Persistent itching
Scalp itching is common, particularly behind the ears or at the nape; it may be absent initially.
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Itchy scalp, live lice and nits · Dehradun
Head itching and tiny eggs in hair? It could be head lice—not dandruff.
Head lice · nits in hair · itchy scalp · children & familiesHead lice (pediculosis capitis) are tiny insects that live among scalp hairs and feed on human blood. They spread mainly through direct head-to-head contact, particularly among children. Having lice is not a sign of poor hygiene, and effective treatment depends on confirming the infestation and using the right method.
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Illustrative medical image. Examination is needed for an individual diagnosis.
Recognise the concern
Common symptoms of head lice
Lice can be difficult to spot because they move quickly and avoid light. Itching may take time to develop and not everyone has symptoms.
Moving lice
Tiny tan or greyish insects that crawl through the hair; they do not jump or fly.
Nits on hair
Small oval eggs are firmly cemented to individual hair shafts near the scalp.
Scratch marks
Redness and excoriations may appear; secondary bacterial infection is uncommon but possible.
Understand the cause
How do head lice spread?
Head lice most often move from one person to another through close hair-to-hair contact during play, at home or in group settings. They crawl; they do not fly or jump. Spread through shared combs, hats or hair accessories is possible but less common.
Pets do not transmit human head lice. Lice are unrelated to cleanliness or socioeconomic background, and they are not known to spread disease. Children and household members should not be blamed or embarrassed.
Diagnosis first
How to confirm lice and nits
Because dandruff and hair-product residue are often mistaken for eggs, unnecessary repeated lice treatment is common. Confirmation matters.
Examine the scalp
Check the nape and behind the ears under bright light for moving lice and eggs close to the scalp.
Fine-toothed louse comb
Systematic combing, especially of wet hair, can help detect live lice or nymphs that are hard to see.
Look for alternatives
Dandruff, seborrhoeic dermatitis and scalp eczema can also cause itching; persistent symptoms without lice need a different diagnosis.
Evidence-informed care
Head lice treatment — choosing the right method
The approach depends on age, pregnancy or breastfeeding status, local product availability, previous treatments and whether live lice are still present.
Permethrin 1% when appropriate
Permethrin 1% lotion is a commonly used first-line option in suitable patients. Follow the exact age restrictions, application instructions and contact time on the prescribed or supplied product.
Repeat at the correct interval
Permethrin may not kill all eggs. A second application is often advised around day 9 if required by the product instructions. Repeating treatment too soon or every day may irritate the scalp without helping.
Fine-toothed combing
A lice comb can help remove lice and nits. Check and comb the hair every 2–3 days for the following 2–3 weeks. Wet-combing can also be an option when medicines are unsuitable.
When initial treatment fails
If live, active lice persist after correct treatment and appropriately timed retreatment, consider misdiagnosis, reinfestation or resistance. A dermatologist may select an alternative agent according to age and availability.
Do not simply switch to stronger products: Permethrin 5% is not routinely preferable to 1% for head lice. Avoid using scabies formulations, insecticide sprays, kerosene, veterinary products or simultaneous multiple anti-lice medicines without medical advice. Young infants need individual treatment guidance.
Practical advice for families
School attendance, family contacts and preventing reinfestation
Head lice are common among schoolchildren. The aim is prompt appropriate treatment, not unnecessary absence or excessive cleaning.
School and nursery
Children generally do not need to leave class early and can return after beginning appropriate treatment. Remaining nits alone should not automatically prevent school attendance; follow local school policies.
Examine close contacts
Check household members and close contacts. Treat confirmed active infestations together, and assess bed-sharing contacts. Routine medication for every family member is unnecessary.
Simple cleaning is enough
Avoid sharing combs or caps. Wash recently used bedding and clothing appropriately, clean combs in hot water and vacuum if needed. There is no need to fumigate or repeatedly spray the home.
Realistic follow-up
A simple plan after starting treatment
The timing depends on which medicine is used; follow its product directions rather than repeating treatment automatically.
Day 1
Confirm active lice, use the selected treatment correctly and check close contacts.
Around day 7–10
Repeat treatment only at the interval recommended for that product; many permethrin regimens use day 9.
Next 2–3 weeks
Inspect and comb periodically; if live lice persist after proper treatment, reassess instead of repeated unsupervised dosing.
Common patient questions
Head Lice / Pediculosis Capitis FAQs
Clear answers without unnecessary tests or unrealistic treatment promises.
Does dandruff mean my child has lice?
No. Dandruff flakes may look like nits but tend to come off hair easily. Detecting a moving louse is the strongest sign of current infestation.
Is permethrin 5% stronger or better than 1% for head lice?
Not routinely. Permethrin 1% is a commonly used head-lice formulation. A stronger scabies formulation does not automatically overcome resistance and should not be self-substituted.
Why do lice come back after treatment?
Possible reasons include missed retreatment, incorrect application, resistance, re-exposure from an untreated close contact or mistaking empty eggs for active lice.
Does everyone in the family need anti-lice medication?
No. Examine close contacts and treat those with evidence of infestation, while giving additional attention to people who share a bed with the affected person.
Can a child go to school with head lice?
Children generally need not be sent home early. They can usually return after starting appropriate treatment, even if some nits remain; follow local school rules.
Do head lice spread through pets, pillows or swimming pools?
Human head lice are spread mainly through direct head contact. Pets do not spread them. Transmission from objects is much less common, and swimming pools are not a typical route.
Patient education, not a personal prescription.
Do not begin or discontinue medicines solely on the basis of a website. An examination helps confirm the condition and select safe treatment. Images on this page are AI-generated medical illustrations, not real patients or treatment results.
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Dr Neeraj Garg · MBBS (IMS-BHU), MD (IMS-BHU)
Maheshwari Hospital, Dalanwala, Dehradun · Consultation ₹800