Dandruff and lice: what to know

Dandruff produces flakes from the scalp and may cause itch, while head lice live on the scalp and lay eggs attached to individual hairs. Dandruff usually brushes or falls away more readily; nits remain firmly fixed near the hair shaft. Itching alone cannot distinguish them. Redness, sores, or crusting may follow scratching, and seborrheic dermatitis can also create heavy scale that is mistaken for lice.

Inspect the hair close to the scalp in bright light, focusing behind the ears and at the nape. If live lice or firmly attached nits are found, use an approved lice treatment exactly as directed and follow any required repeat instructions. Avoid sharing combs, brushes, hats, or bedding until the situation is addressed. For loose flakes without lice, a suitable anti-dandruff shampoo may help; do not use lice products just to treat ordinary dandruff.

Ask a pharmacist or clinician to confirm the finding if you cannot tell a flake from a nit, if treatment has not worked as directed, or if several household members are itching. Seek medical review for painful sores, pus, spreading redness, fever, or a child with significant scalp inflammation. Persistent scale after lice have been treated may be a separate scalp condition.

Ask how the material on the hair was identified, which treatment is suitable for the person’s age, how to manage close contacts, and whether remaining itch is from irritation or an ongoing infestation.