Head lice are tiny, parasitic insects that cling to hair follicles and feed on human blood from your scalp. Head lice don’t spread disease, but they can cause unpleasant scalp itching and irritation. They’re usually transmitted through head-to-head contact with others, and they can spread rapidly. In the United States, an estimated 6 to 12 million children between the ages of 3 and 11 get lice each year. According to a 2022 review of studies, global estimates suggest about 19% of school-aged children have head lice. Head lice are found in every country and across cultures and socioeconomic classes.
In short, lice are nothing to feel embarrassed about. If you have head lice, that just means you or your child had close contact with someone else who had head lice. Kids in preschool and elementary school, along with their household members, tend to get lice most often. According to the Centers for Disease Control and Prevention (CDC), girls tend to get head lice more often, and this may happen because girls are more likely to play with their heads close together. That said, you can still get head lice regardless of your age, hair length, or other factors.
It doesn’t matter whether your hair is washed or unwashed, long or short, or curly or straight. Head lice feed on the blood from your scalp, so they’ll latch onto anyone. Technically, you can get lice even if you have no hair at all, but since lice cling to hair follicles and lay eggs (also known as nits) there, they likely won’t last too long if you have no hair. Typically, lice need very close contact to move from one person to another. The head of someone with lice needs to touch, or nearly touch, another person’s head for long enough for the lice to crawl over. It’s possible to transmit lice by sharing hairbrushes, hats, or other clothing or accessories that touch your head, but experts say this is less common.
Getting head lice has nothing to do with your hygiene habits. Lice are incredibly common worldwide, and these parasites affect millions of children in the United States each year. Anyone can get them regardless of age, hair washing frequency, hair type, or other factors. If you have symptoms of head lice or notice lice or nits in your hair, it’s best to use a prescription or OTC treatment right away. A primary care doctor or another healthcare professional can offer more guidance on dealing with persistent infestations.
Stages of Head Lice
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Prevalence in African Americans
Yes, anyone can get head lice regardless of their race or ethnicity, but infestations are reported less common among Black Americans than their White neighbors. In the United States, infestation with head lice is much less common among African American persons than among persons of other races.
However, it is a surprising misconception that Black people are immune to head lice. This is unequivocally FALSE. Not only can Black Americans get lice, but they do get head lice. I’ve helped multiple Black children and Black adults in my lice center with extreme head lice infestations. The actual statistics related to how likely it is for Black people in America to get head lice vary and are outdated (30+ years old).
While it is clear that head lice among African American children is lower than Caucasian children, in my expert opinion, head lice are on the rise among African Americans. This may be a result of a rapid increase in mixed-race individuals or because American lice are adjusting to more hair types. According to a 2018 article in the British Journal of Family Medicine, head lice affect African American people less commonly compared with other people.
The researchers suggest that this is due to the shape of the claws in most head lice and the width and shape of the hair shaft in coiled hair. The hair shaft in coily hair has an oval cross-section, whereas in other hair types, the shaft tends to be circular. Head lice find it easier to grip onto circular hair shafts. In addition, the researchers note that the use of hair oils could also play a part. For example, petroleum jelly makes hair smoother and less brittle, which is harder for head lice to grip onto. Research has shown that African American women are likely to use more hair products than other women and to use them from a younger age.
Head lice seem to be more common in Caucasian, Hispanic, and Asian American people than in African American people. For example, fewer than 0.5% of African American schoolchildren experience head lice compared with about 10% of schoolchildren of other races.
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Adaptation of Head Lice
Research from 2012 suggests that some head lice have adapted to living in coily hair. The researchers found head lice in four African countries: Senegal, Burundi, Rwanda, and Ethiopia. There is ample evidence that head lice have adapted in multiple ways in different countries, so it is likely that they may have adapted to different hair types in different countries as well. It’s likely that most head lice came to America from those that immigrated from Europe with Caucasian-textured hair.
Head lice are small bugs that live exclusively in hair. Head lice are experts at blending in and they mutate regularly to survive. Adult head lice on Black Americans will likely be dark gray to black, whereas head lice in blond hair will be tan to light brown. Head lice range from almost invisible at birth to the size of a sesame seed when fully grown. All head lice are clear/translucent when they first hatch, but as they age, head lice change in color. The color of adult head lice typically match the color of hair they are infesting. You would expect a dark-skinned/dark-haired individual to have darker head lice than their blonde neighbor.
Lice and Nits in Hair
Blood Scent and Hair Oils
Lice actually smell blood and are drawn to it, like sharks. One theory is that head lice prefer the smell of more Caucasians’ blood over that of their African American friends. This does not mean that White or Black children are dirtier or cleaner, or smell (to humans) in any way. The best way for any person to hide their blood scent and prevent getting lice is by adding pleasant smells to their hair that repel lice.
Hair oils like jojoba oil, coconut oil, and castor oils are used frequently by many African Americans. Many believe that the frequent use of these oils is one of the reasons why Black individuals get head lice less often. Lice are excellent "tightrope walkers" of the hair, but if you grease up that rope, it's a lot harder to walk. Each of their little legs has claws specifically designed to cling onto hair strands without falling off.
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Identifying Head Lice
People with head lice may not have symptoms, particularly with a first infestation or when an infestation is light. Itching (pruritus) is the most common symptom of head lice infestation. It is caused by an allergic reaction to louse bites.
People can also look for signs of head lice eggs. The empty egg casings may be easier to see on dark hair than the lice, as they usually appear white. Eggs are usually within 4 mm of the scalp and are about 0.8 mm by 0.3 mm in size.
Common signs of head lice:
- presence of insects that are black or gray and about 2-3 millimeters (mm) long with six clawed legs
- an itching or tickling sensation in the hair
- feeling or seeing movement in the hair, including crawling but not hopping or flying
- trouble sleeping, as head lice are most active when it is dark
- sores on the head from scratching, which may lead to an infection
Key areas to check for lice and nits:
- the scalp and crown of the head
- around and behind the ears
- the neckline at the back of the head
Checking for lice eggs in the “hot spots” of the head section by 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.
Treatment Options
If you or your child has head lice, it’s important to treat the infestation right away. You can treat head lice with over-the-counter (OTC) or prescription methods, including:
- OTC treatments: You can find permethrin lotion or pyrethrins combined with piperonyl butoxide at your local drugstore or online. You can opt for store brands, generics, or name brands. Examples of brands include Nix, Rid, and Licefreee Spray.
- Prescription treatments: If you still notice live lice after using an OTC treatment, it may help to try a stronger formula. A doctor can prescribe ivermectin lotion, spinosad topical suspension, benzoyl alcohol lotion, or malathion lotion to treat head lice.
- Manual removal: You can use a fine-toothed lice comb to manually remove lice. An application of olive oil before combing will help the lice cling to the comb. You’ll need to repeat at least every 2 to 3 days until no lice or nits remain. Just know that some experts say this treatment may not be enough to completely get rid of head lice.
Most medicated methods will require a second treatment application about 7 to 9 days after the first one. This second treatment targets any newly hatched lice.
Treatment for Textured Hair
Those with spiraled or textured hair or locks may find it more challenging to get rid of lice. In my experience, most lice can be tackled in afro-styles if the hair can be divided into sections and the scalp can be exposed in several areas of the head. On the other hand, if the afro is so thick that it cannot be divided into sections, it may be impossible for lice treatments to penetrate to the scalp in order to kill lice.
There is an appalling lack of lice treatments designed for those with thick, textured hair. Additionally, most lice treatments come in the form of a shampoo, oil, or spray, typically geared toward fine, Caucasian hair. Lice shampoos and sprays usually leave African American hair extremely dry, and what’s more, cannot penetrate to the scalp because the hair is too thick. Oil-based products usually aren’t absorbed well in Black hair, and typically end up dripping off the head instead of staying in the hair and on the scalp.
The best product I have found for Black hair is Head Hunters WipeOut Lice Treatment. WipeOut Lice Treatment has a thick conditioner-like consistency that is significantly better at saturating dense hair. Additionally, this treatment is made from all-natural ingredients that kill head lice (and super lice). Removing lice eggs is absolutely the best way to ensure that you can be done with head lice quickly and that they won’t come back.
Head Hunter's is an all-natural product, but if you would rather go the home remedy route then these are the best home remedies for those with textured hair. No home remedy kills 100% of lice, even the best home remedies only kill about 80% of lice. And they don't kill lice eggs, so remember that you'll need to do multiple re-treatments. Jamaican Castor Oil is a great lice killer.
People with hair extensions, wigs, or hairpieces will need to remove them before treatment. They can then find a space with good lighting and get rid of head lice by:
- wetting the hair and dividing it into sections
- applying a lice treatment or home remedy, such as coconut oil
- moving a louse comb through the hair in sections to remove head lice and their eggs
- rinsing out any excess product from the hair using a shower head or running tap
- checking anyone else in the house for head lice to prevent further spreading
A person should check the hair again 8-12 hours after the treatment and avoid rewashing it until at least 2 days afterward. It is important to continue to comb through the hair once a day with the comb to remove any dead lice. People may need to see a healthcare professional if home remedies are not working.
Prevention Strategies
To help control a head lice outbreak in a community, school, or camp, teach children to avoid activities that may spread head lice. CDC's guidance has not changed-you do not need to send students with head lice infestation home early from school. They can go home at the end of the day, be treated, and return to class after beginning appropriate treatment.
Preventative measures to avoid lice infestations in African-American hair include:
- Routinely inspect your child’s hair, especially after activities involving close contact, such as playdates or school.
- Use a fine-toothed comb to part the hair and check the scalp for signs of lice or nits.
- Teaching children not to share personal items like hats, combs, hair accessories, or bedding is crucial since lice spreads through direct contact.
Natural Lice Prevention Spray
The best way for any person to hide their blood scent and prevent getting lice is by adding pleasant smells to their hair that repel lice. Many use tea tree shampoo for this purpose, but in my experience, lice prevention requires a bit more than that. Read our article 19 Essential Oils that Repel Lice to create your own lice prevention spray or buy a lice repellent shampoo or spray.
Myths and Misconceptions
There are several myths and misconceptions about lice in African-American hair. They simply seek a warm, secure environment close to the scalp to feed on blood. Another misconception is that lice can jump or fly; they can only crawl, meaning direct head-to-head contact is the primary requirement for them to spread.
Common Myths about Head Lice:
- Lice don’t prefer dirty hair and can’t jump or fly.
- Home remedies like mayonnaise or kerosene are not effective!
Some people are less susceptible than others to getting head lice. Head lice have difficulty gripping onto coily hair. As a result, Black people with coily hair and others with this hair type may be less susceptible to head lice.
General Prevention Tips
- Avoid touching heads with others who have head lice.
- Encourage children who play closely together to sit at enough distance so that their heads don’t touch.
- Avoid using pillows, headrests, or other fabric-based furniture items that touch other people’s hair.
- Avoid sharing hairbrushes, scrunchies, hats, and other items of clothing or accessories that touch your head without disinfecting them first.
Disinfect items that may contain head lice:
- Soak items in very hot water for 5 to 10 minutes. Make sure the water is at least 130°F (54°C).
- Wash and dry items on high heat or get them dry-cleaned.
- Seal items in a plastic bag for 2 weeks.
- Vacuum your floor, especially carpeted areas, and all furniture and car seats, if someone in your family has head lice.
Head Lice Prevention Tips
