Dermatology

Lice

What are lice?

Lice are tiny insects that can infest the skin anywhere on the body. Lice infection is characterized by intense itching.

Lice are highly contagious, spreading from person to person by close body contact, shared clothes, and other items (such as hats, hairbrushes, and combs). There are three types of human lice:

• head lice
• body lice
• pubic lice

Facts about lice:

Head lice:

• Head lice are seen mostly in child care settings and among school-aged children.
  
  
• The child usually has itching in the head area.
  
  
• Lice, or the eggs (called nits), can usually be seen on the hair, behind the ears, and on the neck.

Body lice:

• Body lice are usually seen in people with poor hygiene.
  
  
• Body lice are rare in children.
  
  
• Body lice cause severe itching, which is often worse at night.
  
  
• With body lice, in some cases, lice and eggs can be found in the seams of clothes.

Pubic lice:

• Pubic lice are very contagious and can be transmitted through sexual contact or by contaminated items such as towels and clothes.
  
  
• Pubic lice can affect the pubic hair, but also can cause infections of the hair on the chest, abdomen, thighs, and eyebrows.
  
  
• Itching of the affected area is a common symptom of pubic lice.

How are lice diagnosed?

The eggs laid by lice are usually visible to the naked eye, making it easy for your child's physician to diagnose. Pubic lice leave small brown spots on the parts of clothing that come into contact with the genitals or anus.

Treatment for lice:

Specific treatment for lice will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the infestation
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the infestation
• your opinion or preference

Lice are treatable. Treatment may include:

• For head lice and pubic lice:
  
  
  • Application of a medicated cream rinse or shampoo is usually effective treatment for head and/or pubic lice. Specific instructions need to be followed. Discuss this with your child's physician. Examples of medicated cream rinses or shampoos include the following:
    

     

    • malathion (Ovide®) - this is a new treatment that is safe and effective for lice and nits
    • lindane (Kwell®) - do not use if there are open sores on the head because of toxicity 
    • pyrethrins (RID®) - this treatment does not kill nits (lice eggs)
    • permethrin cream rinse (Nix®) - this treatment does not always work due to lice resistance 
      
      
  • Nits need to be removed from the hair with a fine-tooth comb.
    
    
  • Combs and brushes should be soaked in hot water with the shampoo for a period of at least 15 minutes.
    
    
  • Children can return to school or daycare the day following their first treatment for head lice.

• For body lice:
  
  
  • Medications are usually not needed to treat body lice.
    
    
  • Treatment for body lice usually consists of improving hygiene and washing clothes.
    
    
  • Bed sheets and blankets should be washed in hot water and dried in a hot dryer.