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Written for the UK Health Protection Agency:
Head Lice
What are head lice?
Head lice are tiny, wingless grey/brown insects with six legs, about the size of a match-head when fully grown. They live on the human head, feeding by sucking blood from the scalp, and can move quite quickly. Their eggs are known as nits and look like little white flecks on the hair. Head lice are parasites that live for about three weeks. During this time the female can lay up to six eggs per day. These are usually situated near the base of the hair shaft near the scalp. The eggs are firmly attached to the hair and are not washed off by ordinary shampoo.
Although catching head lice may be embarrassing and cause irritation you won’t get an illness from them. Your head may feel itchy straight away due to an allergy to the lice, otherwise it can take up to three months after the initial infestation for discomfort to develop.
Infestation with head lice is also known as pediculosis.
What are nits?
Nits are the empty egg shells left behind after a louse has hatched. They are usually found around the hairline and close to the ears. They are pale or white in colour and do not move.
Do you get head lice because you have dirty hair?
No. Head lice have no preferred hair type and can infest straight, curly, short, long and both clean and dirty hair.
Who gets head lice?
Anyone with hair can catch head lice. It is most common in children aged between four and eleven years, and slightly more prevalent in girls than in boys. Head lice are widespread in the UK and most school children will experience an infestation at least once.
How do you catch head lice?
- By close head-to-head contact with someone who already has head lice
- By sharing combs, brushes, towels, or hats with someone who already has head lice
- If head lice are removed from the head they cannot survive for more than about 24 hours so there is usually no need to wash or fumigate clothing or bedding used by someone who has head lice
- Head lice cannot jump, fly, or swim but spread by crossing from one head to another during close contact. Sometimes whole families can be effected at the same time
- Head lice affect only human beings and cannot be passed to, or caught from, animals
How do you know if you have head lice?
Some people may not notice any symptoms for months after originally catching head lice, others may feel itchy very quickly. Take note if a child is constantly scratching their head.
To confirm that you have head lice, a live louse must be identified. The presence of nits alone may not mean that you are infested. Check the hair at the nape of the neck, around the hairline and just above the ears. Use a fine-tooth comb on the hair over a white piece of paper to spot anything moving. Always check the whole family. Lice droppings, which look like a fine dark powder, can sometimes be seen on the pillow or sheets of an infected person.
How do you detect head lice?
You will need a detector comb - which is an extremely fine-tooth comb. There are a number of different designs available. The more teeth per comb the easier it will be to use. Combs with longer teeth are generally more effective than those with shorter teeth, as it’s easier to reach the scalp with longer toothed combs.
1. Ensure there is good lighting – daylight is best
2. Wash the hair and towel dry, leaving it damp. Use conditioner if this is your usual practice
3. Comb the hair with an ordinary comb to remove knots
4. Using the detector comb, start at the top of the head making sure that the comb is touching the scalp, and slowly comb through to the ends of the hair
5. Wipe the teeth of the comb with a tissue after each stroke and check for lice
6. Repeat until the whole head has been checked. This should take about 15 minutes
If there are head lice you will find them on the teeth of the comb.
What are the symptoms?
People with head lice may experience some or all of the following:
- Live lice in the hair on their head
- Nits stuck to the hair
- Lice droppings
- Itchy head
- Red spots on the scalp
What is the treatment for head lice?
An infestation of head lice does not clear up on its own so you need to treat it. There are two methods for treating an infestation, the first is by wet combing (sometimes called ‘Bug Busting’) and the second by using an insecticide lotion. For either treatment to be successful it must be done correctly, and all infected people should be treated simultaneously.
1. Wet Combing or “bug busting”
This is the treatment for head lice without using chemical substances. You will need to purchase an extremely fine-tooth comb, or buy the ‘Bug Busting’ kit within which one is always included. Follow the instructions in the ‘Bug Busting’ kit, or:
1. Wash the hair in the normal way with ordinary shampoo
2. Rinse off the shampoo and apply ordinary conditioner
3. Comb the hair with a normal comb to untangle any knots
4. When the hair is free of knots change to a fine-tooth comb
5. Place the teeth of the fine-tooth comb into the hair at the roots so that it is touching the scalp and draw the comb through to the ends of the hair
6. Check the comb for lice, and either rinse the comb or wipe it on a tissue
7. Repeat this in all directions until you have combed all the hair from the roots
8. Remember to check the comb for lice after each stroke. A magnifying glass may help
9. Comb over a white surface such as a sheet or piece of paper. Any head lice flicked out by the comb will be easier to spot
10. After you have combed the whole head, rinse the conditioner out
11. Repeat combing with the fine-tooth comb in the rinsed hair to check for any lice you might have missed the first time
The above procedure should be undertaken every four days for at least two weeks. If lice are found on the second, third, or fourth session, it should be continued until no lice have been seen for three consecutive sessions.
2. Insecticide lotion
Do not use lotions or rinses unless you find a living, moving louse. Two applications of the insecticide lotion should be used, seven days apart. (N.B. this is different from the information on the package which states that a single application is sufficient).
1. Ensure you have enough lotion to treat all those affected and follow the instructions on the packet carefully
2. Before applying the lotion make sure the room is well ventilated
3. Apply the lotion to dry hair until the scalp and hair are wet and thoroughly coated. Be especially careful to cover the hair closest to the scalp
4. Allow hair to dry naturally. Keep well away from naked flames, cigarettes or other sources of heat. Do not use a hair dryer
5. Leave the lotion on the hair for 8 to 12 hours overnight. Then, wash and rinse hair as normal
6. A fine-tooth comb should be used to remove dead lice and nits from the hair
7. After treatment, check hair for lice and comb hair with a fine-tooth comb to remove lice every 2 to 3 days
8. After seven days repeat the application
9. If treatment fails and you still find moving lice, or if re-infestation occurs, ask your pharmacist or GP for advice, or use a different insecticide.
Seek advice if the person being treated is aged under one year, suffers from asthma or allergies, is pregnant or breast feeding.
How can you prevent getting head lice?
There is no prevention for head lice infestation. Re-infestation shortly after successful treatment can be prevented by treating all affected people at the same time.
Tying back long hair helps reduce the likelihood of contact with an infected person’s hair.
Regular weekly wet combing can identify any new infestation early.
Contact tracing
You need to identify where the lice came from or you may become re-infected. The source could be a family member or close friend who may not know they have head lice.

