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Head Lice: Care Instructions

Head lice in hair on head, with close-up of louse and eggs (nits)

Your Care Instructions

Head lice are tiny bugs that can live in your hair and on your head. Live lice are tan to greyish white. They're about the size of a sesame seed. It may be easiest to find them at the base of the scalp, at the bottom of the neck, and behind the ears. When you have lice, all people living in your home need to be carefully checked and then treated.

Lice eggs (nits) may be easier to see than live lice. They look like tiny yellow or white dots attached to the hair, close to the scalp. They're often easier to see than live lice. Nits can look like dandruff. But you can't pick them off with your fingernail or brush them away.

Lice aren't dangerous. They don't spread disease or have anything to do with how clean someone is. The lice may make your head itch.

Lice won't go away without treatment. You can treat lice and their eggs with prescription or over-the-counter medicines. After treatment, your skin may still itch for a week or more. This is because of your body's reaction to the lice.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

  • Use an over-the-counter medicine to kill lice. It's important to use any medicine correctly and to choose a medicine that is safe. Talk to your doctor or pharmacist if you have questions.
  • Do not shampoo or condition your hair before you use the medicine. It's best to wait 1 to 2 days after you use the medicine before washing your hair.
  • Check your scalp for live lice 48 hours after treatment. If you find some, try a different type of treatment. It may be that the lice in your area are resistant to the first treatment you tried.
  • Check your scalp again 7 to 10 days after the first treatment. If you find live lice, you need a second treatment. This is to make sure that all lice are killed, including those that hatched since the first treatment.
  • Try not to scratch. It may help to use an over-the-counter cream or calamine lotion to calm the itching. If the itching is really bad, ask the doctor about an over-the-counter antihistamine, such as diphenhydramine (Benadryl) or loratadine (Claritin). Read and follow all instructions on the label.
  • You may want to remove nits after treatment, but you don't have to remove them all. Some people use a special comb to remove nits after using lice medicine. The combs are often packaged with over-the-counter lice shampoos. A flea comb that's made for dogs and cats will also work.
  • Try not to share anything that comes into contact with hair. For example, don't share hair bands, barrettes, towels, hats, combs, or brushes. Teach your children not to share anything that comes into contact with hair if they have lice.
  • You don't need to spend a lot of time or money deep cleaning your home. But it is a good idea to:
    • Soak hairbrushes, combs, barrettes, and other items for 10 minutes in hot water.
    • Vacuum carpets, mattresses, couches, and other fabric-covered furniture.
    • Machine-wash clothes, bedding, towels, and hats in hot water. Dry them in a hot dryer. If you don't have access to a washing machine, instead you can store these items in a sealed plastic bag for 14 days.

When should you call for help?

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have signs of a skin infection, such as:
    • Increased pain, swelling, warmth, and redness.
    • Red streaks coming from an area of the scalp.
    • Pus draining from the area.
    • A fever.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

  • You see live lice or new nits after you have followed the directions for your medicine.
  • Anyone else in your family has lice.
  • You do not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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Care instructions adapted under license by your healthcare professional. If you have questions about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.