What’s Bugging You? Lice Identification and Treatment

baboon grooming another closeup isolated on blackDuring a jail intake for a homeless man brought in for vagrancy, a nurse sees some tiny insects flying about his clothing and he is scratching at them as she interviews him. She is concerned that an infestation may result and initiates a protocol for lice which involves shampooing and showering with the insecticide permethrin and a special laundering process for all clothing. Was this the right action?

Correctional nurses need to be aware of various infestations as a high percentage of inmates in some locales are prone to head, body, and pubic lice. Once these little hitchhikers enter a facility they can spread by direct physical contact or through sharing of personal items like clothing, bedding, or towels. Was this patient infected with lice? Let’s look at some information about these little critters.

Do lice fly?

Lice remain on a person’s hair or clothing and wander to the skin to blood feed once or more often each day. They have tiny straw-like mouthparts – similar to those of mosquitoes – that they use to suck blood from skin capillaries. They’re unable to burrow into the skin. Lice never develop wings, so they cannot fly.  They’re also incapable of jumping. So, this patient did not have lice.

Lice cause itching

Lice may cause an allergic reaction that can cause itching. For head lice, the itching tends to be mild and temporary.  Body lice tend to cause far more itching, and even make the infested person feel ‘lousy’. Public lice tend to cause much itching in the affected area.  This patient’s itching may be caused by the insect in question but further investigation is needed.

Lice are not very common

Lice are not nearly as prevalent as is generally believed, and other creatures and objects on a person are frequently mistaken for lice.  Other insects include fleas, ticks, mites and bedbugs. None of these insects have wings, though. The homeless man in our case may merely have gnats or fruit flies about his person.

Lice are relatively tiny – as small as a poppy seed and as large as a sesame seed. A screener must have good eyesight, be close enough to see the creature, use a magnifying lens, and some expertise to identify lice; distinguishing them from other insects. In fact, other kinds of insects and even bits of debris are frequently mistaken to be lice. As in this case, misdiagnosis and unnecessary treatment can be frequent.

When in doubt – don’t treat

Treating everyone who enters a facility is not a good idea; nor is it cost effective. Treatment focused just on those infested is consistent with sound medical practice.  It can also dramatically save time and precious funds; while reducing the risk of lawsuit. The standard medications used in prisons for delousing contain the insecticides permethrin and pyrethrins. These have become less effective as resistance is becoming widespread.

When positive lice identification is confirmed, treatment can be ordered as follows:

  • Head lice can be treated with one or two 10-minute applications of a pediculicide.
  • Body lice usually require no treatment to the person. Instead, a person with body lice should bathe and change into prison-issued clothing. The infested clothing should be disinsected by proper laundering, or disposed of.  If body lice are detected on the body hairs of a person, a full-body treatment with a pediculicide is needed.
  • Pubic lice would necessitate treatment to the affected area only.

Ongoing prevention measures for lice include frequent (at least weekly) laundering of clothing and linens, and early recognition and treatment of genuine infestations.  The Federal Bureau of Prisons Lice and Scabies Protocol of March 2011 recommends the following actions:

  • Be sure laundry temperatures are set to at least 130 degrees Fahrenheit to kill lice and their eggs on linens and clothing. Use a hot cycle for drying, as well.
  • Educate inmates about lice and how to get treatment if they observe lice. The FBOP Protocol includes inmate education handouts that might be helpful.
  • Inmates should not be transferred to other facilities until 24 hours after initiation of treatment.  If moved before the 2nd treatment application (7 days), communication and continuation of treatment should be provided.

How are you managing lice, bedbugs, fleas, and ticks in your facility? Share your thoughts in the comments section of this post.

Photo Credit: © Sascha Burkard – Fotolia.com


  1. says

    Great thought-provoking column. Note that the identification and treatment problems are not restricted to lice. Personnel in jails and prisons – as well as in schools, businesses and health care facilities – frequently err when they find what they believe is evidence of infestations by bed bugs, scabies mites and yet other pests. Quite often, the conclusions are merely subjective – and incorrect. Ideally, one would objectively confirm the condition by properly identifying the actual pest or by basing the conclusion on clinically and epidemiologically relevant findings. Performing due diligence in these cases benefits the patient, and it can save considerable costs and time to prison personnel. It also can reduce risks of litigation by ensuring that evidence-based practices are followed.

  2. says

    Great information. I own a professional head lice removal and resource center in Olathe, KS. I work to provide a safe treatment option, but also am passionate about educating the community.I find that many healthcare professionals have trouble identifying head lice. Identifying the insect is key. Understanding the life cycle is helpful, along with know what the insect looks like during all stages of the life cycle.When dealing with head lice proper combing and removal of nits(eggs)is important to get past the infestation quickly. Knowing what you are looking for is the most important to make a proper diagnosis and make treatments effective when following evidence based practices.

  3. Bridget says

    That sounds very scary and disgusting. As a nursing student I am not sure what type of nurse would I’d like to become. I have thought about becoming a correctional nurse but not set in stone as of yet. This article is interesting and gives an idea of what is to come.

    • Lorry Schoenly says

      Hi, Bridget: I hope you continue to consider correctional nursing in your future. There are probably scary and disgusting moments in most nursing practices, but there are also many rewarding ones. You can make a real difference in the lives of others in our specialty.

  4. Dorothy Laughlin says

    What are the small things that look like fruit flies but leave eggs that look like lice eggs? How can I get a response to this question?

    • Lorry Schoenly says

      Hi, Dorothy: Thanks for this question. I don’t have an answer but will forward it to an entomologist colleague and copy you on the email. He may be able to help. I’m guessing he will ask for picture, though. Lorry

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