17 Lice Symptoms with Pictures: Signs That You Have Head Lice

The back of a woman's neck with a severe lice rash.

Discover 17 common head lice symptoms and find out the early and later signs of lice so you can figure out whether or not you have it. 

Even the word “lice” makes most heads itch. Itching alone, however, can be caused by a variety of things like dry scalp or simply changing shampoos, so how can you know if you might have head lice? Find out seventeen early, late, and extreme signs of head lice, which you can use to determine whether or not you have lice.

An enlarged super lice bug

Types of Lice

If you’re having some issues with your head and you bathe regularly, you might have head lice.

There are three main types of human lice: body lice, pubic lice, and (the most common) HEAD LICE

Body lice (the least common type of lice) is associated with poor hygiene and can be easily treated by bathing and changing into clean clothing. It’s typically only seen in homeless or refugee camps. If you are someone who bathes regularly, you certainly don’t have body lice.

Pubic lice, also known as “crabs,” is…well...in pubic hair. However, pubic lice can make their way into eyebrows, beards, or chest hair. Pubic lice is similar to an STD and is generally only passed during intercourse.

Head lice stick solely to the hair of the head and near the head. Head lice is NOT associated with poor hygiene. On the contrary, it does not matter how much you wash your hair, head lice are completely unphased. 

Head lice is a widespread problem in the United States. It’s estimated that around 12 million kids get head lice every year, the most common ailment for kids, second only to the common cold. The largest number of kids affected are between the ages of 3-12 (about 50% of cases), but head lice among teens and adults is also common.

This article focuses solely on the signs and symptoms of head lice (not body or pubic lice). 

What Are Head Lice?

A translucent looking head lice bug on a blond hair strand

Head lice are tiny parasites that live, breed, and feed exclusively on the human scalp. They are extremely contagious among close family and friends, especially among children. Most head lice is passed directly from one individual’s head to another during head-to-head contact such as hugging, snuggling, and sleeping together, but it can also be spread through inanimate objects that come in contact with hair such as brushes, hats, hair accessories, jackets, helmets, and other clothing.

Head lice are not dangerous and do not spread diseases, but they can cause very uncomfortable symptoms, all of which will be discussed here. 

Super Lice

Map of the united states in red; the words SUPER LICE 48 STATES is written across the image.

A fourth type of lice making big news these days is a new strain of head lice: super lice. Super lice and regular head lice are virtually the same bugs, except super lice has mutations that make them (and their eggs) extremely difficult to kill. These super lice are becoming the “new” strain of head lice.

Super lice and head lice have all of the same signs and symptoms, except super lice cannot be killed with traditional treatments.

The new “super lice” are extremely resistant to the over-the-counter and prescription treatments that worked on head lice years ago. There are only a handful of treatments that work to kill BOTH head lice and super lice, and most are only available online. If you discover you have lice, be sure to use a  lice treatment that works on BOTH regular lice and super lice, like the ones recommended here.

Signs and Symptoms of Head Lice

Obvious Signs of Head Lice

#1: Bugs in the Hair 

Lice are small parasitic bugs. They can be almost invisible as babies (also called “nymphs”) and grow to the size of a sesame seed as adults. Their food source is human blood, which they get from feeding off the human scalp. 

Lice are experts at survival in hair under most conditions; they can’t be washed out, brushed out, or blow-dried out. They almost never leave the head unless travelling to another head.

Head lice are the only bugs that live in human hair. If you find multiple bugs in your child’s hair and wonder if it is head lice, the short answer is yes, it is.

A human finger is the back drop of a translucent lice bug crawling across a blond hair strand

This is what head lice looks like. This photo compares the size with that of a woman’s pointer finger:

  • 6 legs attached to upper ⅓ of body, not on the large abdomen
  • No wings
  • Tan to brown (often translucent) body, darker body as they get older and after they die
  • Black stomach/intestines visible through translucent body (larger after feeding)
  • Antennae
  • Tapered/claw-like legs

If you find a bug like this in the hair, then your search for answers is over. Yes, you are dealing with lice. Go to the How to Get Rid of Head Lice section in this article.

A translucent/blond lice bug camouflaging in blond hair

If you don’t see bugs in the hair, DO NOT automatically assume you do not have lice. It is rare to see lice crawling around in the hair during the early stages of a lice infestation. Lice are experts at camouflaging in hair. For instance, check out at how well that same bug blends in with hair in this picture.

Early Signs of Head Lice

#2: Lice Eggs

Lice eggs, also called “nits,” are one of the first signs of head lice. Nits can be found long before any lice are usually spotted in the hair and before your head starts itching. 

Nits are often mistaken for dandruff or dirt in the hair because they are small and their shiny appearance can make them look white. There are 7 main differences between lice and dandruff. Some of the significant differences are that nits stick to your hair strand, they;re teardrop-shaped, and they vary in color from translucent to almost black.

Looking for Lice Eggs

A lice egg (nit) compared to the size of a human finger.

Unlike adult lice, nits do not move around or hide. These eggs are glued onto the hair strand so they will not fall off. 

This makes finding lice eggs much easier than finding grown lice. Because nits in your child’s hair is one of the first signs of a lice infestation, finding them at this stage can help you eliminate lice entirely when there are only a few adult lice bugs.

Hot Spots

The best places to look for lice eggs are in the “hot spots” of the head: behind the ears, the nape of the neck and the crown of the head.

Lice eggs are about the size of a poppyseed. They can be translucent to almost black in color depending on how close they are to hatching.

One of the defining traits of lice eggs is that they will not flick, blow, or brush off. They are glued to the hair strand about ¼ inch away from the scalp.

side-by-side images of blond girl's hair. Three circles identify the hot spots that lice usually lay lice eggs (nits)

How to Check for Lice Eggs

Checking for lice eggs in the “hot spots” of the head small section by small section is the best way to determine whether someone has lice in the early stages. Here’s a link to a full tutorial on how to check for head lice.

#3: Itching (Some Do, Some Don’t)

Itchy Scalp

Most people do not noticeably itch until they have had lice for a full month!

Talking about lice makes most heads itch. (You’re probably itching your head at this very moment.) However, when I say “lice causes an itchy scalp,” I’m not talking about a little scratch here and there. After a full month of having head lice, most people’s heads begin driving them crazy. The itch is a deep internal nagging that you just can’t seem to scratch enough to satisfy. 

Most people assume the itchiness is caused by lice moving around on the head, but it is actually the result of an allergic reaction to lice saliva, which is why it takes most people a full month to begin itching.

Each time lice feed on your blood, a small amount of their saliva shoots into your scalp. A little bit of this saliva goes unnoticed, but after a month of this repeated feeding, your head develops an allergic response to the lice bites and saliva. 

The scalp will then begin to itch constantly, even when lice are not feeding. Just like a mosquito bite itches more after the mosquito has left, even if the lice are removed, the scalp can still itch for several days until the allergic reaction goes away. 

Some people are EXTREMELY allergic to lice, and their head goes into hyper-itch as soon as a single bug feeds on their head. These people usually figure out that they have lice right away, before it turns into an infestation.

Unbelievably, though, some people’s heads do not itch AT ALL! They can be fully infested with head lice for months and not have ANY allergic reaction. These people usually don’t discover lice until they have spread it to many people.

A girl with a braid scratches her hair.

 

Itching Around the Ears

Similar to the deep “itch you just can’t scratch” feeling on the scalp, many people have the same feeling in the hairline near their ears and behind their ears. This makes sense when you consider that behind the ear is one of the “hot spots” where lice prefer to lay their eggs.

Itchy Neck

The neck is another one of those “hot spots” where lice like to lay their eggs. Itching right at the hairline of the neck and the neck itself is very common.

#4: Rash or “Lice Bites”

Neck Rash or “Lice Bites”

Another sign of lice caused by an allergic reaction to lice saliva is a neck rash or red bumps on the neck. For many people, this sign can show up even before the itching begins. Many people term this lice bites.

The back of a woman's neck with small red bumps

Most commonly, a blotchy, painless (or itchy) rash develops at the nape of the neck in the hair. The rash sometimes spreads to below the hairline at the nape of the neck.

The back of a woman's neck with a severe lice rash.

Other people with more severe reactions will have a blotchy red rash starting in their hairline and reaching to the end of their neck or have several red bumps on their neck. Severe neck rashes like this usually itch quite a bit.

Rash Behind the Ears

A woman with a rash behind her ear

The second most common place is behind the ears. This rash is usually either completely red, blotchy red, or has a small lice bite-type appearance. It may itch, but is usually not painful.

Red, Patchy Rash on the Scalp

Some people who develop an overall red/patchy scalp, but it is less common than a rash behind the ears and on the neck.

#5: Ticking or “Something is in My Hair” Sensation  

It is very rare for most people to actually “feel” lice crawling on their head, although it is VERY common to believe that you “feel” lice crawling on your head (even if you don’t have lice!). This is just our mind playing tricks on us through the power of suggestion.

However, there are some individuals with very sensitive heads who can actually feel lice moving on their hair. (These are usually the same folks that can reach into their hair and just pull out a bug.) People with highly sensitive scalps like this usually know that they have lice right away and it doesn’t progress very far.

#6: Restless at Night, Sleepy During the Day 

A small girl asleep at the breakfast table, a bowel of cereal is in front of her

Lice are nocturnal, which means that they do most of their moving and feeding at night. This movement and feeding usually increases feelings of discomfort and itching in the night hours. It is not uncommon for someone with lice to “sleep all night” but wake up completely exhausted because they have been scratching their head all night, which in turn leads to sleepiness and fatigue during the day. 

#7: Itching Scalp While Sleeping

Parents, if you see your child scratching her head frequently while they’re sleeping, it is a tell tale sign of head lice. 

#8: Increased Dandruff

The top of a woman's head with large chunks of dandruff

While many people believe that they are seeing dandruff when they are actually seeing lice eggs, there are also several people that have an increase in dandruff when they have head lice. This is part of their bodies’ “allergic reaction” trying to fight off lice. The dandruff usually comes off in large chunks. This skin condition can be normal for some people, but a sudden onset of extreme dandruff like this can be a response to head lice.

#9: Tickling Sensation on the Whole Ear

Some people’s first sign of head lice is that their ears feel strange. I have heard it described by people as “tingling ears,” “itchy ears,” or “like someone is tickling my ears.” The sensation is unique; their whole ear feels strange, inside and out. I have had several clients in my lice center with this reaction to head lice. Every time they get head lice they always have the same strange tickly/tingling/itching of their whole ear.

#10: Bumps on Scalp

The back of a girl's neck, the scalp is red/pink at the base of the hair

Some people develop several “cyst-like” bumps on their scalp, similar to acne. It is unclear whether these bumps are actually swollen areas where lice have fed (lice bites) or if it is an overall allergic reaction to lice saliva.

Later Signs of Head Lice

#11: Sores and Scabs on the Scalp

Sores and scabs on the scalp are usually the consequence of severe scratching where fingernails dig into the scalp so intensely that the outer layer of skin comes off. In rare cases, bacteria can enter into these scabs and a bacterial infection on the scalp can ensue.

#12: Weeping of the Scalp

Weeping of a clear or light pink fluid (“serous fluid”) is usually only in severe cases of head lice. This serous fluid is the scalp’s reaction to trying to fight off bacteria and heal the scalp. Unfortunately, when the clear fluid dries in the hair, it becomes glued together and matted, making head lice more difficult to address.

#13: Irritability

If your child is especially irritable, it can also be a sign of head lice. This increased irritability is usually a result of fitful sleeping due to itchy scalp and general discomfort from head lice.

Extreme Reactions to Head Lice

#14: Rash or red bumps on the shoulders or upper back

Most people’s lice rashes do not extend past the neck, but for those with severe allergic reactions to lice saliva, the rash can extend to the shoulders and upper back. This does not mean that lice are feeding on the shoulders or back; it’s just that the allergic, histamine response is making its way down the body. 

#15: Fatigue and Feeling Awful

There are, on rare occasions, people whose bodies respond to lice as if they had a systemic infection, such as the flu. Their body will start producing bacteria-fighting white blood cells with the intention ward off the “sickness.” (This doesn’t work against lice, unfortunately). While their body is amping up to try to fight off lice, they will often have flu-like symptoms and just feel lousy.

In very rare occasions, severe head lice can cause anemia (due to lack of red blood cells). These people usually experience extreme fatigue.

#16: Swollen Lymph Nodes

Swollen lymph nodes or glands is usually another result of someone’s body gearing up to try to fight off an infection such as a virus or bacteria. In rare occasions, some people with lice get swollen lymph nodes because their body is trying to fight the “sickness,” which is really a lice infestation. 

#17: Low-Grade Fever

Along the same vein, if the body is preparing to attempt to fight off head lice, a person may have a low-grade fever. This is extremely rare and only happens to people whose bodies have extreme reactions to lice saliva.

How Can I Treat the Symptoms of Head Lice?

Because lice symptoms are the results of an allergic reaction to lice saliva, the only way to get rid of the symptoms of head lice is to actually get rid of lice. There are hundreds of people that try to treat their itchy, lice-infested scalp with dandruff shampoo to no avail. As long as lice are on your head, you will have symptoms.

(A quick disclaimer for the rest of this article: links here will take you to sites where you may purchase these products, and if you do make a purchase from these links, I will earn a commission. However, all of my recommendations are based solely on the quality of these products and the decision to purchase through these links is entirely up to you.)

How to Get Rid of Head Lice

(Remember, because the super lice mutation is so common, make sure you do what is needed to kill BOTH lice and super lice.)

Here are the basic principles of getting rid of head lice:

  1. Use a treatment that works on BOTH lice and super lice, such as Ladibugs, Lice Clinics, Head Hunters or Fairy Tales.
  2. Remove all lice eggs with the Nit-Free Terminator Comb.
  3. Check all family members for head lice with a lice comb or treat all family members with an enzyme shampoo like LiceLogic Clear & Free Shampoo
  4. Keep checking with a lice comb and/or retreat 10 days later, not only a week later.
  5. Lice eggs on the head hatch after 7-10 days, so if you retreat or recheck after only a week, you may miss something that hasn’t hatched yet.
  6. Clean your house using the following principles as a guide (or check out the article Lice Cleaning Checklist to Get Rid of Lice in Your Home):

Think 48 Hours

Focus on cleaning items that have been in contact with the lice-infested individual within the last 48 hours. Lice cannot live longer than 48 hours on household items.

Do Not Use Lice Sprays

Lice sprays do not work on super lice at all. Multiple scientific studies have shown that that almost all lice in the US are resistant to the pesticide found in lice sprays. The only lice sprays that work for killing super lice are enzyme lice sprays like LiceLogic Clear & Free All Purpose Spray.

 

Vacuum

You can vacuum surfaces such as couches and mattresses.

Clean Your Brushes

Soak hair brushes, combs, and hair accessories (such as hairbands, clips, and headbands) used by the person with lice in hot water (135° F or greater) for at least ten minutes. (I do not recommend boiling brushes and combs, however, because they will melt.)

Items in the Dryer

Put items in the dryer for forty minutes on high heat.

Bag Items for 2 Days

Lice can’t live without blood for very long, so anything that could have lice on it will be safe to use again after 48 hours. If an item is something that you cannot run through the dryer, like a favorite stuffed toy or delicate clothing, you can seal it away in a bag for a couple days. 

Don’t Forget Carseats

Vacuum your car seats.

What If My Head Still Itches After Lice Treatment?

It is common for some of the symptoms of head lice to continue after lice are gone. This is because head lice themselves are not the cause of the symptoms, but the lice saliva that enters into the scalp each time they feed. This is similar to other bug bites that itch significantly for several days after the literal bite. Lice symptoms decrease within a day or two of getting rid of lice and typically go away completely after a week. 

After having lice and undergoing rounds of lice treatments, many people’s scalps are considerably itchy and uncomfortable. The anti-itch shampoo I believe to be most effective at settling that itch is Neutrogena T-Gel Stubborn itch. Wash with it every day for a week, leaving it in the hair for at least ten minutes each time you shower.

If your symptoms do not go away, it is unfortunately likely that you did not completely eliminate lice. Super lice today are extremely resistant to most over-the-counter and prescription treatments. Be sure to use a lice treatment that kills both lice and super lice. 

What About Prescriptions for Lice?

Most prescription lice treatments use pesticides similar to the ones you’d find in over-the-counter treatments. They’re just larger doses or you’re supposed to keep them on for longer periods of time. 

Since most lice these days are resistant to pesticides, it doesn’t matter how high the dose or how long you leave them on; they won’t work to get rid of lice! I would never use a prescription lice treatment on my own children or recommend one to you. 

Lice Prevention

If you have discovered that you have avoided lice this time and your symptoms are actually related to something else, great! However, just because you’ve dodged it this time doesn’t mean you will always be so lucky. You can take steps to prevent getting head lice with these three simple principles:

  1. Avoid head-to-head contact such as long hugs, sleeping in the same bed, putting your head on other’s shoulders, whispering in someone’s ear, looking at tablets or phones with heads touching, and selfies.
  2. Avoid sharing things that come in contact with hair such as brushes, combs, hair accessories, hats, jackets, clothing etc
  3. Make your hair undesirable to lice by using a lice prevention spray or lice prevention shampoo every day. The best ones are LiceLogic, Head Hunters, Rosemary Repel, and Ladibugs.

These are only a few lice prevention strategies effective against super lice. For more, read the article 21 Lice Prevention Strategies Every Parent Should Know.

Here’s a quick summary of the signs and symptoms of head lice.

17 Signs and Symptoms of Lice

  1. Bugs in the hair
  2. Lice eggs in the hair (often mistaken for dirt or increased dandruff)
  3. Itchy scalp, ears, or neck
  4. Rash or “lice bites” on the neck, behind the ears, and on the scalp
  5. Tickling or “something is in my hair” sensation
  6. Restless at night, sleepy during the day
  7. Itching the scalp while sleeping
  8. Increase in dandruff
  9. Tickling sensation on the whole ear
  10. Bumps on the scalp similar to acne
  11. Sores and scabs on the scalp
  12. Weeping clear fluid on the scalp
  13. Irritability
  14. Rash or red bumps on the shoulders or upper back
  15. Fatigue and feeling “awful”
  16. Swollen lymph nodes
  17. Low-grade fever
Best of luck on your lice journey! (1)

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