Pediculosis capitis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Searching for lice in hair

An infestation is diagnosed by looking closely through the hair and scalp for nits, nymphs, or adults. Finding a nymph or adult may be difficult; there are usually few of them and they can move quickly from searching fingers. If crawling lice are not seen, finding nits within a 1/4 inch of the scalp confirms that a person is infested and should be treated.

Physical Examination

If you only find nits more than 1/4 inch from the scalp (and don't see a nymph or adult louse), the infestation is probably an old one and does not need to be treated. If you are not sure if a person has head lice, the diagnosis should be made by your health care provider, school nurse, or a professional from the local health department or agricultural extension service.

Scalp

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

Trunk

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

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  Pediculosis capitis. With permission from Dermatology Atlas.

Nit drawing

A: Head Lice: Nit

Nits are head lice eggs. They are hard to see and are often confused for dandruff or hair spray droplets. Nits are laid by the adult female and are cemented at the base of the hair shaft nearest the scalp. They are 0.8 mm by 0.3 mm, oval and usually yellow to white. Nits take about 1 week to hatch (range 6 to 9 days). Viable eggs are usually located within 6 mm of the scalp.

Adult female louse

B: Head Lice: Adult female louse

The adult louse is about the size of a sesame seed, has 6 legs (each with claws), and is tan to grayish-white. In persons with dark hair, the adult louse will appear darker. Females lay up to 8 nits per day. Females are usually larger than males.