It can be a little confusing (and freaky) when you or someone you love suddenly develops an unusually itchy scalp. While all the scratching could be related to something innocent, like dryness or dandruff, it’s also a major sign of head lice.
The parasitic insects feed on human blood, but it’s not always easy to spot them on your scalp. What you might be able to see, though, is the damage they leave in their wake.
Lice bites, like lice themselves, are pretty small, but you can still see them if you know what to look for. Here, doctors explain what the bites look like (with lice bite pictures included), break down the symptoms, and offer tips on what to expect for treatment.
What do lice bites look like?
When lice bite, they inject a little bit of their saliva into your skin. The bites alone are “miniscule,” but they become more visible due to your body’s reaction to the lice saliva, says John Brancato, M.D., an emergency medicine physician at Connecticut Children’s. “They can then look like numerous small mildly red or abraded spots,” he says.
When you scratch a lice bite, sores can develop, according to the Centers for Disease Control and Prevention (CDC). And those sores can sometimes become infected with bacteria that’s found on your skin.
You won’t necessarily see the rash or sores right away, though. Normally, you’ll spot nits (a.k.a. lice eggs) first. These look like tiny grains of rice and attach firmly to the base of hairs. “It’s not like dandruff, where you can flake it off,” says Gina Posner, M.D., a board-certified pediatrician at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif. “It’s on the hair and you have to really pull it off.”
While you might spot live lice during your search, you won’t necessarily see them all the time. In general, live lice are harder to find than nits and bites, Dr. Brancato says.
Where do lice bite?
Lice tend to bite on “the scalp, right where the hair meets the follicle opening,” says Ashanti Woods, M.D., a pediatrician at Baltimore’s Mercy Medical Center. “Lice like warm areas with lots of hair,” Dr. Posner says, and they tend to bite when they’re hiding in there.
The bites are usually hidden under hair, but you may be able to see them when you really search a person’s scalp. You can sometimes also spot them behind the ears and along the nape of the neck, Dr. Posner says.
Are lice bites itchy?
Definitely. That allergic reaction to the lice saliva can lead to some major scratching. “Most of the time, you see someone itching their head a lot,” Dr. Posner says. The CDC also explains that you may experience a tickling sensation (like something is moving in the hair) and feel irritable or have trouble sleeping, since head lice are most active in the dark.
How long do lice bites take to heal?
Everyone is different but, in general, bites will heal after several days. Unfortunately, dealing with just the bites won’t get rid of the infestation. If the bugs continue to make your scalp home, Dr. Posner says you’ll still be dealing with consistent bites. “You need to get rid of the culprits,” she says.
How to treat lice bites
It’s crucial to get rid of the lice infestation. There are several options out there, but the CDC recommends using an over-the-counter medication that contains either pyrethrins (naturally occurring pyrethroid extracts from the chrysanthemum flower) or permethrin (a synthetic pyrethroid similar to naturally occurring pyrethrins). This should kill live lice.
Nit combing—removing nits with a special comb or your fingers—is also crucial in the process, since nits can hatch and then start biting you as well, Dr. Posner says.
If that doesn’t work, your doctor may prescribe medication like benzyl alcohol, ivermectin lotion, malathion lotion, or spinosad. If the itching is intense (and it usually is), Dr. Posner says you may want to take an antihistamine like Benadryl or Allegra to help you stop scratching.
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