Doc Dispels Common Myths About Head Lice

Parents should be reassured that personal hygiene has nothing to do with the problem

Although lice do not cause serious physical harm, they can result in a lot of emotional distress because many people still mistakenly believe they are a sign of poor hygiene, an expert explains.

Head lice bite into the scalp to feed on blood, but these bites are usually not painful. Still, a lice infestation can strike fear in families for a number of reasons, including the stigma of being deemed "dirty."

A lice infestation, however, is not a reflection of a person's cleanliness, according to Dr. Andrew Bonwit, a pediatric infectious disease expert at Loyola University Health System in Illinois.

"Personal hygiene and socioeconomic status have nothing to do with having or transmitting head lice. The head louse is an equal-opportunity pest," explained Bonwit in a university news release. "The infestation is usually a nuisance and almost never a serious problem in itself."

There are other common misconceptions about lice, Bonwit pointed out. In order to ease parents' fears, he dispelled the following myths:

  • Myth: Pets spread lice. "Animals are not known to carry head lice nor to transmit them to people," Bonwit said.

  • Myth: Sharing personal items spreads lice. "Although it's probably best not to share such items as combs, hairbrushes and hats, these do not seem to transmit the pest," Bonwit added. "Transmission of lice seems to occur only by direct head-to-head contact from one person to another."

  • Myth: Kids with lice should be sent home from school immediately."The American Academy of Pediatrics does not endorse 'no-nit' policies that exclude children from school because nits are present," Bonwit noted. "In fact, even the presence of mature head lice is not considered a valid reason to exclude children, only a cause for prompt referral to the physician for treatment."

  • Myth: Lice carry disease. "Head lice do not transmit serious infectious disease," Bonwit explained.

Although lice often cause a big stir, they are tiny and often hard to spot. "Lice are very small, about the length of George Washington's nose on a quarter," said Bonwit, who is also an assistant professor of pediatric infectious disease at Loyola University Chicago Stritch School of Medicine. "The lice produce eggs, called nits, which become strongly cemented to the host's hair shafts."

Nits look like small, dark spots on the side of the hair shaft. Although the infestation isn't painful, it can be itchy, Bonwit cautioned. "Sometimes the patient has been so itchy that he or she scratches the scalp to the point of minor skin infections and even causing some enlarged lymph nodes on the back of the neck or behind the ears," he said. "While these changes may alarm parents, they aren't directly harmful."

The U.S. Centers for Disease Control and Prevention reports that up to 12 million lice infestations occur each year in the United States among children aged 3 to 11 years.

"Parents and school staff may become understandably upset by outbreaks of head lice, but it is important to remember that if the problem occurs, it is treatable, although repeat applications of medicine are usually needed," Bonwit said.

The most common lice treatment is over-the-counter or prescription shampoos or lotions that must be applied to the scalp, left on for a specified time, then rinsed off. Often a fine-toothed comb is also needed to remove nits to prevent further infestation.

"The life cycle is about seven days from the laying of the eggs to the hatching, so a second insecticide treatment is recommended, after the first application," Bonwit advised. "If the treatments are used as directed, problems other than scalp irritation are unlikely to occur."

Don’t pull your hair out over head lice

So-called “super-lice” are big news now, just in time for children to go back to school. While that news may be somewhat overblown, as any parent who has been through one will tell you, a lice infestation can be a time-consuming and worrisome health issue. One of the bigger concerns for parents is that if their child is diagnosed with lice, they will have to stay home from school or daycare, something that recent guidelines have stated is NOT the case.

Here are six important facts about lice to keep in mind:

  1. Anyone can get lice.

    Lice are not related to cleanliness. Anyone can get lice if they are in prolonged, close contact with someone else with lice. Lice only infect people—not pets—and cannot hop or fly. They spread by crawling from one scalp to another scalp. It is very uncommon to get lice from hats or brushes or combs since they cannot survive off the scalp for more than 24 hours.

  2. If your child has lice, he/she’s actually had them for a while.

    The characteristic itch on the scalp, back of the neck or behind the ears is an allergic reaction to lice saliva. It often takes three to four weeks for that reaction to start.

  3. Regular scalp checks are the best way to help keep lice away.

    According to the American Academy of Pediatrics, here’s how to check your child for lice:

    • Check your child in a brightly lit room.

    • Part the hair and check your child’s scalp.

    • You are trying to find either crawling lice or eggs (called nits) on the hair. Live lice are small insects (OK, that’s a little gross, we admit), about the size of a sesame seed (2 to 3 mm). They are hard to see because they move fast and avoid light. Nits are quite small (less than a millimeter) and appear pearly/white, almost like a grain of uncooked rice. They will be firmly attached to the hair shaft very near the scalp.

    • You can also wet the hair, and comb it out with a fine-toothed comb. After combing you can wipe the comb on a wet paper towel, and check the comb and the paper towel for nits.

    Nits can be confused with dandruff or dirt, so if you are unsure check with your pediatrician.

  4. Your best bets for treating lice are lotions and combs.

    If your child has lice the American Academy of Pediatrics recommends treatment with one of several topical lotions that will kill the lice and possibly even kill the eggs.

    The first choice is an over the counter (OTC) lotion containing 1 percent permethrin. This choice is generally very effective, but if it doesn’t work there are prescription lotions that have each been tested and are safe to use on children. Depending on your pharmacy and insurance plan, some of these lotions can each be expensive.

    Sometimes parents decide to avoid any chemical treatments, and although there are other options, none has been proven to work. One approach is to pick out all of the eggs by combing damp hair with a fine-toothed comb. This can be challenging because of the time it takes to remove eggs from each hair shaft over many days, especially if a child has fine, long hair.

    Other methods include suffocation, meaning the application of either petroleum jelly or other thick preparations such as mayonnaise or olive oil. This method is rarely effective, and the ointments can be hard to remove from the child’s hair. Never use kerosene or gasoline or products meant for animals on your child.

    All household members should be checked for lice and nits and treated accordingly. Given that most household members are in close contact with one another, it is prudent to have a low threshold for treating all household members, even parents.

    You might have seen recent news stories suggesting that a) treatment-resistant lice are more common than ever, and b) parents shouldn’t use the usual first-line, over-the-counter  treatments anymore. To those stories I offer one caveat: The study behind them was funded by the maker of a prescription lice treatment. Let the reader beware.

  5. Lice are not very hearty.

    Lice can’t survive off the scalp for more than a day, so they can’t live for very long on any objects. Also, since they can’t hop or fly from person to person, they are only contagious by scalp-to-scalp contact. This is good news.

    To rid your home of lice, you don’t need to do multiple deep cleans or throw away items. And you don’t need to spray with any pesticide. You just need to clean objects that have been near a child’s head for the past three days (e.g., hats, towels, pillow cases, stuffed animals, hair care items). Lice can’t survive in heat, so any item should be washed in hot water and dried in a hot drier. Any item that can’t be washed can be dry cleaned, vacuumed (in the case of furniture) or sealed in a plastic bag for two weeks.

  6. Children with lice CAN go to school.

    According to the American Academy of Pediatrics and the National Association of School Nurses, lice and nits are no reason to exclude a child from school, daycare or any activity. These organizations have taken this position for two reasons:

    • As I mentioned above, by the time your child gets diagnosed she likely has had lice for three to four weeks, and likely got them from school or daycare. Thus, excluding a child from school or childcare does very little to prevent the spread of lice.

    • Head lice are not a dangerous medical illness that would warrant any kind of quarantine.

The future of mutating, treatment-resistant head lice is already here

Head lice aren't particularly dangerous, but they are a nuisance -- one that has become such a common part of life with young children that multiple over-the-counter remedies are available to parents.

That very fact has made the increase in prevalence of lice cases since the 1990s -- despite the corresponding increased access to effective treatments -- so puzzling.

A new study that will be presented at the National Meeting & Exposition of the American Chemical Society on Tuesday suggests one reason for the increase: After decades of treatment with anti-pest remedies sold in drugstores across America, head lice are evolving to resist our efforts to snuff them out.

The study found that of the head lice samples collected across 30 states, all but five showed signs of a very high level of resistance to pyrethroids -- the chemicals contained in some of the most common over-the-counter treatments.

"We are the first group to collect lice samples from a large number of populations across the U.S.," said Southern Illinois University at Edwardsville researcher Kyong Yoon. "What we found was that 104 out of the 109 lice populations we tested had high levels of gene mutations, which have been linked to resistance to pyrethroids."

The trio of mutations -- called kdr, for "knock down resistance" -- affects the insect's nervous system and makes them less sensitive to the insecticide chemicals that are found in lice treatments and also in mosquito repellant or fly spray, for example.

In four states, head lice were found to have one, two or three of the mutations. Only one state -- Michigan -- had head lice samples that didn't show any signs of widespread resistance to treatment; Yoon added that the reason for that is unclear.

 In recent decades, pyrethroids have been increasingly used as a pesticide as part of a broader effort to shift away from harsher chemicals like DDT. Pyrethroids resistance has been found, for example, in house flies.

Anecdotal evidence and previous studies have also suggested that head lice were also increasingly becoming resistant. A 1999 study, for example, found evidence of resistance to pyrethroids in the United States in a small sample of kids who had contracted and had been treated for lice multiple times in the past.

The solution, Yoon says, may be to treat lice with other chemicals that are more likely to be available with a prescription.

"If you use a chemical over and over, these little creatures will eventually develop resistance," Yoon added. "So we have to think before we use a treatment. The good news is head lice don't carry disease. They're more a nuisance than anything else."

The Meaning of Lice

Here we are, my husband, daughter and I, sitting in beauty parlor chairs, our heads slathered in fluffy blobs of hair conditioner mixed with baking soda while a stalwart woman unflinchingly scrapes our scalps with tiny combs. After eight hours of this, we’re getting hungry, and begin looking through a stack of delivery menus. We’re thinking Mexican or Thai.

We call this the Lice Place, and we have come here because a gang of the tiny insects was found on the head of a child in my daughter’s second-grade class. A respectable head disinfecting establishment, the Lice Place is nonetheless understandably hidden behind a storefront cheerfully disguised with a flowery-decal-laden door. Lice are notoriously hard to spot and even harder to remove, so we are here, rather than home, for an expert examination — and really because I am insect phobic. It’s true that a fear of something most people find disgusting invites very little sympathy or understanding — unlike say a fear of the color yellow, bookcases or cheese — but I understand the severity of my own issue perfectly. So I outsourced the solution.

Our diagnosis: mother and child both had those little critters in their hair. Apparently they had been merrily mating and giving birth on our heads as we bobbed around town focused on our thoughts and not the community taking shape above them.

All this makes me think of Jane Goodall. She was a heroine of every schoolgirl I know from my generation — a passionate scientist who followed her heart to study primates in the jungle, and the star of several grainy science films of my youth. I remember my friends and I watching these films, our mouths open, smug teenagers begrudgingly awed, as she hid behind a tree or a rock, whispered provocatively off-camera, and in turn watched her beloved chimpanzees picking at each other’s fur, looking for tiny insects and then eating them. These were beautiful scenes of calm companionship, the image of communal living at its best.

So why didn’t this feel as lovely?

Another family comes into the Lice Place. The father looks at us, looks away, then looks at us again with an expression of embarrassed, grossed-out friendship. We strike up a conversation. We learn that his daughters go to a fancy girls’ prep school and I can’t help feeling pretty great about this. Clearly this is not a scourge of low lives. In fact, it is a point oft-mentioned, lice are especially drawn to clean hair. We cling to this fact as stickily as those lousy eggs cling to our locks. We talk about soccer and how to suffocate a nit, while his girls read Shakespeare.

As I sit in my beauty chair, I consider an article I read recently in The Times. The headline asked: Should Americans Fear Their Furniture? What followed was an interview with documentarians who had just finished a film on all the toxic chemicals contained in pretty much every piece of upholstered furniture made since 1975.

I suppose this should not be shocking to me. All the old familiar comforts of American life have been found to be deadly. Apples bathed in pesticides. Chickens fed a steady diet of chemicals. Wheaties and Cheerios laden with G.M.O.s. A mother and daughter leaning their heads together over “Charlotte’s Web” may have always imparted a faint stirring of agita. But now that copy of “Charlotte’s Web”? The one from the library? It could totally have bedbugs.

My daughter suffers the indignities of head lice removal with a stoic silence. My husband and I suffer the indignities of the bill a little less bravely. It turns out that the cost of eight hours of vigilant attention to every strand on an entire family’s collective head could get you a studio apartment in Williamsburg for about two weeks.

We ditch the delivery menus and decide to go out to dinner instead, maybe get a little air. The Lice Place had not covered us in the cloaks that are a staple at a normal hair salon (I think we were all too chastened to ask), so we walk stiffly down the street, covered in the blotches and splotches left by those soft clouds of hair cream and baking soda that flew around us like we were in some really unappealing snow globe.

We knew it was a short break because there was much more work to do. The bagging of pillows. The dry cleaning of duvet covers. More time and money to spend on getting back to normal. Not to mention the moral duty to tell your child’s close friends’ mothers that they are at risk.

And ah, the dilemma — with whom can I laugh about this? The friends who get to find out are in the small, precious category of close enough to get it, nice enough not to judge, sturdy enough not to feel threatened. Those to whom I don’t need to mention that lice are especially drawn to clean hair.

We sit quietly at the restaurant, reminded that no matter how well ordered our lives, havoc can break loose. No matter how much we think we are embracing the natural world (munching on organic kale, suffering under unflattering environmentally friendly light bulbs), that world can turn against us. No matter how good the school, how well read the parents, things can get primal. And no matter how sweet the tendril of hair gently curled on your daughter’s neck on a warm spring day, the fact remains — that tendril can turn quickly icky.

It is only lice. So blessedly minor. But it all highlights nonetheless the randomness of misfortune, the fragility of life, how nature can still turn overly intellectualizing and technologically shielded humans into vulnerable, helpless creatures. It reminds me of death.

It reminds me to feel joyous while I can.

We eat.

SPECIAL REPORT: Stopping the cycle of head lice

Many parents worry that their children will get head lice.  According to the American Academy of Pediatrics, that happens for six to 12 million children a year.

Stephanie Speers kids are part of that statistic.

“I went to braid [my daughter’s] hair, and my stomach just dropped,” Speers said.  She saw lice and their eggs, known as nits.  “I started checking [my sons’] hair, and I was like, okay so it’s apparently a family affair.”

Speers’ daughter had lice once before when she was younger.  She said over-the-counter treatments took weeks to get rid of the bugs and eggs.  Patty Ziegler had a similar experience with her daughter. 

“[Lice] are very contagious and will spread quickly,” said Ziegler.

More and more now, professional grade treatments like Ziegler’s are needed to get rid of lice.

“Most lice are super lice,” explained Karen Sokoloff.

Sokoloff added, many over-the-counter treatments don’t get the nits, and home remedies are ineffective.  “What will happen is they’ll comb out what’s visible, and they’ll leave in the tiny [nits].  They’ll just miss it.”

Many school districts have changed their policies within the last five years after recommendations from the AAP and CDC.  The Madison Metropolitan School District is one of those.

“We’re really trying to make more of a caring policy and a less exclusionary policy,” said Sally Zirbel-Donisch, the health services coordinator at MMSD.

Zirbel-Donisch said students at MMSD are no longer routinely mass screened for lice because research showed that wasn’t stopping the spread.  Also, students do not have to go home immediately if head lice are found.  At their parents’ digression they can stay through the rest of the school day because typically children will have had lice for weeks prior to the discovery.  They are sent home with instructions on how to remove lice and checked the next day.

However, a note is not sent home to all parents when a child has lice in the class, grade or school.  “A lot of times those children are stigmatized and isolated, and children in the class know who those students are, and so we really want to protect a child’s privacy,” said Zirbel-Donisch.

Speers’ kids go to school in Janesville.  The district reports a nit reduction policy, meaning as long as no live bugs are found on a student, they can stay in class even if they have nits.  The full Janesville district policy is available at the end of this article.

Speers said, she would appreciate a note going home to parents if someone else in her children’s grade had lice.  “I think it’s really frustrating. I don’t view contracting lice as anything different than the flu bug or a cold or something like that,” she said.  “I think that they should let parents know, so that they can be on the lookout, catch it early, not let the other kids just pass it… It spreads as fast as a virus.”

While the stigma associated with lice prevents some districts from doing this, many health professionals say the stigma is not true.

“I hate the stigma. It’s so backwards,” said Ziegler.  “It’s those kids with the clean hair and the most friends [who get lice].”

Health professionals say the reason for this is because lice are usually spread in a social hair-to-hair contact situation, and the bugs typically only can attach to clean hair.

“People think that head lice is a sign of poor hygiene, but it’s the opposite,” said Sokoloff.

No matter your school or district policies, health professionals suggest stopping the spread of lice by taking matters into your own hands and preventing future cases.

“That openness, that willingness to say, hey we had a case of lice in our family. Texting, emailing, calling friends and saying, maybe take a look at your child and make sure,” said Ziegler.

“The only way to stop the cycle is for everybody who hangs out together checked and treated,” Sokoloff said.

That’s something Speers said she was quick to take care of, notifying her son’s daycare and parents of her other children’s friends.  After she and her three kids were treated at The Bright Side, they went home lice free.

Janesville School District Head Lice Policy

Live lice – These are live lice that have hatched from the eggs and can be seen in a person’s
hair. They are capable of laying eggs and continuing the life cycle of lice.

Nits – These are the eggs that are found on hair shafts, can be hatched or unhatched. They are
cemented on the hair shaft and are hard to remove. Nits close to the scalp have not hatched. Nits
further away from the scalp (more than 1 inch) have already hatched.

Classroom – This is the specific room that a student with live lice or untreated nits were identified.

Grade level – This is the grade level (i.e. all third grade classrooms) where cases of live lice or
untreated nits were identified.

Unit – This is the two grade levels that share time together at recess/lunch (i.e. 4th and 5th grade, or 2nd
and 3rd grade).

  1. At the beginning of each school year, schools will include the introductory letter on head lice in the
    informational packet to parents. This introductory letter informs parents about the district actions
    on head lice and actions parents can take to help manage head lice in the school.

  2.  Keep Alert! Be suspicious of students who repeatedly scratch their heads.

  3. If a student is found to have live head lice, send the student home to be treated along with the letter.

  4. If the student is found to have nits only, contact the parent/guardian. Do not send the student home.
    Send the letter home with the student.

  5. All other household members to the identified case, should be checked. Household members should be sent home for treatment if live lice are found. If
    no live lice are found, the student may stay in school.

  6. Up to three students that are in the same school as the case person, who may be considered a
    suspect or close contact, should be checked for head lice. Students to consider include:

    • Frequent playmates.

    • Students who recently shared combs, brushes, hats, coats, gym towels and/or equipment,
      helmets, dress up clothing, etc.

    • Students who share the same locker or cubbies. Students who are frequent “huggers”.

  7. At the elementary and secondary school level:

    • If no other close contacts are found to have live head lice, the follow up screening can stop.

    • If 2 or more close contact students are found to have live lice or nits, proceed to check the
      students in the classroom(s) of the students found to have head lice.

    • If five or more students in the classroom(s) are found to have live head lice or nits,
      immediately contact the school nurse for further direction.

  8. Students sent home for treatment can return to school after completing treatment and changing into
    clean clothes.

  9. Upon returning to school, students will be checked for live lice. If no live lice are found, the
    student can return to class. If live lice are found, the student will be sent home with the proper

  10. Students with nits only and no live lice will be able to return to class. The school district supports a
    reduced nit plan. Students with recurrent cases of head lice shall be encouraged to have the nits

  11. The following actions are recommended to prevent the spread of head lice at school:

    • Store each student’s hats, coats, jackets in separate lockers or cubbies.

    • Do not have dress-up clothes at school that different students can play with and wear without
      being laundered between students.

    • Teach students not to share clothing, towels, hats, scarves, helmets, combs, hair clips, head
      bands, or other personal grooming articles.

    • Store smocks, gym clothes, etc. in separate lockers or cubbies.

    • For longer hair, braid your child’s hair or have it pulled back in a ponytail.

Itchy Head? Lice May Be to Blame

Unfortunately, at some point in a child’s life, a parent will more than likely have to deal with the dreaded lice infestation. According to the Centers for Disease Control and Prevention, lice infestations are most common among children ages 3–11, with an estimated 6–12 million infestations each year.

Jamie Primosch, said they commonly see infestations in young girls because there is more hair in which the lice can thrive. However, there are a few ways to prevent head lice in children.

Most important in the battle against lice is ensuring that your children do not have head-to-head contact with other children. That means they should be taught to avoid sharing hats, scarves, hair accessories, helmets, combs or brushes with their friends. Children with long hair should try to wear their hair pulled back, preferably in a bun, when possible. Primosch suggested the use of hairspray as a preventive measure against lice. Hairspray can cause the hair to stick together, making it harder for lice to cling to the hair. You may also try using certain essential oils, such as tea tree or peppermint. Although there is little scientific evidence that essential oils truly work, Primosch said that when she sprays them during treatments, she sees the lice run away from the oils.

Finding out if a child has lice can be difficult because louse (singular for lice) are small and move quickly. Parents may need to pull out a magnifying lens and a fine-toothed comb to find live lice. If you discover that your child does have a lice infestation, you should immediately inform your child’s friend’s parents, your child’s school, and any activities your child participates in, such as softball or baseball where the infestation can spread through helmet sharing. Additionally, Primosch said you need to ensure everyone in the household is checked for lice as it can quickly turn into a major problem.

To treat a lice infestation, invest in a quality metal lice comb and carefully comb the entire hair shaft. Primosch said parents can also use essential oils (peppermint, tea tree or rosemary), over-the-counter products or a mineral product, which has a high pH level that kills live bugs and eggs. If a parent chooses to use an over-the-counter method, Primosch recommends buying a separate comb from the one included and continuing to comb meticulously every day or every three days after treatment because many products only kill live lice and not eggs.

“If you miss any eggs, it’s going to start all over again,” Primosch said. Lice lay five to 10 eggs a day, eggs take 10 days to mature, and the life cycle of an adult is 30 days. Such a quick life cycle means that a case of lice can escalate quickly if not caught early.

Once a child and everyone in the family has been checked and treated, the next step is to clean other items that have been in contact with an infested person. Primosch said all bedding should be washed and dried on high heat (at least 120 F) to kill possible live bugs. Car seats, furniture and floors should be thoroughly vacuumed, and stuffed animals, pillows and hair accessories should be put away in a bag and isolated for two days.

According to the Alachua County Public Schools Parent Guide, children found to have live head lice will be sent home with instructions for treatment. A student may return to school following treatment and after all lice and eggs have been treated and removed.

lFinding and treating lice can be a daunting task, but by being vigilant with prevention, inspection and treatment, you can rid yourself and your family of this pesky infestation.

Do head lice change color?

According to the research of R. Hoeppli, ancient Chinese medicine used lice to cure “high fever and severe headaches as if the skull is cracking.” A paste made from 300 – 500 black lice, spread on the head, was said to do the trick. I must admit, I’d rather have 500 pureed lice on my head than 500 live ones, but the question this raised for me was where one would find black lice. Is there such a thing?

Head lice that I’ve seen have ranged from pale ivory through a golden – sometimes reddish – brown; magnified, they are transparent. Lice that have fed have a black mass inside – presumably blood in the process of being digested – but are not, themselves, black. There is a colour range, to be sure. But black? A literature search turned up some interesting things:

  • Head lice may have a natural way of blending in without actually changing color. Ibarra and Hall wrote: “Eggs and lice are well camouflaged, reflecting the colour of their surroundings.”

  • Newly hatched lice that have not fed are transparent (Meinking) and do not have color until after they’ve fed.

  • Color that matches the background has been shown to have evolved in other species of lice. This, however, refers to colour change over generations, not within the life span of a single organism.

The ‘wisdom’ that human head lice change color depending on the hair color of the host is oft repeated on websites and in non-academic publications. Published scientific information to back it up, however, appears nonexistent. Similarly, parasitology texts and laboratory identification references do not mention it

I remain highly skeptical that our head lice can change color within one generation, or that black head lice actually exist. I conclude that the Chinese remedy called for human head lice that had fed and had blood in their guts..


An itchy scalp and white objects in your hair can mean dandruff, or it might be head lice. To make sure you get it right, use our guide to spot the difference.

While they share certain similarities – an itchy scalp being the most obvious – there are key differences that distinguish head lice from dandruff.

Let’s look at three differences you can use to tell them apart.


The major difference between these two conditions is their cause. Head lice are small parasitic creatures that feed off human blood. Saliva secreted by lice irritates the scalp, and is the cause of the itchiness and sores that characterize a lice infestation.

Dandruff, on the other hand, is caused by sensitivity to oleic acid. This acid is a by-product of the malassezia microbe, which we all have on our scalps. Not everyone is sensitive to oleic acid, but in some cases it can cause irritation, itching, and flakes.


While there are similarities, it’s not that hard to spot differences in the way dandruff and head lice look:

  • The white flakes caused by dandruff are excess skin flakes, and as such will not be attached directly to the hair – by contrast, teardrop-shaped lice eggs are directly adhered to the follicle, often very close to the scalp.

  • Adult head lice can actually be spotted, although it’s a bit difficult. Use a head lice comb on wet hair under good lighting for the best effect


Because malassezia is distributed across the entire scalp, dandruff is not a localized problem: flaky dandruff patches can be found all over the scalp.

By contrast, head lice have definite preferences for their home. They’ll usually be found behind the ears and on back of the neck, both areas where they like to lay their eggs. Head lice symptoms are usually focused on these areas as well.

Now that you’ve done the hard work and know which of these conditions you have, it’s time to talk about treatment. First up: dandruff.

Treating dandruff

Compared to head lice, dandruff is fairly simple to deal with. A proven dandruff shampoo will help soothe the symptoms of dandruff, while helping to neutralize the cause and washing away any flakes.

For best effect, use your dandruff shampoo every time you wash your hair. Dandruff is a chronic condition which will come back if untreated.

Dealing with head lice is an entirely different story.

Treating head lice

Head lice hatch every seven to ten days, with a total life cycle of about four weeks. Any treatment, therefore, needs to take this into account.

Start with an over-the-counter head lice solution. Most of these will target the hatched lice, so you’ll need to repeat the process every week or so to make sure you get them all.

While you do this, you should also invest in a metal lice comb. These fine-tooth combs are designed to remove the eggs from the hair follicle. You should use your comb every day for about an hour, cleaning the comb of nits and lice on a disposable tissue or towel between strokes.

Unfortunately, as we’ve mentioned, the lifecycle of head lice is about four weeks, so you’ll need to keep up treatment for at least this long to make sure you’re completely louse free.

Or you can always call us at Larger Than Lice, we’ll be more than happy to assist you!