Synopsis
Confirm lice by finding live insects, distinguish head, body and pubic infestation from bite hypersensitivity, coordinate contact and environmental measures, and identify anaphylaxis, infection, tick and safeguarding concerns.
- Diagnose head lice only by finding a live moving louse with wet detection combing; nits alone may be empty or non-viable.
- Check household members and treat those with live lice on the same day; routine treatment of uninfested contacts is unnecessary.
- Use wet combing on days 1, 5, 9 and 13 with a check on day 17, or a licensed physical insecticide exactly as directed.
Key red flags
Airway, breathing or circulation compromise after a bite, expanding severe infection, fever with travel or tick exposure, eyelash lice with ocular injury, unexplained genital lice in a child or widespread infestation in a vulnerable person requires urgent assessment.
Sudden airway swelling, wheeze, hypoxia, hypotension or collapse after a bite or sting requires intramuscular adrenaline.
Investigation priorities
Confirm active head lice before treatment.
Management branches
A live louse is found by detection combing.
- Check household members and treat all confirmed cases on the same day.
- Use scheduled wet combing or a licensed dimeticone product, repeating at seven days when its instructions require it.
Key medicines
Dimeticone 4% lotionApply to dry hair and scalp until fully covered, leave for the product-specified period and repeat after seven days when directed.
Cetirizine 10 mg tabletsAdults and people aged 12 years or older take 10 mg orally once daily when bite-related itch warrants an antihistamine.