Lice and dandruff. An itchy scalp and white specks in your hair can signify either of these conditions. Lice are easy to confuse with dandruff, and while both are usually treatable at home, distinguishing one from the other is essential to choose the right treatment. Every year, 6 to 12 million people in the United States get head lice, most of whom are children ages 3 to 12 years old.
Dandruff, also known as seborrheic dermatitis, is a chronic skin condition that causes the top layer of skin to shed too quickly. This shedding produces a dry, flaky, itchy scalp. People with dandruff may also notice flakes of skin on their clothes. Some types of dandruff are caused by yeast, which tend to be particularly itchy.
Symptoms of dandruff include:
Some people with dandruff notice temporary hair loss, but hair loss is more typical of other conditions.
Some people with dandruff develop seborrheic dermatitis on other areas of their body. When this happens, a person might notice flaking or scaly skin on the face, chest, neck, or ears. These areas may be dry, red, and painful or itchy. Most people, however, experience a mild form of dandruff only on the scalp.
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Dandruff often responds well to over-the-counter (OTC) anti-dandruff shampoos. People can purchase these shampoos in drugstores or online. African-Americans tend to have drier hair and scalps, so they may be better off shampooing with anti-dandruff shampoo only once per week. People with light-colored hair should avoid shampoos with coal tar since this can change hair color.
Some people find that their dandruff does not get better with an anti-dandruff shampoo. If symptoms do not improve, the flakes may be due to a yeast infection on the scalp, an autoimmune condition, eczema, or a severe case of dandruff. A dermatologist can help someone identify the underlying cause, as well as any triggers. Some people may need prescription anti-dandruff shampoos.
Dandruff is common and difficult to prevent. Regularly washing the hair reduces dandruff in some people, but lack of hygiene does not cause dandruff. People with dandruff can try to identify triggers, such as cold or dry air. People with particularly dry scalps sometimes get relief from sleeping with a humidifier. A proven dandruff shampoo will help soothe the symptoms of dandruff, while helping to neutralize the cause and washing away any flakes. For best effect, use your dandruff shampoo every time you wash your hair. Dandruff is a chronic condition which will come back if untreated.
Look for shampoos with coal tar, salicylic acid, ketoconazole, or selenium sulfide.
Lice are parasites that live on the scalp and eat human blood. Lice can cause intense itching. Head lice do not spread diseases, but they are highly contagious. Close contact with the head or hair of a person with lice - such as from sharing hairbrushes or giving hugs - can spread the infestation. Young children often hug or touch each other, and so head lice are more common in kids than adults and families with kids. Head lice are tiny insects that live on the skin covering the top of your head (scalp). Head lice infect the scalp and hair and can be seen at the nape of the neck and over the ears.
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Lice are much more common among children and people in close contact with children, such as teachers, parents, daycare workers, and babysitters. Signs and symptoms of lice include:
A range of insecticidal shampoos can kill lice, sometimes with just one treatment. It is also vital to comb nits out of the hair. People should follow the procedure on the shampoo packaging. Over-the-counter (OTC) lice remedies work well, but some lice are resistant to these medicines. So if the first treatment does not work, a person may want to see a doctor for an alternative prescription remedy. Lice remedies are available at pharmacies and online. Head lice cannot live for long without a host. Washing items that make it easy for lice to hop back onto a person can reduce the spread of these bugs.
To prevent lice, avoid close contact with people at high risk of lice, especially very young children. Avoid sharing combs, brushes, pillows, and other items where lice may hide. If a person in the family has lice, treat them and other family members for lice.
When treating head lice, wash all clothes and bed linens in hot water with detergent.
Treatment for head lice can come in the form of medicated shampoos. Shampoos containing permethrin and pyrethrin kill lice and nits and are recommended for adults and children over 2 years of age. You may have to wash your hair with the medicated shampoo again after 7 to 10 days to ensure that all the lice are dead.
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To apply treatment, you should:
It is often advised to continue treatment until all the lice and nits are gone. Depending on your medication, a follow-up treatment is recommended about 7 to 9 days after the first treatment or if you see crawling lice.
You may require over-the-counter (OTC) or prescription medication. These medications include:
Nonmedical remedies can be used in addition to medicated shampoos to help prevent head lice from spreading. A lice infestation requires a little more work around the house to make sure that all of the tiny insects and their eggs are destroyed. Wash clothing, towels, and bedding in very hot water and dry them on a high heat setting. Vacuum upholstered furniture and carpeting, and bag up stuffed animals and other toys for at least 3 days and up to 2 weeks. Any remaining lice will die without food.
Head lice hatch every seven to ten days, with a total life cycle of about four weeks. Any treatment, therefore, needs to take this into account.
While they share certain similarities - an itchy scalp being the most obvious - there are key differences that distinguish head lice from dandruff.
The major difference between these two conditions is their cause. Head lice are small parasitic creatures that feed off human blood. Saliva secreted by lice irritates the scalp, and is the cause of the itchiness and sores that characterize a lice infestation. Dandruff, on the other hand, is caused by sensitivity to oleic acid. This acid is a by-product of the malassezia microbe, which we all have on our scalps. Not everyone is sensitive to oleic acid, but in some cases it can cause irritation, itching, and flakes. Lice is a contagious condition caused by a parasite, while dandruff is a skin condition that can’t be passed from person to person.
While there are similarities, it’s not that hard to spot differences in the way dandruff and head lice look: The white flakes caused by dandruff are excess skin flakes, and as such will not be attached directly to the hair - by contrast, teardrop-shaped lice eggs are directly adhered to the follicle, often very close to the scalp. Adult head lice can actually be spotted, although it’s a bit difficult. Use a head lice comb on wet hair under good lighting for the best effect.
Because malassezia is distributed across the entire scalp, dandruff is not a localized problem: flaky dandruff patches can be found all over the scalp. By contrast, head lice have definite preferences for their home. They’ll usually be found behind the ears and on back of the neck, both areas where they like to lay their eggs. Head lice symptoms are usually focused on these areas as well. While dandruff is visible on the scalp, lice lay eggs on hair, not the scalp. Lice infect the scalp and hair and can be seen at the nape of the neck and over the ears.
Most of the time, lice are killed with the proper treatment. Some people will develop a skin infection from scratching. Contact your provider if:
