Head lice (lice is plural, louse is singular) are tiny insect-like animals called arthropods that may live on the head and cause itching. Head lice may also live in the eyebrows, eyelashes, and beard. However, some infestations in these areas are from a related species called pubic lice (crabs).
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Head lice is spread by personal contact and by sharing combs, brushes, hats, and other personal items.
This condition is more common in young children.
Factors that may increase the chance of lice include:
Some people with head lice do not have any symptoms.
When symptoms do occur, they may include:
You will be asked about your symptoms and medical history. A physical exam will be done. Your head and scalp will be examined for lice and lice eggs (nits).
Do not self-diagnose and self-treat head lice. Some treatments can cause irritation and should only be used by people who have the infestation.
Treating head lice involves removing eggs and killing lice so that they can't continue to lay eggs. Treatment may be difficult. In some regions, lice have become resistant to many commonly used medications. Some experts recommend that treatment be given only when live adult lice are seen.
Most cases of head lice can be treated with over-the-counter preparations. However, there is increasing resistance to the medications permethrin and pyrethrin in the United States. There are other treatments that may be effective, such as herbal remedies that contain coconut oil and anise.
Prescription creams or lotions may be prescribed to treat head lice. These include benzyl alcohol lotion, ivermectin lotion, and malathion lotion.
In certain cases, your doctor may prescribe lindane. Lindane is neurotoxic and carries a black box warning. Follow the instructions carefully. It should only be prescribed to patients who are unable to take other medications or who have not responded to them. According to the Food and Drug Administration’s warning, lindane can rarely cause serious side effects, including seizure and death. Those especially susceptible are infants, the elderly, children and adults weighing under 110 lbs, and individuals with other skin conditions. Lindane is toxic and should not be overused. Patients are given small amounts (1-2 ounces) of the shampoo or lotion and instructed to apply a thin layer and not to reapply.
Lice are common, especially in children. To prevent outbreaks of head lice:
Centers for Disease Control and Prevention
Nemours Kids Health
Caring for Kids—Canadian Paediatric Society
Lindane shampoo and lindane lotion. Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm110452.htm. Updated July 16, 2015. Accessed February 9, 2016.
Medication guide lindane lotion. Food and Drug Administration website. Available at: http://www.fda.gov/downloads/Drugs/DrugSafety/UCM133687.pdf. Updated August 2007. Accessed February 9, 2016.
Medication guide lindane shampoo. Food and Drug Administration website. Available at: http://www.fda.gov/downloads/Drugs/DrugSafety/UCM133688.pdf. Updated August 2007. Accessed February 9, 2016.
Head lice. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/contagious-skin-diseases/head-lice. Accessed February 9, 2016.
Head lice treatment. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/parasites/lice/head/treatment.html. Updated December 28, 2015. Accessed February 9, 2016.
Revised lindane lotion label. Food and Drug Administration website. Available at: http://www.accessdata.fda.gov/drugsatfda_docs/label/2003/006309lotionlbl.pdf. Accessed February 9, 2016.
Revised lindane shampoo label. Food and Drug Administration website. Available at: http://www.accessdata.fda.gov/drugsatfda_docs/label/2003/006309shampoolbl.pdf. Accessed February 9, 2016.
Roberts RJ. Clinical practice. Head lice. N Engl J Med. 2002;347(17):1381-1382.
12/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Burgess IF, Brunton ER, Burgess NA. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr. 2010;169(1):55-62.
11/26/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pariser D, Meinking T, Bell M, et al. Topical 0.5% ivermectin lotion for treatment of head lice. N Engl J Med. 2012;367(18):1687-1693..
Last reviewed February 2016 by David L Horn, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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