Lice and parasitic insects can be found on people’s heads, and bodies, including the pubic area. The three phases of life cycle are: egg (nit), nymph (baby louse), and adult louse. Nits are lice eggs found firmly attached to the hair shaft. They can be confused with dandruff or hair spray droplets. The adult louse is tan to grayish-white and about the size of a sesame seed.
Lice move by crawling; they cannot hop or fly. Dogs, cats and other pets do not play a role in the transmission of human lice. Body lice are known to spread disease.
Most people with head lice do not have any symptoms. Some people feel itching or have a skin-crawling sensation, irritation of the scalp, neck and/or ears.
Treatment consists of 2 steps: Step 1 - Treating person, any infested family members, partners and/or roommates as well as bedmate as a precaution and then Step 2 - Treating the living area.
Step 1: Treat the Person
- Remove all clothing. Put on clean clothing AFTER treatment.
- Apply lice medicine according to label instructions. A second bottle may be required for extra-long hair.
- Permethrin: OTC – Nix. Permethrins are safe and effective and may continue to kill newly hatched eggs for several days after treatment. A second treatment may be necessary in 7-10 days to kill any newly hatched lice. Sometimes the treatment does not work secondary to resistance.
- Pyrethrins: Over the counter – A-200, Pronto, R&C, RID, and Triple X. Though safe and effective, pyrethrins only kill crawling lice, not unhatched nits. A second treatment is recommended in 7- 10 days to kill any newly hatched lice. Sometimes the treatment does not work secondary to resistance.
- Do not re-wash hair for 1-2 days after treatment.
- Warning: do not use a cream rinse or combination shampoo/conditioner before using lice medicine
- If some live lice are still found 8-12 hours after treatment but are moving more slowly than before, do not retreat. The medicine sometimes takes longer to kill the lice.
- Comb dead and remaining live lice out of the hair using a special metal nit comb (often found in the lice medication packages).
- A 1:1 solution of vinegar and water applied to the hair for 15 minutes can be used to remove the remaining nits and lice.
- After treatment, check, comb, and remove nits and lice from hair every 2 to 3 days.
- Check all treated persons for 2 to 3 weeks until you are sure all lice and nits are gone.
- Instruct patients to inform any sexual partners that they are at risk for infestation and to avoid any sexual partners until partners have been treated and the infestation has been cured. Itching does not indicate re-infection.
- Diphenhydramine HCL (Benadryl) can reduce the itch. Use per label directions.
To treat body lice:
Step 2: Treat the Household
- Machine-wash all washable clothing, towels and bed linens that the infested person touched during the 2 days before treatment. Use the hot water cycle (130° F) to wash clothes. Dry laundry using the hot cycle
- For all clothing, stuffed animals, comforters, etc., that cannot be washed or dry cleaned, store into a plastic bag and seal for 2 weeks.
- Soak combs and brushes for 1 hour in rubbing alcohol, Lysol*, or wash with soap and hot (130° F) water.
- Vacuum the floor and furniture. Do not use fumigant sprays; they can be toxic if inhaled.
To treat nits and lice found on eyebrows or eyelashes:
Vaseline rubbed slowly into the eyelids, lashes, and brows is used to treat infestation of lice from the eye for 8-10 days. An alternative is applying baby shampoo, with a cotton swab, to the lashes and brows three times each day for 5 days. An immediate alternative is to remove the lice with fingernails, nit comb, or forceps with eyelids closed.
When to Seek a Medical Evaluation:
- Persistent skin itch, dermatitis on trunk and neck or nits found on the body despite thoroughly washing body, clothes and linens.
- Persistent head lice after re-treatment
- Persistent lice which seem to be as active 8-12 hours after initial treatment.
- Intense nocturnal itching without presence of lice or nits.
- Continued itching 2-3 weeks post treatment.
- Sexually transmitted infection concerns, pubic or groin itch
- Rash appearing in lines, not due to scratching.
In an emergency go to Mount Nittany Medical Center or call 911 for an ambulance.
Test Results and Advice Nurse
Send secure message to advice nurse via the UHS website or call 814- 863-4463.
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This content is reviewed periodically and is subject to change as new health information becomes available. This information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Approved by the UHS Patient Education Committee Revised 01/10/18