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Dr Emiy Altman, Dermatologist NJ, explains how to diagnose and treat head lice.

The new school year just started.  Sometimes children bring home more than school books and assigned projects.  They can also come home with itchy scalps, and after a short while other members of the family begin to itch as well.  When the parents examine their child’s scalp, they find white, stuck-on flakes and a red rash around the hairline.

This itchy scalp condition is most likely head lice, or pediculosis capitis.  Pediculosis is extremely common; more than 12 million Americans are infested each year. Head lice infestation is more common in the warmer months of the year.  Head lice are transmitted by contact or by sharing combs, brushes, scarves, hats, anything that touches the hair.  Children often get lice from their classmates, and school-wide epidemics are not uncommon.

The average length of the head louse is 1-2 mm. The louse is wingless and white to gray and has a long, flattened, segmented abdomen. It has 3 pairs of clawed legs. Its average life span is 30 days. After incubation of the eggs the nymph molts 3 times before reaching its adult form (8-10 d later).

Headlice (pediculosis capitis)

Headlice (pediculosis capitis)

Headlouse egg (ovum) attached to the hairshaft

Headlouse egg (ovum) attached to the hairshaft

The female head louse lays as many as 10 eggs (ova) per 24 hours, usually at night.  She positions her eggs at the base of the hair shaft within 1-2 mm of the scalp, with a predilection for the hair line at the back of the neck and the backs of the ears.  These eggs may appear to be dandruff flakes except they are adherent to the hairs and cannot be shaken off.

Headlouse hatching from the egg

Headlouse hatching from the egg

Louse nits in hair

Louse nits in hair

The entire scalp is usually itchy, but the rash is preferentially located at the back of the neck and/or ears.  The rash frequently looks for all the world like eczema that has been scratched.

Louse bites

Louse bites, back of neck

Treatment of head lice involves shampooing your hair with a lice shampoo, such as permethrin shampoo.  The recommended number of treatments is one, however I found that with my patients, we need 5-7 consecutive days of treatment to kill all the lice.  You also need to get a lice comb and comb out all the eggs from the hair.

Lice comb Bugbuster

Lice comb Bugbuster

I recommend that all members of the household get treated at the same time to make sure there are no residual lice in the house.  All the combs, brushes and hats need to be washed with hot soapy water.

I also recommend an evaluation by a dermatologist or your regular doctor to make sure this is the proper diagnosis.  Also, please make sure you don’t have any allergies or sensitivities to the ingredients of the shampoo.

Disclaimer: Dr. Emily Altman and Advanced Skin Wisdom provides the content on this website solely for informational and educational purposes. Information provided on this website should not be considered medical advice and is not a substitute for consultation with a qualified medical professional. Communications to or from Dr. Altman and Advanced Skin Wisdom and any person will not be considered to establish a patient/doctor relationship.

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Disclaimer: The information on this Web site is solely for to educate patients. It is not intended to be medical advice and, therefore, should not be considered a substitute for consultation with a qualified medical professional. Communications to or from the Summit Medical Group Web site and any person will not be used to establish a relationship between a patient and doctor.