Head lice: how to get rid of them, step by step

• Itching on the scalp, often behind the ears and at the back of the neck
• A tickling feeling, like something moving in the hair
• Tiny tan or brown bugs, about the size of a sesame seed
• Small eggs (nits) glued to hairs close to the scalp
• Sores from scratching

Nits stick tightly to the hair and do not brush off like dandruff. The first time a person has lice, the itching can take 4 to 6 weeks to start.

Lice spread mostly through head-to-head contact. Less often, they spread through shared hats, combs, brushes, towels or bedding. They crawl. They cannot hop or fly, and pets do not spread them. Getting lice has nothing to do with being clean.

• Use a lice medicine from the store, like permethrin 1% lotion. Follow the box exactly, including how long to leave it on.
• Do not use conditioner, or a shampoo with conditioner, before the medicine. Do not wash the hair again for 1 to 2 days after.
• Comb out lice and nits with a fine-toothed nit comb. Check and comb every 2 to 3 days for 2 to 3 weeks.
• Permethrin does not kill all the eggs, so treat a second time about 9 days later.
• Check everyone in the home. Treat everyone who has lice on the same day.

A few lice may still move slowly 8 to 12 hours after treatment. That is normal, so keep combing. If they are as active as before, the medicine may not be working. Talk with a doctor before treating again. Also ask a doctor before treating a young child.

• Wash clothes, bedding and towels used in the 2 days before treatment in hot water, then dry them on high heat.
• Seal things you cannot wash in a plastic bag for 2 weeks.
• Soak combs and brushes in hot water for 5 to 10 minutes.
• Vacuum floors and furniture where the person sat or lay.
• Do not use bug sprays or foggers. They are not needed and can be harmful.

Children do not need to leave school early. They can be treated at home and go back once treatment has started. Check your school's rules, since some schools ask for treatment first.

• Pus, honey-colored crusts, or redness and swelling that spread on the scalp or behind the ears
• Swollen, tender glands (lymph nodes) with a fever
• Lice or nits on the eyelashes or eyebrows. Do not use lice medicine near the eyes.
• A scalp rash or sores that do not look like lice
• Lice medicine from the store was used the right way and did not work

If you are in Virginia or West Virginia, you can start a visit online at any time. It is for adults and children 4 and older (with a parent or legal guardian) with a typical case of head lice. A clear, close-up photo of the hair near the scalp helps.

A board-certified physician reviews your answers and photos. The plan is usually permethrin 1% from the store, plus wet-combing and steps for the home. If a prescription is right for you, the doctor can send it to your pharmacy. If you need to be seen in person, the doctor will tell you.

It is not for anyone with the in-person reasons above, or with a weak immune system.

Visits start at $59. You see the price before you pay, and you do not need insurance.