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Lice are tiny, wingless, parasitic insects that feed on your blood. Lice are easily spread — especially by schoolchildren — through close personal contact and by sharing belongings.
Several types of lice exist:
Head lice. These lice develop on your scalp. They're easiest to see at the nape of your neck and over your ears.
Body lice. These lice live in clothing and on bedding and move on to your skin to feed. Body lice most often affect people — such as homeless or transient individuals — who aren't able to bathe or launder clothing regularly.
Pubic lice. Commonly called crabs, these lice occur on the skin and hair of your pubic area and, less frequently, on coarse body hair, such as chest hair, eyebrows or eyelashes.
You or your child can have good personal hygiene habits and still get lice. Unless treated properly, this condition can become a recurring problem.
Itching, the most common symptom of all types of lice infestation, is caused by an allergic reaction. Lice bite the skin to feed on a person's blood. The saliva from these bites causes the allergic reaction and itching.
Itching may not occur right away, depending on a person's sensitivity and history of lice infestation. The first time a person is infested with lice, it may take several weeks or months for itching to start or to be noticed. In a repeat case of lice, a person may begin to itch within 2 days of infestation because the immune system reacts more quickly when exposure has occurred before.
Some people become very sensitive to lice bites and have unbearable itching. Others build up tolerance to the bites and have little or no itching, even with repeated infestations.
In addition to itching, symptoms of lice infestation vary depending on which type of lice is present.
Head lice and their eggs (nits) can be seen on hair, the nape of the neck, and behind the ears. They can vary in color from white to brown to dark gray. The eggs are tiny round or oval shapes that are tightly attached to the hair near the scalp and do not slide up and down on the hair.
Frequent scratching may cause broken skin or sores to form on the scalp. The damaged skin may weep clear fluid or crust over, and it may become infected. In response to infection, the lymph nodes behind the ears and in the neck may become tender and swollen.
A pubic lice infestation may cause itching around the genitals as well as the anus, armpits, eyelashes, and other body areas with hair. Pubic lice bites may cause small, flat, blue-gray marks (maculae cerulea) that look like bruises on the torso, thighs, or upper arms. The marks may last for several months, even after all lice have been killed. Pubic lice, like head lice, can be seen on shafts of hair.
Pubic lice that infest the eyelashes and eyelids may cause irritation and crusting in those areas. The lice may be visible near the base of eyelashes.
Pubic lice tends to be spread by sexual contact. If you or your teen has pubic lice, you may also have some other sexually transmitted infection (STI). Symptoms of STIs can include itching, tingling, burning, or pain of the genitals.
Itchy sores from body lice usually develop in the armpits, around the waist, and along the trunk where seams of clothes press against the skin. The lice and eggs are generally not seen on the skin but may be found in the seams of the person's clothing.
Other conditions, such as dandruff or scabies, can cause symptoms similar to those of a lice infestation.
Treatment for head lice is recommended for persons diagnosed with an active infestation. All household members and other close contacts should be checked; those persons with evidence of an active infestation should be treated. Some experts believe prophylactic treatment is prudent for persons who share the same bed with actively-infested individuals. All infested persons (household members and close contacts) and their spouses should be treated at the same time.
Retreatment of head lice usually is recommended because no approved pediculicide is completely ovicidal. To be most effective, retreatment should occur after all eggs have hatched but before new eggs are produced. The retreatment schedule can vary depending on whether the pediculicide used is ovicidal (whether it can kill lice eggs).
When treating head lice, supplemental measures can be combined with recommended medicine (pharmacologic treatment); however, such additional (non-pharmacologic) measures generally are not required to eliminate a head lice infestation. For example, hats, scarves, pillow cases, bedding, clothing, and towels worn or used by the infested person in the 2-day period just before treatment is started can be machine washed and dried using the hot water and hot air cycles because lice and eggs are killed by exposure for 5 minutes to temperatures greater than 53.5°C (128.3°F). Items that cannot be laundered may be dry-cleaned or sealed in a plastic bag for two weeks. Items such as hats, grooming aids, and towels that come in contact with the hair of an infested person should not be shared. Vacuuming furniture and floors can remove an infested person's hairs that might have viable nits attached.
Treat the infested person(s): Requires using an over-the-counter (OTC) or prescription medication. Follow these treatment steps:
Before applying treatment, it may be helpful to remove clothing that can become wet or stained during treatment.
Apply lice medicine, also called pediculicide, according to the instructions contained in the box or printed on the label. If the infested person has very long hair (longer than shoulder length), it may be necessary to use a second bottle. Pay special attention to instructions on the label or in the box regarding how long the medication should be left on the hair and how it should be washed out.
WARNING:
Do not use a combination shampoo/conditioner, or conditioner before using lice medicine. Do not re-wash the hair for 1-2 days after the lice medicine is removed.
Have the infested person put on clean clothing after treatment.
If a few live lice are still found 8-12 hours after treatment, but are moving more slowly than before, do not retreat. The medicine may take longer to kill all the lice. Comb dead and any remaining live lice out of the hair using a fine-toothed nit comb.
If, after 8-12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. Do not retreat until speaking with your health care provider; a different lice medicine (pediculicide) may be necessary. If your health care provider recommends a different pediculicide, carefully follow the treatment instructions contained in the box or printed on the label.
Nit (head lice egg) combs, often found in lice medicine packages, should be used to comb nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective.
After each treatment, checking the hair and combing with a nit comb to remove nits and lice every 2-3 days may decrease the chance of self-reinfestation. Continue to check for 2-3 weeks to be sure all lice and nits are gone.
Retreatment generally is recommended for most prescription and non-prescription (over-the-counter) drugs on day 9 in order to kill any surviving hatched lice before they produce new eggs. However, if using the prescription drug malathion, which is ovicidal, retreatment is recommended after 7-9 days ONLY if crawling bugs are found.
Supplemental Measures : Head lice do not survive long if they fall off a person and cannot feed. You don't need to spend a lot of time or money on housecleaning activities. Follow these steps to help avoid re-infestation by lice that have recently fallen off the hair or crawled onto clothing or furniture.
Machine wash and dry clothing, bed linens, and other items that the infested person wore or used during the 2 days before treatment using the hot water (130°F) laundry cycle and the high heat drying cycle. Clothing and items that are not washable can be dry-cleaned
OR
sealed in a plastic bag and stored for 2 weeks.
Soak combs and brushes in hot water (at least 130°F) for 5-10 minutes.
Vacuum the floor and furniture, particularly where the infested person sat or lay. However, the risk of getting infested by a louse that has fallen onto a rug or carpet or furniture is very small. Head lice survive less than 1-2 days if they fall off a person and cannot feed; nits cannot hatch and usually die within a week if they are not kept at the same temperature as that found close to the human scalp. Spending much time and money on housecleaning activities is not necessary to avoid reinfestation by lice or nits that may have fallen off the head or crawled onto furniture or clothing.
Do not use fumigant sprays; they can be toxic if inhaled or absorbed through the skin.