crawls there to feed.

Pubic lice

A health care provider may diagnose pubic lice when they see moving lice or nits on hair in the pubic area or on other areas of coarse hair, such as chest hair, eyebrows or eyelashes.


Use drugs that treat lice only as directed. Applying too much can cause red, irritated skin.

Head lice

Head lice treatment may involve:

  • Nonprescription products. Shampoos containing permethrin (Nix) are usually the first option used to combat lice. Permethrin is a synthetic version of pyrethrin, which is a chemical compound extracted from the chrysanthemum flower. Permethrin is toxic to lice. Follow the directions closely when using this product.

    A lotion containing ivermectin (Sklice) also is available without a prescription. Ivermectin is toxic to lice. The lotion is approved for use in adults and children age 6 months or older. You can apply it once to dry hair and then rinse with water after 10 minutes.

    (Video) HEAD LICE, Causes, Signs and Symptoms, Diagnosis and Treatment.

    Don't repeat the ivermectin treatment without talking to your health care provider first. Possible side effects include eye irritation or redness, dandruff, dry skin, and a burning sensation at the application site.

    In some locations, lice have grown resistant to the ingredients in nonprescription treatments. If nonprescription treatments don't work, your health care provider can prescribe shampoos or lotions that contain different ingredients.

  • Oral prescription drug. Ivermectin (Stromectol) is available by prescription as a tablet taken by mouth. The oral drug effectively treats lice with two doses, eight days apart. This drug is typically used when other treatments haven't been effective.

    Children must weigh at least 33 pounds (15 kilograms) to take oral ivermectin. Side effects may include nausea and vomiting.

  • Topical prescription drugs. Malathion is a prescription drug that you apply to the hair and then rub into the hair and scalp. Malathion has a high alcohol content and is flammable. So keep it away from heat sources such as hair dryers, electric curlers and cigarettes.

    If you're pregnant or breastfeeding, talk to your health care provider before using this drug. The drug isn't recommended for children 2 and under. It's not clear if it's safe for use in 2- to 6-year-olds.

    Spinosad (Natroba) is a newer prescription treatment for head lice. You can apply it to dry hair and the scalp for 10 minutes and then rinse with water. The treatment doesn't usually need to be repeated. But it can be used again after seven days if live lice are still present.

    Possible side effects of spinosad include redness or irritation of the eyes and skin. This drug isn't recommended for children younger than age 4.

    (Video) How to spot and treat Head lice (nits) | Doctor O'Donovan explains...

Body lice

If you have body lice, first bathe with soap and water. After bathing, apply permethrin (Nix) to the affected areas before bedtime and then shower in the morning. Repeat this treatment nine days after the first application.

Also take other measures to get rid of body lice. Wash clothing and bedding with hot, soapy water — at least 130 F (54 C) — and dry them at high heat for at least 20 minutes. Vacuum the floors and furniture. And seal unwashable items in an airtight bag for two weeks.

Pubic lice

Pubic lice can be treated with many of the same nonprescription and prescription treatments used for head lice. Carefully follow the package instructions. Talk to your health care provider about treatment of lice and nits on eyebrows or eyelashes.


Whether you use nonprescription or prescription shampoo to kill lice, much of the treatment involves self-care steps you can take at home. These include making sure all the nits are removed and that all clothing, bedding, personal items and furniture are free of lice.

In most cases, killing lice that are on you isn't difficult. The challenge is getting rid of all the nits and avoiding contact with other lice at home or school.

Request an appointment

Lifestyle and home remedies

You can get rid of lice with a patient, detailed approach that involves cleaning yourself or your child and any personal belongings that may contain lice.

(Video) Head Lice - Causes, Symptoms and Treatment Options

These steps may help you get rid of lice:

  • Check other household members for lice and nits. Treat anyone who has signs of lice.
  • Use lotions and shampoos. Choose from among several nonprescription lotions and shampoos designed to kill lice. Apply the product according to package instructions.

    You may need to repeat treatment with the lotion or shampoo in about 9 to 10 days after the first application. Be sure to check the age recommendations of the drugs before using them on children.

  • Comb wet hair. Use a fine-toothed or nit comb to physically remove the lice from wet hair. Repeat every 3 to 4 days for at least two weeks. This method may be used in combination with other treatments. It is usually recommended as the first line treatment for infants younger than 2 months.
  • Wash items. Wash bedding, stuffed animals, clothing and hats with hot, soapy water — at least 130 F (54 C) — and dry them at high heat for at least 20 minutes.
  • Seal unwashable items. Place them in an airtight bag for two weeks.
  • Vacuum. Vacuum the floor and furniture well.
  • Wash combs and brushes. Use very hot, soapy water — at least 130 F (54 C) — or soak combs and brushes in rubbing alcohol for an hour.

One thing you don't need to worry about is your household pets. Lice prefer people to pets. So your pets don't need any treatment for lice.

Alternative medicine

Many home or natural remedies, such as mayonnaise or olive oil, are used to treat head lice. But there's little to no evidence of their effectiveness.

A special machine that uses hot air to dehydrate head lice and their eggs is another alternative treatment method. The machine requires special training and is currently available only at professional lice treatment centers.

A regular hair dryer can't be used to do this at home because it's too hot and could burn the scalp. The machine that dehydrates lice is cooler than most hair dryers but has a much higher flow rate to kill the lice by drying them out.

Preparing for your appointment

Often, you can get rid of lice with nonprescription treatments and by properly washing household items that had lice on them, such as sheets, towels and clothes. If these steps don't work, see your health care provider.

(Video) Head Lice Symptoms and Treatment - 4 Signs of Lice to Watch For

Here's some information to help you get ready for your appointment and what to expect from your provider.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including when you might have been exposed to lice, whom you might have exposed and what household items might be contaminated.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Write down questions to ask your health care provider. Your time with your provider is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out.

Some basic questions to ask your health care provider about lice include:

  • How do I treat lice?
  • Is there a generic alternative to the medicine you're prescribing?
  • How often can I safely use this product?
  • How do I get rid of lice from household items?
  • Who do I need to inform about my condition?
  • What other actions do I need to take to avoid getting lice again or giving it to others?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
  • Should I plan for a follow-up visit?

In addition to the questions that you've prepared to ask your health care provider, don't hesitate to ask questions during your appointment when you don't understand something.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, such as:

  • When did you first begin experiencing symptoms?
  • How were you exposed to lice?
  • Is there anyone you might have exposed to lice?
  • How severe are your symptoms?

What you can do in the meantime

If you think or know you have lice, avoid sharing personal items, bedding, towels or clothing. Bathe and follow self-care measures, including washing items in hot water.

If you think or know you have pubic lice, also avoid sexual activity until you've been treated.

By Mayo Clinic Staff

(Video) Lice (Head, Body and Pubic Lice) | Pediculosis | Species, Symptoms and Treatment


How do you diagnose and treat lice? ›

The diagnosis of head lice infestation is best made by finding a live nymph or adult louse on the scalp or hair of a person. Because adult and nymph lice are very small, move quickly, and avoid light, they may be difficult to find. Use of a fine-toothed louse comb may facilitate identification of live lice.

What kills lice immediately? ›

Washing, soaking, or drying items at a temperature greater than 130°F can kill both head lice and nits. Dry cleaning also kills head lice and nits. Only items that have been in contact with the head of the infested person in the 48 hours before treatment should be considered for cleaning.

How do you self diagnose head lice? ›

Use fingers to separate hair and create a part. The part should allow you to clearly see the person's scalp. Look for lice crawling on the scalp where the hair is parted or on the hair shaft. The lice will be dark in color and the size of a poppyseed.

What is the protocol for lice? ›

Clothes, bedding, and towels used by a person with head lice two days before treatment should be washed in hot water and dried on the hot cycle to kill any lice. Other items that cannot be washed or dry-cleaned can be placed in a sealed plastic bag for two weeks to kill any lice or nits on those items.

How do you clean your house after lice? ›

How to Clean Your Home after Discovering Head Lice
  1. Disinfect hairbrushes and combs in boiling water. Bring a kettle of water to a boil. ...
  2. Put linens and blankets in the dryer. Water doesn't smother head lice; hence, no need to wash the linens and blankets. ...
  3. Consider dry cleaning some items. ...
  4. Vacuum your home. ...
  5. Bottom line.

How long does it take to get rid of head lice? ›

With effective treatment, head lice will completely go away after two to three weeks. The duration is dependent on how many lice made a home in your hair. Make sure you follow the instructions on your medicated shampoo, lotion or cream to get rid of lice quickly.

Can head lice live in pillows? ›

Can head lice live on pillows or sheets? Head lice cannot live for long on pillows or sheets. It is possible for a live louse that has come off a person's head to crawl onto another human host who also puts their head on the same pillows or sheets.

What kills lice overnight? ›

Petroleum jelly (Vaseline).

Like olive oil, many moms swear by this (other options: styling gel or mayonnaise). The thick jelly supposedly suffocates lice by clogging their breathing holes. For best results, coat the hair and scalp, cover it overnight with a shower cap, and wash out the next morning. Comb for nits.

How do you get rid of lice permanently in one day? ›

It is not usually possible to get rid of lice in one day, as an infestation needs to be treated. However, there are treatments that can help get rid of lice and symptoms caused by lice more quickly. Lice infestations must first be treated by improving the hygiene of the infected person.

Can I see lice on my pillow? ›

Head lice do not live on pillows or sheets, as they need to feed on the scalp of a host in order to survive.

Would it be obvious if I had lice? ›

You may be able to see the lice, but they're often hard to spot because they're small, avoid light and move quickly. Lice eggs (nits) on hair shafts. Nits stick to hair shafts and may be hard to see because they're very tiny. They're easiest to spot around the ears and the hairline of the neck.

Do you feel lice crawling on head? ›

Not everyone feels lice moving around on their scalp, but some people do. Dr. Garcia says that most of her patients say they “don't feel anything,” but others may get a creepy, tickling sensation as lice move around their head.

Do I need to treat my whole house for lice? ›

Lice cannot live if it has no source to feed off of, so while it is important to thoroughly clean your house the extreme amount often expected isn't always needed. It's important to wash any machine washable items.

Should you treat everyone in the house for lice? ›

All infested persons (household members and close contacts) and their bedmates should be treated at the same time. Some pediculicides (medicines that kill lice) have an ovicidal effect (kill eggs). For pediculicides that are only weakly ovicidal or not ovicidal, routine retreatment is recommended.

How long should someone with lice stay home? ›

Students diagnosed with live head lice do not need to be sent home early from school; they can go home at the end of the day, be treated, and return to class after appropriate treatment has begun. Nits may persist after treatment, but successful treatment should kill crawling lice.

Do I need to wash sheets after head lice? ›

Head lice do not live on furniture, hats, bedding, carpet or anywhere else in the environment. Treating anything other than the human head does not eradicate head lice. There are two main treatment options to remove head lice: mechanical removal.

What to do with couch after lice? ›

Any chairs or couches that could have eggs or head lice should be scrubbed with warm wet cloths. If the surface is hard or leather, we recommend a cleaner such as bleach or Lysol that will not damage the furniture. However, hot water and soap with a little bit of elbow grease should do the trick.

What does vinegar do to lice? ›

However, if you are trying to find out how to get rid of nits using vinegar, you should know that using vinegar to kill nits or lice eggs is totally ineffective. Vinegar has no negative effect on the lice eggs. What it will do is sting like crazy if there is any kind of cut on the scalp.

What bugs live in your hair but not lice? ›

The bottom line. The type of insect you're most likely to find in your hair is the head louse. But fleas, bedbugs, or ants may also temporarily live on your scalp. It's also possible to mistake a scalp condition, like dandruff or psoriasis, for lice.

How do you calculate how long you have had lice? ›

So if you look on the scalp and see no visible adult lice and several small nits, it's likely that you've caught lice in the earlier stages and had them for less than 2 weeks. Nits and nymphs: 1.5 to 2 weeks. If you see nits and small, moving lice, you've likely had lice for 1.5 to 2 weeks.

Can you use lice shampoo two days in a row? ›

1. Can you use lice shampoo 2 days in a row? You shouldn't apply lice shampoo twice in a row, Antaya says, as it's not intended for this purpose. Keep in mind, it can take at least 8 to 12 hours for the treatment to kill adult lice.

Can lice survive a hair dryer? ›

The proportion of lice killed varied from 10% with the bonnet‐style hair dryer to 80% with the Louse‐Buster with hand piece.

Can you sleep with someone with lice? ›

Lice are most often spread by head-to-head contact with another person who has lice, such as sleeping in the same bed. Although they do not survive long away from a human host, lice may also be spread by wearing another person's hat or clothing, or by using another person's comb, brush, or bedding.

Can I sleep in my bed if I have lice? ›

Avoid sleeping in the same bed as the person with an active lice infestation. Avoid sitting where the person with lice has sat in the past two days. Wash linens and clothing in hot water and dry on high heat. Place stuffed animals, pillows and items that cannot be washed into an airtight bag for two weeks.

What do head lice hate? ›

What repels head lice? Coconut, tea tree oil, lavender, eucalyptus, rosemary, lemon grass, and peppermint are scents popularly believed to repel lice. Using any coconut scented shampoo and conditioner is an easy way to increase your defense. At 1% concentration, tea tree oil killed 100% of head lice after 30 minutes.

How long can lice live on a hairbrush? ›

Adult head lice can survive for 2 days and nits for around 1 week on a hairbrush. Soaking combs or hairbrushes in hot water of at least 130°F (54.4°C) for 5–10 minutes will kill any lice and nits.

What smell kills lice? ›

Prevention of Head Lice

Weekly head checks and the use of mint spray is your best defense. Mint Spray Recipe: Put 10 drops of mint essential oil into 16 ounces of tap or bottled water in a spray bottle. Spray on hair at least daily.

How many lice are usually found on a head? ›

How many head lice are usually found on an infested person? Typically, 10–15 head lice are found. The number of lice often depends on personal hygiene, for example, how often the person bathes, shampoos, or changes and washes his/her clothing.

Why can't you use conditioner after lice treatment? ›

Do not use a conditioner. It can keep the lice medicine from working. Rinse well with warm water and towel dry. Do not use the towel again until it has been laundered.

Does tea tree oil prevent lice? ›

It might keep lice away

On its own, tea tree oil was the most effective treatment tested. Tea tree oil and peppermint appeared to be most useful for repelling lice. Tea tree oil and lavender were also found to prevent some feeding by lice on treated skin.

Where do lice live when not on humans? ›

Head lice are obligate parasites. This means that they cannot survive without a human host. This species can live only on human hosts, so you cannot get them from your dog, cat, guinea pig, or any other kind of furry pet you may have. Lice don't have wings, so they can't fly.

Can adults get head lice? ›

Can adults get head lice? Adults can get head lice, but they're most common in children aged between four and 11. If you have head lice, you'll usually have up to around 30 lice living on your scalp. But, there could be up to 1,000 lice if you have a very bad case of lice.

Can lice hide in couches? ›

CONCLUSION. Lice cannot live on couches, carpets, beds, or anywhere else other than on a human body. They are only spread by direct human to human contact or through shared items like combs and brushes.

Why do I feel like I have lice when I don t? ›

It's likely that you are experiencing psychosomatic itching if you are still itching after a lice infestation. It's just like watching a movie where a character has bugs on them or finding an ant on your hand; psychosomatic itching makes your skin crawl all over the place without actually experiencing the stimuli.

What are the tiny brown bugs in my hair not lice? ›

Some common bugs that can be mistaken for lice are ants, bedbugs, and fleas. A few things all these bugs have in common is they're small in size, can be dark colored, and can give you an itchy head. A few things that can be mistaken for lice nits are dandruff, hair product, or dirt.

What causes head lice to begin? ›

Head-to-head contact with an already infested person is the most common way to get head lice. Head-to-head contact is common during play at school, at home, and elsewhere (sports activities, playground, slumber parties, camp). Although uncommon, head lice can be spread by sharing clothing or belongings.

Why do I feel crawling on my head but I don't have lice? ›

Causes of crawling sensations on the scalp include delusional infestations, hallucination, substance abuse, a parasitic infestation, side effects from medication, or issues with the neurologic system.

How do you get rid of lice in one day naturally? ›

Vinegar contains properties that kill and get rid of nits and lice. This mixture should be applied directly to the whole scalp. Mix 1 cup of vinegar with 1 cup of warm water. Next, distribute this mixture onto the scalp and cover your hair with a hair cap.

What is phantom lice? ›

People who suffer from conditions like phantom lice syndrome, delusional bug syndrome or Morgellons disease report feeling like something is literally trapped under their skin. They believe lice, bugs, worms, eggs, fibers or tiny specks are right under their skin or are trying to come out of it.

What kills head lice on furniture? ›

Throw pillow cases, armrest covers, stuffed toys, and throws can usually be removed from furniture and laundered. Drying them on high heat for 20 minutes kills nits and bugs. But heat may also damage them, and it's also effective to set them aside and not touch them for a day.

Can you vacuum lice out of your hair? ›

Vacuuming: While a vacuum is a good tool for cleaning up the ground after manual lice removal with a comb, it is not a wise idea to attempt to vacuum lice out of someone's hair. This is an uncomfortable and ineffective solution as lice have special claws to hold onto hair.

What is the most effective lice treatment? ›

Permethrin (Nix)

Permethrin lotion 1% is approved by the U.S. Food and Drug Administration (FDA) for treating head lice in children 2 months and older.

What not to do when you have lice? ›

Do not share clothing such as hats, scarves, coats, sports uniforms, hair ribbons, or barrettes. Do not share combs, brushes, or towels. Disinfest combs and brushes used by an infested person by soaking them in hot water (at least 130°F) for 5–10 minutes.

Should I treat myself for lice if my child has it? ›

It is important that all members of the family with symptoms of an infestation are treated. It is also important to wash bedding, clothing and towels. Treatment involves using prescription or over-the-counter medicine to kill the lice.

Should I tell people I have lice? ›

In many cases, the presumed 'infestation' is imagined rather than real. So, telling others may simply be spreading misinformation. OK, but if you've found a bona fide louse, and have not removed it or treated appropriately, then make a risk assessment.

How long are you contagious after lice? ›

After the first treatment, when the egg-laying lice are eliminated, you are no longer contagious.

How do you clean your house of lice? ›

How to Clean Your Home after Discovering Head Lice
  1. Disinfect hairbrushes and combs in boiling water. Bring a kettle of water to a boil. ...
  2. Put linens and blankets in the dryer. Water doesn't smother head lice; hence, no need to wash the linens and blankets. ...
  3. Consider dry cleaning some items. ...
  4. Vacuum your home. ...
  5. Bottom line.

Can a doctor check for head lice? ›

See your family's health care provider or pediatrician if you suspect that your child has head lice. The provider will examine your child's scalp and look for a live nymph or adult louse to determine if he or she has head lice. The provider can carefully inspect your child's hair.

Should I go to the doctor if I think I have lice? ›

If you think you have lice, call your doctor. Your doctor can recommend a medicated shampoo, cream rinse, or lotion to kill the lice. These may be over-the-counter (OTC) or prescription treatments.

Should I go to the doctor for lice? ›

If you find head lice or nits in eyelashes or brows, talk to your doctor. If over-the-counter products are not effective, your doctor can prescribe a cream, lotion, or shampoo to treat your head lice. Certain prescription medicines are also safer for women who are pregnant or breastfeeding.

How do you tell how long you've had lice? ›

So if you look on the scalp and see no visible adult lice and several small nits, it's likely that you've caught lice in the earlier stages and had them for less than 2 weeks. Nits and nymphs: 1.5 to 2 weeks. If you see nits and small, moving lice, you've likely had lice for 1.5 to 2 weeks.

Why do I have nits but no lice? ›

Can someone have nits but no lice? It may be possible to have nits but no lice. If a person cannot find any nymphs or adult lice in the scalp and the nits are more than a quarter of an inch from the scalp, these may be dead and from an old infestation. However, the lice could be in hiding.

Is it possible to have nits and no bugs? ›

Children can have a few nits without actually having a case of head lice. Usually children have no more than 10 to 20 live lice. Good lighting is important when you are checking. Head lice move fast and are hard to see.

What are the black dots on my scalp lice? ›

Feces — Look for lice feces on the scalp, which are tiny black specks. If you see them, examine the rest of the head for live lice. Eggs — Female lice typically attach eggs 1/4-inch from the scalp. There can be from a few to several hun- dred nits in a child's hair.

Is it bad to have lice for years? ›

Head lice should not be considered as a medical or public health hazard. Head lice are not known to spread disease. Head lice can be an annoyance because their presence may cause itching and loss of sleep.

Do lice like hot water? ›

Soaking hair care items (such as combs, brushes, and hair clips) in hot water (at least 130°F) for at least 15 minutes to kill any lice or eggs.


1. Crabs STD (Pubic Lice) - Symptoms & Treatment Of Pubic Lice
(Dr. Graham Dersnah)
2. Pubic lice Symptoms – Causes Treatment Signs and Symptoms of Pubic lice and Pubic Crab
3. Lice | How To Get Rid Of Head Lice
4. Head lice: How to treat
(American Academy of Dermatology)
5. Identifying & Treating Lice
6. What Lice And Their Eggs Look Like
(Kids Health By Dr. Tahir)


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