Head Lice: Diagnosis and Therapy

Gabriel J. Martinez-Diaz, MD; Anthony J. Mancini, MD

Disclosures

Dermatology Nursing 

In This Article

Clinical Manifestations

Children with head lice may initially be asymptomatic. However, itching, which is confined to the scalp, and which may become quite severe in intensity, is common and is traditionally the first clinical symptom. Nits are attached by the louse to hair shafts, within a few millimeters from the scalp, and can often be found in the occipital and posterior auricular regions of the head. It is often easier to observe nits (which appear as oval-shaped, white-to-tan-to-gray eggs firmly attached to the hair shaft) than adult crawling lice. Other possible manifestations of a head lice infestation include excoriations, secondary impetiginization, pyoderma with or without hair loss, cervical lymphadenopathy, conjunctivitis, fever, malaise, and occasionally a diffuse morbilliform hypersensitivity eruption (AAP, 2009; Janniger & Kuflik, 1993; Mumcuoglu, Klaus, Kafka, Teiler, & Miller, 1991).

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