When should you worry about itchy scalp if you have head lice?

Head lice can cause an itchy scalp because the skin reacts to bites and contact with lice. Look closely near the scalp, particularly behind the ears and at the nape, for live lice or eggs attached firmly to individual hairs. Loose flakes are not the same as attached eggs. Scalp itch can also result from dandruff, eczema, irritation, or a reaction to hair products.

Check the scalp in good light and use a fine-toothed comb on wet, conditioned hair. If a lice treatment is advised, follow its directions precisely and complete any required combing or repeat application. Check household members and avoid sharing combs, hats, towels, and hair accessories. Wash recently used bedding and clothing as directed. Never use pesticides, kerosene, or other household chemicals on the scalp.

See a clinician or pharmacist if you cannot tell whether live lice are present, the scalp is very inflamed, or symptoms do not improve after the recommended plan. Get prompt help for painful or oozing sores, crusting, spreading redness, swollen glands, or fever. Facial swelling or trouble breathing after a product is an emergency. Persistent itch without confirmed lice deserves assessment for another cause.

Ask how live lice should be confirmed, which product is safe for your age and scalp, whether contacts need treatment, when follow-up is needed, and what to use if the scalp remains irritated after lice are gone.