Exams and Tests

To find out if your child has lice, the doctor will do a close visual exam to look for live lice or their eggs (nits) on the hair. The doctor may also use a fine-toothed comb to help detect lice. He or she may need to look at the lice or eggs under a microscope to confirm the diagnosis.

Treatment Overview

Lice will not go away without proper treatment. Treatment should begin as soon as symptoms of lice are noticed or when live lice and eggs (nits) are seen on the person's body or in clothing. Specific treatment depends on the type of lice infestation.

• Head lice and pubic lice are killed with over-the-counter or prescription medicines applied to the skin or scalp, and sometimes with a prescription pill. The most common way to treat lice is to use medicated creams, lotions, or shampoos that kill lice.
• Body lice, which live and lay eggs in the seams of clothing, are destroyed by washing clothing in hot water [130°F (54.4°C) or higher] for 5 minutes or more. This will usually kill adult lice and prevent eggs from hatching. Body lice are only present on the skin when they feed and will usually go away if you bathe daily and wear clean clothes.

Children with head lice can return to school or day care after their first treatment. Some schools have a "no nits" policy in which the child can only go back to school or day care after eggs have been removed. "No nits" policies are discouraged by medical experts. Most doctors agree that a child should be allowed to return to class after proper treatment and should be urged to avoid close head-to-head contact with other students. Confidentiality should be maintained so as not to embarrass a child who has head lice.

Itching may continue even after all lice are destroyed. This happens because of a lingering allergic reaction to their bites. Over-the-counter cortisone (corticosteroid) creams or calamine lotion may help. For severe itching, antihistamine medicines (such as Benadryl) or stronger, prescription-strength corticosteroid creams may be needed. Don't give antihistamines to your child unless you've checked with the doctor first. And don't use cortisone cream for longer than 7 days without talking with your doctor. Do not use the cream on children younger than age 2 unless your doctor tells you to. And don't use it in the rectal or vaginal area in children younger than age 12 unless you've checked with the doctor first.

What to Think About

Who should be treated?

• Household members and anyone who has been in close contact with a lice-infested person should be checked for signs of lice. If they have itching and skin sores that are commonly seen with lice infestations or if lice or eggs are found on their bodies, treatment is recommended.
• Anyone who has shared a bed with a person who has lice should be treated, whether they have symptoms or not.
• If lice recur (come back) after treatment, everyone in the household should be treated again with medicine.
• People who have pubic lice are encouraged to tell their sex partners so that they can also be treated. It is also a good idea to see a doctor to be tested for other sexually transmitted infections.

Treatment is not likely to work if:

• You don't use the medicine as directed.
• You stay in contact with other people who have lice but who did not get treated.
• Lice become resistant to the medicines and don't die. This occurs in some locations more than others. Talk to your doctor if you think a lice medicine isn't working as expected.