What should you know about head lice in hair?

A live louse confirms an active infestation. Nits are eggs attached firmly to individual hairs, often near the scalp; loose white flakes are more likely to be dandruff or product residue. Lice spread mainly through close head-to-head contact. They do not reflect poor hygiene, and pets do not maintain head-lice infestations.

An itchy scalp is common, but some people have little or no itching at first. Scratching can irritate the skin and create small sores. You can read more about [Itchy Scalp](/symptoms/itchy-scalp/) and [Head Lice](/conditions/head-lice/).

Check the hair in bright light, separating small sections and looking especially behind the ears and at the nape. A fine-toothed detection comb used on wet, conditioned hair can help find live lice. If lice are found, follow the product instructions exactly; some treatments need a repeat application because eggs may remain.

Avoid sharing combs, brushes, hats, towels, or pillows until treatment is complete. Wash recently used bedding and clothing according to their care instructions, and vacuum areas where the person rests. Treat close household contacts only when live lice are found or a clinician advises it. See [Head Lice Treatment](/treatments/medical-dermatology/head-lice-treatment/).

Arrange a [GP Consultation](/treatments/consultations-and-assessment/gp-consultation/) if you cannot tell whether the scalp finding is lice, if a correctly used product has not worked, or if the scalp has spreading redness, pus, marked swelling, or worsening pain. Seek prompt medical advice for a child who is very unwell or has a significant skin reaction.

Ask which treatment suits the person’s age and scalp condition, whether a repeat application is needed, how to confirm clearance, and what to do if itching continues after live lice are gone.