Itching

Only 1 in 3 people with head lice experiences itching. It is worse behind the ears and at the back of the neck. Itching is caused by an allergy to the saliva of the louse, and it may be several weeks before it occurs.

Seeing the Lice

There are various ways of looking for lice.

Tip the head down and brush or comb the hair thoroughly from root to tip over a piece of white paper. Inspect the paper and the brush or comb closely for signs of life. You may see the skins that the young lice have cast off – these look like lice. This method is not very reliable because, in dry hair, lice move away from the area that is being disturbed.

A better method uses a ‘lice comb’ (a special comb with narrow-spaced teeth), which you can buy from a pharmacy. Wash the hair, leave it damp and comb out tangles with an ordinary comb. Rub some ordinary conditioner into the hair. Then divide the hair into sections and carefully comb each section with the lice comb, starting at the scalp. Every now and again, wipe the comb on a tissue and look closely for live lice. This works better than the dry hair method, because lice stay very still when hair is wet, so they can be combed out.
If you have Afro-Caribbean hair, do not bother with a lice comb – it will be too uncomfortable. Instead, use lots of conditioner and an ordinary comb.

Look for Nits

The nits are egg-cases, attached to the hairs. They are oval in shape. The empty egg cases (left behind after the baby louse has hatched) are translucent white, and easier to spot than the lice, which run away from the light. As the hair grows, the egg case will move further down its shaft, so the position of the nits on the hair gives you an idea of how long you have had them. Hair grows at about 1 cm a month. Therefore nits 1 cm from the scalp mean 1 month, 2 cm mean 2 months, and so on.

If you have never seen them before, it can be difficult to decide whether a white speck is a nit or not. Globules of hair lacquer and bits of dandruff can be confused with nits. And if you pull out a normal hair, you may notice the whitish thickening at its root, which you may mistake for a nit. A magnifying glass will help.

Look for Black Specks

Look for black specks on the pillow or collar, these are louse faeces.

Look for Bites

Look for tiny, inflamed bites on the scalp, or a rash on the back of the neck or behind the ears.

For more information, see our sections on how head lice can be caught and how to treat head lice. If your scalp is itching but you cannot find any head lice, see our pages on itching and dandruff.

First published on embarrassingproblems.com
Reviewed and edited by Dr Ahmed Kazmi
Last updated: June 2025 by Dr Chin Whybrew