What do lice look like?

Until the threat came up, you probably didn’t think much about head lice. But now that you’re concerned, are you wondering how to spot the disgusting creatures?

The most common reasons to suspect a lice infestation are:

  1. Itchy scalp
  2. Exposure of a friend or classmate
  3. Flaky debris that you think may be nits.

Of these reasons, an itchy scalp is probably the most likely to turn out to be a lice infestation. However, other causes of itchy scalp include dandruff, dry skin, seborrhea, mosquito bites, allergy to hair products, and impetigo. Just thinking about lice can make your scalp itch. Don’t jump to conclusions, you may just need to change shampoo.

Simple classroom exposure without any symptoms is a fairly low-level risk for finding head lice. Looking for a single louse is like looking for a needle in a haystack. Only when the insects multiply will they be easily detectable. Even then, adult lice are hard to find. They look like an aphid or a tiny spider, and can easily slip away from an intruder who examines them.

Nits, on the other hand, are pretty easy to spot. Look for them on the scalp at the nape of the neck. If you can’t find them here, go ahead. Nits appear as pearly ovals that adhere firmly to the hair shaft. That’s not to say you can’t pull them out if you pull hard enough, but they don’t come off easily like dandruff or dry skin. Finding a single true nit is enough to diagnose lice. However, if you find one, you will probably find more. If you are not sure if you have found nits or dandruff, search until you find a few more to confirm the diagnosis.

People infested with lice may or may not have symptoms. An itchy scalp is the most common symptom, and a bumpy rash is the second. If one person in the family has head lice, all other people who live in the same household should also be inspected, whether they have symptoms or not. Even if no one else is found to harbor lice, treating them anyway is a consideration, especially if the infestations recur.

Most people with lice do not need to visit the doctor. There are several over-the-counter remedies that your pharmacist can recommend. However, for resistant cases, stronger prescription drugs are available through your doctor, who will want to see you to confirm the diagnosis.

Copyright 2010 Cynthia J Koelker, MD

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