Head lice

Symptoms

Head lice are tiny wingless insects that live and feed on the scalp. They are about the size of a sesame seed and can be clear, reddish-brown or dark. They cling to the hair shaft with the hook-like claws on their legs. ‘Nits’ are the eggs of the head lice. They are small, whitish specks about the size of a pinhead firmly glued to the base of the hair shaft, and are found particularly behind the ears and nape of the neck. Unlike dandruff, they cannot be brushed off the hair strand. Lice hatch from the nits in 7–10 days, and mature into adult lice within 18 days and begin breeding. Nits are often easier to identify than live lice. After hatching, the nit ‘shells’ are white or clear, but still firmly attached to the hair shaft. The symptoms of lice infestation include:

• a very itchy scalp
• lice visibly crawling on the scalp and hair
• nits which are attached to the hair shaft
• sores on the scalp due to constant scratching
• a fine black powder (lice faeces) or pale grey lice skins on the pillow.

How to check for head lice and nits

• Wet the hair and comb the conditioner through the whole head using a head lice comb.
• Comb hair thoroughly in small sections. Check every part of the head and check each section several times because lice can crawl quite quickly between sections.
• Wipe the conditioner off the comb onto a white cloth, paper towel or tissue.
• Look for signs of live lice and nits, which will make a ‘popping’ sound when crushed between your fingernails.
• Apply a lice treatment if you see any signs of live lice.

See a pharmacist or doctor if:

• you have a negative reaction to head lice chemicals such as a very sore or red scalp
• treatment is needed for a baby under 12 months of age
• you are pregnant, breastfeeding, or have sensitive skin.

Causes

Head lice are spread by head-to-head contact, or sometimes by sharing hats, head gear, combs or brushes with a person with head lice. Infestation is more common in children because they often play closely together or share items of clothing. An infestation is not a sign of dirty hair or poor cleanliness. Lice can live for around a month, but cannot survive for more than 2 days away from the human scalp. They crawl and so cannot jump or fly from person to person. They do not live on animals.

Lifestyle options

How can you stop head lice spreading?

• Advise any close contacts and the child’s school.
• After the first treatment is applied, the infected person can return to school or work; untreated children may be asked not to attend school until treatment has occurred.
• Avoid head-to-head contact and sharing of combs, brushes, hair accessories.
• Tie up long hair.
• Check children’s hair for nits regularly – anyone can catch head lice or become re-infected through an untreated contact. Using the conditioner and comb method once a week aids early detection.

Pharmacy options

Always inform pharmacy staff if you are taking any other medicines, or if you have any other health conditions, because some over-the-counter medicines may not be suitable for you. Do not use head lice treatment as a prevention. Treat only if you have seen live lice. Head lice can become resistant to some treatments, so using different products can help minimise this problem. It is important to treat all family members and close contacts on the same day.

Non-chemical treatment

This requires removing all of the head lice physically using hair conditioner. It is similar to the method used when checking for head lice but must be done every day, for at least 10 consecutive days to ensure all lice and any hatched eggs are removed.

Insecticidal treatments

Insecticidal products are available as hair shampoos, sprays, lotions, conditioners or mousse with different active ingredients. Application:

• If lice are still active after a second treatment, they may be resistant to the particular insecticide, so treat again using a product from a different group (ask your pharmacist for advice).
• If a second product fails, contact your doctor for a referral to a specialist for a prescription medicine.
• Soak combs and brushes in hot water (>50°C) for at least 5 minutes.
• Wash personal items like headgear, pillow cases, sheets, and towels in a hot wash cycle (>60°C).
• Items that cannot be washed or dry-cleaned, should be placed in an air-tight plastic bag for 3–4 days.

Ask your pharmacist for advice on the most suitable treatment for you.

More information

Health Direct: www.healthdirect.gov.au
DermNet NZ: www.dermnetnz.org/topics/head-lice

Disclaimer: The information provided is a guide only, is current at time of publishing, and is not intended to replace the advice of your pharmacist or doctor.

IN EMERGENCIES DIAL 000.