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Head licePublished by Bupa's health information team, February 2008. This factsheet is for people who have, or whose children have, head lice, or who would like information about them. Head lice are insects that live on the scalp and neck. They may make your head feel itchy. Although head lice may be embarrassing and sometimes uncomfortable, they don't usually cause illness. However, they won't clear up on their own and you need to treat them promptly.
About head liceHead lice are wingless insects. They are grey or brown, have six legs and are about 1 to 3mm in length when fully grown. Female lice lay eggs that are smaller than a pinhead and these attach to your hair close to the scalp. The eggs hatch about seven to 10 days later. Young lice are called nymphs - it takes about 10 days for them to become adults and capable of laying new eggs. When lice hatch they leave empty shells called nits attached to the hair. You may mistake them for flakes of dry skin. Unlike dandruff, nits stick to the hair and you won't be able to remove them with normal shampooing. SymptomsHead lice can cause your head to feel itchy - you may find this is worse behind your ears or on the back of your neck. However, you can have head lice for up to three months before you notice any itchiness, or you may not have any itching at all. If you scratch a lot, the skin can become broken and infections may develop. Other signs of possible head lice infestation include:
If you spot nits or droppings then you need to make a further investigation. CausesAnyone can get head lice, but they are most common in children aged four to 11. This may be because of their close contact with each other at school. Girls seem to be more likely to get them than boys. You can only get head lice through head-to-head contact. They can't hop, fly or swim. Head lice can only live for a short time away from the scalp and those found away from the head are usually dying. Head lice can be found in all types and lengths of hair - having head lice is not a sign that your hair is dirty. They are found just as often in clean hair. How do I look for head lice?Head lice are hard to spot on the hair but you can remove and then identify them by combing them out. This is called detection combing. You do this by combing the hair in sections using a special fine-toothed comb, available from pharmacies. You will probably find it easier to comb the hair if it's wet and you apply a few teaspoons of olive oil or hair conditioner (rinse this off afterwards) as head lice can move rapidly in dry hair. It's important to comb the entire length of the hair from root to tip. After each stroke, check the comb for lice. You can also comb hair over a piece of paper, a white tissue or a bowl of water, which you can then check for lice. It will probably take you about 10 to 15 minutes to comb a head. If you are in doubt about what you have found, you can tape a suspected louse to a piece of paper and ask a health professional (a school nurse or pharmacist, for example) for confirmation. He or she will be able to advise you on suitable treatments. Infestation is only confirmed if you find a live head louse. TreatmentIf you do confirm head lice infestation, there are two treatments available:
The insecticides can be strong chemicals and may cause side-effects such as scalp irritation. Only use them if you are sure there is a head lice infestation. Check every member of your household if you or your child has a confirmed infestation. Because of the risk of side-effects and head lice becoming resistant to insecticides, don't treat the whole family as a preventive measure. InsecticidesSome types of insecticides are available over the counter, such as:
Another type, carbaryl (eg Carylderm), is only available on prescription from your GP. He or she may prescribe this if the infestation has not been cleared by other insecticides. Insecticides for treating lice are available as lotions, liquids or shampoos. These are either alcohol-based or water-based and there doesn't seem to be any difference in effectiveness between the two. Alcohol-based insecticides aren't suitable for everyone, particularly if you have eczema or asthma, so it's usually recommended that you use water-based products. These are also recommended for young children. If you are pregnant or breastfeeding you should try to use wet combing instead, but you can use malathion preparations if you need to. Check with your GP or health visitor before using any insecticides. Don't use insecticides to treat children under the age of two - use wet combing if possible. Always follow the instructions carefully. Usually the insecticide lotion should be rubbed onto your scalp and hair (or your child's) and left for at least 12 hours before you wash it out. Shampoos and foams aren't recommended because they don't remain in contact with the lice long enough to kill them. Insecticides kill living lice, but may not kill the eggs. You will need to repeat the treatment a week later to get rid of any lice that have hatched since the first treatment. Wet combing or "bug busting"This is a method of removing lice with the regular use of a fine-toothed comb (the teeth of the comb must be 0.2 to 0.3mm apart). You need to comb through the entire head of hair every four days for at least two weeks. It's important that you keep doing this until there have been three consecutive sessions without seeing any lice. You can get a "bug-busting" kit on prescription, from a pharmacy or from the charity Community Hygiene Concern. The kit contains four specially designed combs and detailed advice. Wet combing doesn't involve strong chemicals, and lice can't become resistant to it. It can also be used to routinely check the hair for infection. However, there is little good evidence to say how well it works compared to insecticides. Alternative treatmentsYou may also wish to try using dimeticone. This isn't an insecticide - instead it coats the surface of the lice. It's recommended if you are pregnant or breastfeeding as it has a good safety record. However, it's not thought to be as effective in removing eggs. Other treatments are available that contain essential oils (including tea tree), herbal extracts or homeopathic tinctures. There is no scientific evidence to show that these work. It's important to remember that even though these products may be called "natural", they can still be harmful. After treatmentWhichever treatment you use, a follow-up check using a nit comb should be carried out a few days after the course of treatment. If you do find any eggs, it doesn't necessarily mean that the treatment has failed - the lice may have been killed and you could just be seeing empty egg cases. If you do find a live adult louse, it may be because you have been re-infested. Treatment does sometimes fail, often because insecticides aren't used properly. Lice can also become resistant to one or more insecticides. If this happens, you may need to use a different type of insecticide or try wet combing. A school nurse, pharmacist or GP can advise you on the best insecticide to use depending on patterns of resistance in your area. PreventionThe best way to prevent head lice spreading is to regularly check your whole family's heads and treat them as soon as live lice are found. It's important to check your own hair and your children's hair if you have been in contact with someone with confirmed head lice, so that everyone can be treated simultaneously. It's essential to tell everyone that you or your child has been in contact with about their possible exposure to head lice. They can then be checked and treated if necessary as soon as possible. This will help to minimise head lice from spreading to other people, and prevent you or your child from getting them again after treatment. This includes schools, nurseries and other family members such as grandparents. However, you don't need to keep your child away from school as he or she is likely to have had head lice for several weeks before you find them. Studies have shown that head lice repellents aren't effective, so it's not recommended that you use these. There is no need to treat bed linen, towels or hats with insecticides. Head lice don't survive away from the scalp and can only pass from person to person by head-to-head contact. Pets don't spread human head lice. Further information
Sources
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr James Quekett, BscMB ChB MRCGP DRCOG DFFP, General Practitioner (GP) and GP Appraiser, Gloucestershire, and by Bupa doctors. It has been patient reviewed by Community Hygiene Concern. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: February 2008
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