What are those white spots on your head?

While you are picking your son up from school, he says his head has been really itchy all day. When you get home, you look at his head and notice small, white dots scattered throughout his hair. You take him to the doctor and find out he has lice. How did this happen? How do you get rid of them?


Lice are tiny, wingless insects that feed on your blood. Adult lice are about the size of a sesame seed, and eggs (nits) look like tiny pussy willow buds. Sometimes, nits look like dandruff but aren’t as easy to remove. Nits usually hatch one week after they are laid. Lice are easily spread through close personal contact or by sharing belongings. This is why it is so common for children to become infested with them. There are three types of lice: head, body, or pubic. Head lice live on your scalp, body lice live in clothing or bedding and move onto your skin to feed, and pubic lice (aka crabs) live on the skin and hair of your pubic area or areas with coarse body hair, such as chest hair, eyebrows or eyelashes. Symptoms of a lice infestation are intense itching in the affected area, tickling feeling from the movement of hair, presence of lice or nits, and small red bumps on the affected area’s skin.


The first step in treating a head lice infestation is using over-the-counter products, like shampoo or lotion, that contain pyrethrin or permethrin. It is vital to follow the directions on how to use the product and repeat the treatment in about nine days, if necessary, to get rid of the lice completely. If your infestation doesn’t respond to these treatments, your doctor may prescribe an oral medication (note: children must be over 33 pounds to take these medications). Your doctor can also prescribe a medicated lotion, malathion, that you can rub into your hair and scalp. This medication is flammable, so do not use hair dryers or curling/flat irons while the product is in your hair. Also, if you smoke, be careful with cigarettes near your hair. Benzyl alcohol lotion, ivermectin lotion, and spinosad topical suspension are also available to help treat lice infestations. Body lice don’t typically require direct treatment but must be removed from the surrounding environment. Pubic lice can be treated with many of the same treatments used for head lice. Some medications are unsafe for pregnant women or children under certain ages. Be sure to talk to your doctor about the right treatment for you or your children.

In addition to treating the infestation directly, there are several steps you need to take to remove any lice and nits from the surrounding environment to prevent the spread of lice to other family members or a reoccurring infestation in the infected individual. It’s vital to check all household members for lice and nits and treat anyone with signs of an infestation. You can check for lice and nits by combing wet hair with a fine-toothed or nit comb. This will physically remove lice and nits from the hair. You will need to repeat this process every few days for at least two weeks. Wash any items, such as bedding, clothing, stuffed animals, and hats, in water at least 130°F and dry them on high heat for at least 20 minutes. If items cannot be washed, put them in an airtight bag for at least two weeks. Be sure to vacuum the floor and furniture thoroughly. It is essential to wash any combs or brushes in hot water or let them soak in rubbing alcohol for at least an hour. The good news is that lice prefer people, so you don’t have to worry about checking or treating your pets.


It’s challenging to prevent a lice infestation, especially for children in daycare or school, because of the close contact with other children. Some strategies to prevent an infestation are to teach your children to limit the amount of head-to-head contact with classmates as much as possible. It’s a good idea to teach them not to share personal belongings, like hats, scarves, coats, combs/brushes, hair accessories, or headphones. While these are some excellent techniques to apply, it’s unreasonable to expect your children to not participate in any form of contact that can potentially spread lice. Remember, a lice infestation isn’t a reflection on your, or your children’s, hygiene habits.

Lice are an annoying and frustrating thing to deal with, but with the right steps, you can decrease the chances of getting an infestation. If you have any questions or concerns about lice, please speak with your doctor. If you would like more information, please visit the Center for Disease Control’s lice page at https://www.cdc.gov/parasites/lice/index.html