How to Treat Head Lice

How serious is head lice really? And how can we easily and most rapidly treat and eradicate it?

Sanaz Majd, MD
5-minute read
Episode #253

head lice treatment

School is officially back in Fall session, and that means our children return to the germ breeding ground. You’ve likely already experienced one, two, or even three bugs in your household by now since September. It’s a rite of passage of sorts. There’s no escaping it…sorry. I have two rambunctious five-year-old identical twin girls who take turns spreading the germs in our family. I completely empathize, believe me.

Like us, you and your family have likely already been plagued this season with the common cold or flu virus, or possibly pink eye or whooping cough (a current epidemic in many parts of the country)—all previously covered House Call Doctor topics. But there are other bugs in the kingdom, and one in particular that can make our skin crawl (no pun intended): head lice.

A five-year-old spunky little girl was brought in by Dad for possible head lice. The school nurse had called the parents and asked them to pick her up “right away” when the teacher spotted nits in her hair after finding her scratching away at her scalp.

I want to go back to school!” She says with excitement and fervor in my office. She tells me she loves school because she “gets to learn new things.” Hard to keep such enthusiasm contained at home. Should she stay home or go back to school?

Dad is frustrated, as he had to take off from work to tend to this issue. The school will not allow her to return until she’s been treated, the nits eradicated, and a note to provide “proof” of this visit for the school.

That’s quite a tall order. After all, head lice doesn’t kill. There’s no long-term health effects. Let’s compare that to the flu, which kills up to 50,000 people in the U.S. alone. Strict rules as such do not exist for the flu or other more serious illnesses when they really should. Some perspective.

Does this sound familiar? Many of you with kids have surely experienced a similar scenario.

What is Head Lice?

“Pediculosis capitis” is the fancy medical term used to refer to head lice. It’s caused by the louse Pediculus humanus capitis, which lays up to 10 eggs (or “nits”) a day at the base of the hair shaft. Contrary to belief, they are transmitted via direct contact with the lice or nits. Head lice do NOT jump like fleas, or fly like bees. Simply sitting next to another child at school is not a common mode of transmission. It’s not nearly as contagious as you might think, compared to say the flu virus, measles, or chicken pox—all viruses with potential for significant complications.

They also can theoretically be transmitted via sharing combs, brushes, hats, or bedding. But solid evidence to back up these claims are lacking thus far.

Kids are particularly susceptible, but it can affect anyone regardless of age, sex, and socioeconomic status. Hygiene is irrelevant. Anyone can contract head lice if they are exposed. End of story.

Diagnosis of Head Lice

It is best visualized using a fine-toothed comb while inspecting the base where hair meets the scalp. Live lice and nits are often visible to the naked eye. The lice are 2-3 mm in length, and are often white, gray, or less commonly darker in color.

No special tests are required for diagnosis—your doctor should be able to diagnose it simply based on exam.

The Head Lice Controversy

How can we get rid of head lice? Believe it or not, eradicating them is not typically complicated, and certainly more efficient than the common cold or flu viruses,

One of my personal responsibilities as House Call Doctor is to interpret the medical jargon and information in order to better inform my listeners so that you are equipped with the best evidence-based information. Like the super over-hyped “pink eye,” head lice is up there with being one of the most stigmatized yet rather benign infectious processes.


Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.

About the Author

Sanaz Majd, MD

Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women's health and patient education.