September is National Head Lice Prevention Month in the U.S, coinciding with a time of year when infestations tend to surge. “Head lice can occur throughout the year, but cases are often noticed more frequently in late summer and early fall, when children return to school and resume close-contact activities,” says Dr. April Armstrong, chief of dermatology at the University of California, Los Angeles.
The insects don’t spread disease, but they can still cause a great deal of distress, doctors say. “Having head lice is not a sign of poor hygiene, but it can cause stress and anxiety because there is this stigma that it is,” says Dr. Carla Torres Zegarra, a pediatric dermatologist at Children’s Hospital Colorado. “If left untreated, it can also be very bothersome, causing itching and disturbing sleep.”
Head lice, or Pediculus humanus capitis, are tiny, wingless insects that feed on human blood. They are found mostly on the scalp, but sometimes appear on eyebrows and eyelashes.
Are they the same as pubic or body lice?
No. There are three different types of lice that feed exclusively on humans: head lice, pubic or “crab” lice, and body lice. Unlike head lice, which have elongated bodies, pubic lice have short and round bodies, resembling crabs. Pubic lice typically spread through sexual contact and are most common in adults.
Since head lice can only crawl and not jump or fly, they typically spread via head-to-head contact. “That’s why it happens more in kids, because they play in close proximity,” Torres Zegarra says.
Getting head lice has nothing to do with personal hygiene or the cleanliness of the environment, and is caused solely by exposure to an infested person.
Animals don’t get or spread head lice.
How do you know if you or your child has head lice?
People can have head lice without symptoms, too. “With a first infestation, itching may not begin for four to six weeks because it takes time for the body to develop an allergic response to louse saliva,” Armstrong says.
Misdiagnosis of head lice is common. “Many presumed lice and nits submitted by physicians, nurses, teachers, and caregivers to a laboratory for identification were found to be artifacts such as dandruff, hairspray droplets, scabs, dirt, or other insects,” such as those blown by the wind and caught in the hair, AAP says.
Head lice infestations most commonly occur in preschool- and elementary school-age children and their families.
How do you treat head lice?
There are several over-the-counter and prescription medications approved by the U.S. Food and Drug Administration (FDA) to treat head lice, including lotions and shampoos that contain the insecticides permethrin or pyrethrin. Treatment of head lice often involves using one of these medications, combined with “careful combing using a fine-toothed lice comb,” Armstrong says.
In some cases, head lice can be resistant to these topical medications, AAP says. In those situations, manual removal of lice and nits might be necessary—an option also available to people who want to avoid insecticide-containing products. The AAP says home remedies such as using mayonnaise, melted butter, or olive oil could work to suffocate the lice, though these methods are not FDA approved or recommended, and more research still needs to be done on their effectiveness. A prescription oral medication can also be used.
Torres Zegarra says she sometimes sees patients with itchy scalps who developed irritation because they tried head lice treatments despite not having any evidence of lice. “What I end up treating is not lice but the skin irritation caused by multiple treatments that were tried on the scalp,” she says.
“Long or very thick hair may require more product and more time to comb thoroughly, but it can be treated successfully without removing the hair,” Armstrong says. “If live lice remain after treatment has been used correctly, a clinician should determine whether the cause is medication resistance, reinfestation, or an incorrect diagnosis before additional treatments are applied.”
How do you prevent head lice?
If someone is confirmed to have head lice, members of their household and other close contacts should be carefully checked for infestation. “Clothing, towels, and bedding used during the two days before treatment can be washed and dried using heat,” Armstrong says. “Combs and brushes can be soaked in hot water. Extensive cleaning, fumigation, and pesticide sprays are unnecessary.”
Ultimately, Torres Zegarra says “there’s no need to panic” when head lice arise. “It’s a nuisance problem but not a health crisis,” she says, adding that children with head lice shouldn’t be quarantined or kept away from school.
“No healthy child should lose out on education because of head lice. They should avoid head-to-head contact, but they shouldn’t be shamed or isolated,” Torres Zegarra says.
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