Just the thought of head lice and nits is enough to make most of us start itching.
While they’re notoriously common in school children, anyone can be affected so it’s important to know what both head lice and nits look like, and how to get rid of them.
Dr Juliet McGrattan gets to the nitty-gritty of nits and lice with our complete guide to head lice risk, detection, treatment and prevention.
Head lice vs nits: what do they look like?
Head lice are tiny greyish coloured insects about the size of a sesame seed. They don’t have wings and live their lives crawling around in human hair, feeding on blood from the scalp; they live for about forty days. Head lice are parasites and don’t live anywhere else other than on the human head.
Nits are the eggs of the head lice. They are creamy white in colour and attach to the hair shaft to stop them falling off. It’s easy to confuse nits with dandruff. A female louse can lay around one hundred eggs. The nits hatch from the eggs after about a week and the empty egg case remains in place.
What causes head lice?
Head lice are very common and anyone can get them. They are however particularly frequent in children of primary school age. Head lice don’t care whether your hair is clean or dirty, long or short, curly or straight.
How do you get head lice?
Head lice don’t have wings and they can’t jump – despite what you may have heard. They are usually caught by direct head-to-head contact with someone who has them; that’s why they’re common in school children and can spread around the class.
You may receive head lice advice from your school from time to time. Once away from the scalp the lice can only survive about a day, so while it’s possible to get infected through sharing a hairbrush or hat, it doesn’t happen very often.
Head lice and nits symptoms
When it comes to how to tell whether you have head lice or nits, there are a number of signs to look out for:
- You will see lice or nits in your hair. Lice may fall off your head and onto your clothes or desk.
- Nits can take a bit more finding – follow our nit detection tips to check if you are infected.
- You may feel something crawling or moving in your hair.
- Your scalp may itch, sometimes intensely, as the biting, saliva and droppings of the lice irritate the scalp.
- Your sleep might be affected due to itch or tickling sensations as the lice move.
- You might have itchy, bumpy red spots and scratch marks on your scalp or hairline.
- You might see tiny dark specs of louse droppings on your pillow or clothes.
How do I check for head lice and nits?
You can spot nits by looking very closely at someone’s hair, you may need a magnifying glass. It’s very hard to do this on yourself so enlist some help. The nits are the egg cases and appear as creamy white specks attached to an individual hair shaft.
Dandruff, dried hairspray and other styling products can sometimes look like nits but they can be easily removed from the hair shaft whereas nits need to be ‘picked off’. They can be difficult to spot but are more frequently found around the sides and back of the head.
Finding a live louse will give you the definite diagnosis. They can be tricky to find and require some patience and a fine toothed head lice detector comb that you can buy from a pharmacy. You can comb either wet or dry hair. Then simply follow our nit detection steps:
• Detangle hair with a wider toothed comb or hairbrush.
• Start at the front of the head and take a small section of hair, about as wide as the comb and not too thick.
• Run the comb from close to the scalp right through to the ends of the hair.
• Examine the comb and look for lice. They may vary in size if they haven’t had time to fully develop into adults.
• If you find a louse, then wipe or rinse it off the comb before moving on to the next section of hair.
• Work your way around the entire head, including the hair at the back of the head and nape of neck.
• Look out for lice falling onto the floor or shoulders while you’re combing.
• Check all family members.
How to get rid of head lice and nits
You don’t need to see a nurse or doctor to treat head lice. You can do it at home and also get advice from your pharmacist.
The most important step is to remove the live lice so they aren’t able to lay any more eggs. This can be done by wet combing. Wash your hair and then apply a generous amount of normal hair conditioner. Rub it right through from scalp to roots so all the hair is coated.
Then follow the process of combing as describe in the detecting nits section above. Use a nit remover comb with close, fine teeth. It can take an hour to do this for long, thick hair so take your time, it requires patience to do it well. You can wash out the conditioner when you have finished.
Working your way through all the hair in small sections will remove lice and some nits but many nits will remain and further lice will hatch so it’s important to repeat the wet combing process at least four times with four days in between each combing. To ensure treatment is complete you should keep repeating it until you have had three combings without any lice seen.
What if wet combing doesn’t work?
Empty egg cases may remain on your hair and these are harmless so seeing a nit doesn’t mean the combing hasn’t worked. Similarly, itching can continue for two to three weeks after lice have been removed so don’t use continued itching as a sign that wet combing has failed.
If you have carefully wet combed four times over 16 days and there are still live lice, then you will need to visit your pharmacist for some medicated treatments. There are two types:
• Physical insecticides
These smother the lice to kill them so lice can’t become resistant to them. Examples include Hedrin©, Full Marks© and NYDA©
• Chemical insecticides
These poison the lice and lice can become resistant to them. The only one available in the UK is Derbac © which contains the chemical Malathion
It’s important to follow the instructions on the leaflet supplied with the medicated treatment. Each one is used in a slightly different way and many require a second treatment after a period of days.
Do natural treatments for head lice work?
Many people use tea tree oil, eucalyptus or other essential oils. Electric combs have also been tried. There are not however sufficient or adequate studies to be able to fully recommend these alternative therapies. Wet combing with conditioner is medication free and has been proven to be effective if done correctly.
What if the head lice and nits just won’t clear?
Remember that it’s only if you see live lice that you can be sure than infestation remains. Empty egg shells may take a few weeks to fall out and itching can take three weeks to resolve. If treatments don’t seem to be working, then it may be that you need to re-visit how you are wet combing or whether you followed any product instructions to the letter.
Have you kept wet combing for three times after any live lice were seen? Have a chat with your pharmacist to see if they have any suggestions for the treatments that will suit you best. It may also be that family members and close friends have head lice and that re-infection has occurred. Get them checked them but don’t treat them just in case, only if you see live lice.
How do I prevent head lice and nits?
There’s no easy way to prevent head lice. It can help to keep long hair tied back to minimise hair to hair contact in young children. You shouldn’t use head lice medicated treatment to keep lice away and insect repellents don’t work well. The best option is to use the nit detection steps regularly, perhaps once per week, to detect lice and treat them as early as possible.
Last updated: 25-09-2020
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