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Thurston County, Washington

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Public Health and Social Services

Head Lice

Head lice are small, wingless insects about the size of a sesame seed which infest the hair. Head lice are clear in color when hatched, then develop a reddish-brown color after feeding.

Head lice lay their eggs (nits) close to the scalp but can be found anywhere on the hair shaft. The nits are small, yellowish-white, and oval-shaped and are attached to the side of a hair shaft usually less than a half inch from the scalp. Most often nits can be seen in the hair behind the ears or the nape of the neck.

It takes about 7-10 days for nits to hatch and another 7-10 days for the female to mature and begin laying her own eggs.

Infestation with head lice is not a health hazard or a sign of uncleanliness and is not responsible for the spread of any disease.

Lice need the blood of human beings to survive. In most cases, head lice will not survive for more than 24-48 hours off of its human host. The nits (eggs) live for about 10 days away from the body.

Usually, the first indication of an infestation is itching or scratching of the scalp. Scratching at the back of the head or around the ears should lead to an examination for head lice.

Transmission of head lice can occur by direct contact with and infested individual or by sharing clothing, combs, brushes, or bedding. In addition, placing clothing worn by someone who has lice in a shared clothing storage compartment or locker may also result in head lice spread.

Head lice can be spread as long as lice or eggs remain alive on the infested person or clothing.

Pets do not carry human lice.

Most head lice and their eggs can be killed with a variety of lice shampoos and lotions that can be purchased without a prescription from any drug store. Follow the product directions carefully; all of the lice shampoos/lotions can be toxic when misused.

Check all household members and close contacts of the person infested with lice. For products other than Nix® do not treat a person if you do not see lice/nits in their hair.
Nix® can be used preventatively for household members of infested persons.
In general, hair should be washed with a mild shampoo that contains no cream rinse or conditioners. Rinse and towel dry. Then, apply the agent (i.e., Nix®) as directed.

  • A vinegar and water rinse (equal parts) may be used before the Nix® creme rinse to help remove the nits ~ use vinegar only before Nix®, never after.
  • Apply Nix® creme rinse taking care to keep it out of the eyes. Let it remain on the hair for 10 minutes. If Nix® gets in the eyes, flush it out with water immediately.
  • Rinse the Nix® out of the hair with clean water. Do this over a sink. Do not use in a bathtub or shower as this would cause unnecessary contact with the Nix®.
  • Use a clean towel to dry the hair and section off the hair.
  • Comb the hair from the scalp to the end of the hair with a clean lice comb (i.e., LiceMeister™). With the comb and your fingernails, remove ALL of the nits -- refer to LiceMeister™ Comb handout. DO NOT SHAMPOO FOR 24 HOURS AFTER USING THE Nix® TREATMENT.
  • DO NOT use shampoos containing conditioners/cream rinse or hair products such as mousse, gel, hair spray, hair coloring, mayonnaise or vinegar for two weeks after using Nix®. Using these hair products may weaken the action of the Nix® creme rinse.

Chlorine in pool water may also weaken the action of the Nix® creme rinse and should be avoided for two weeks after using Nix®.

None of the lice shampoos will kill 100% of the nits.

All nits must be removed manually (i.e., comb/fingernails) to prevent them from hatching and infesting a child or family again. Manual removal of all nits is crucial.

You may need to retreat again after 7-10 days, but this is not usually necessary as most products are highly effective. Itching may continue for up to one week after treatment.


Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies.

The most common signs and symptoms of scabies are intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales. Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria.

Scabies should be treated with topical creams that can kill the mites, which are available by prescription from your health care provider. In addition to the infested person, treatment
also is recommended for people they have been in contact with.

Bedding, clothing, and towels used by infested persons and people they are in close contact with should be decontaminated. To disinfest items,

  • Wash them in hot water and dry in a hot dryer or dry-clean.
  • Store items that can’t be washed in a sealed plastic bag for at least 72 hours.
  • Thoroughly clean and vacuum rooms.