Red flags & when to go in person for Lice (Pediculosis)

Audience: adult

Lice (pediculosis) are tiny insects that live on the scalp and cause itching. They spread mainly through close head-to-head contact. While lice are common and usually not dangerous, they can be very uncomfortable. Most lice cases can be managed at home using over-the-counter treatments and careful combing. Telemedicine can help guide you on how to treat lice, check for signs of infection, and advise on prevention. However, some situations need in-person care, such as when itching is severe, the scalp looks infected, or treatments don’t work. Knowing when to seek in-person care is important to avoid complications like skin infections. This guide explains red flags, what telemedicine can and cannot do for lice, and how to prepare for and follow up after a telemedicine visit. Remember, this information is educational and not a substitute for medical diagnosis or treatment.

Red flags — go in person / ER

• Severe itching that interrupts sleep or daily life — seek in-person care promptly.
• Signs of scalp infection such as redness, swelling, pain, warmth, or pus — get medical evaluation.
• No improvement after two weeks of treatment — consult a healthcare provider in person.

What telemedicine can do

• Providing guidance on identifying lice and nits.
• Advising on over-the-counter treatment use and prevention.
• Answering questions about lice and when to seek further care.

What telemedicine cannot do

• Performing physical scalp examinations.
• Treating severe infections or allergic reactions.
• Prescribing or managing prescription medications requiring monitoring.
• Removing extensive nits or lice physically.

What Are Head Lice?

Head lice are tiny insects that live on the scalp and feed on human blood. They are about the size of a sesame seed and can be hard to see. Lice lay eggs called nits, which stick to hair near the scalp. Lice spread mainly through close head-to-head contact, especially among children and families. Lice do not jump or fly and are not a sign of poor hygiene.

Common Symptoms of Lice

The main symptom of head lice is itching on the scalp, caused by an allergic reaction to lice bites. You may also notice a tickling feeling or see lice moving in the hair. Small red bumps or sores can appear on the scalp, neck, or shoulders from scratching. Nits may be visible as tiny white or yellowish dots attached to hair shafts close to the scalp.

When to Seek In-Person Care (Red Flags)

While many lice cases can be managed at home or through telemedicine, certain signs mean you should see a healthcare provider in person:

If you notice any of these, seek in-person medical evaluation promptly.

How Telemedicine Can Help

Telemedicine providers can help by:

Telemedicine is a convenient way to get expert advice without leaving home, especially for mild cases.

Limitations of Telemedicine for Lice

Telemedicine cannot:

If your condition worsens or does not improve, an in-person visit is important.

Preparing for Your Telemedicine Visit

Before your tele-visit, prepare by:

This helps the provider give you the best advice.

After Your Telemedicine Visit

After your visit, you may need to:

Good follow-up helps ensure lice are fully cleared.

How to prepare for your tele-visit

• Ensure you have good lighting to show your scalp during the visit.
• Have a fine-toothed lice comb ready to inspect your hair.
• Note any treatments you have already tried and their effects.
• Prepare to describe your symptoms clearly, including itching and any scalp changes.
• Write down any questions or concerns you want to discuss with the provider.

After your tele-visit

• Follow the treatment instructions provided carefully and completely.
• Check household members or close contacts for lice and treat if needed.
• Clean bedding, hats, combs, and hair accessories to prevent re-infestation.
• Monitor your scalp for signs of infection or worsening symptoms.
• Schedule an in-person visit if symptoms do not improve or red flags develop.

FAQs

How do I know if I have head lice?

Head lice cause itching on the scalp and you may feel something moving in your hair. You might see tiny insects or their eggs (nits) attached close to the scalp. Using a fine-toothed comb on wet hair can help find lice or nits.

Can lice be spread through hats or bedding?

Lice mainly spread through direct head-to-head contact. While it’s less common, lice can sometimes spread through sharing hats, combs, or bedding. Cleaning these items can help prevent spread.

Are over-the-counter treatments effective?

Many over-the-counter treatments can kill lice if used correctly. It’s important to follow the instructions carefully and repeat treatment if needed. Sometimes, lice can be resistant, and you may need advice from a healthcare provider.

Can I get rid of lice without medicine?

Combing wet hair thoroughly with a fine-toothed lice comb can remove lice and nits. This method is often used alongside treatments. However, it requires patience and careful technique.

When should I see a doctor in person for lice?

See a doctor in person if itching is severe, if you notice signs of infection like redness or pus, if treatments don’t work after two weeks, or if you have allergic reactions. These situations need medical evaluation and possibly prescription treatment.

Sources

1. Head Lice — Centers for Disease Control and Prevention (CDC).
2. Head Lice - Treatment — MedlinePlus, U.S. National Library of Medicine.
3. Pediculosis (Lice) — Mayo Clinic.
4. Head Lice: Diagnosis and Treatment — Merck Manuals Consumer Version.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If you have concerns about your health or experience any red flags, please seek evaluation by a healthcare professional in person.