Understanding and treating scabies and head lice

Over the summer season, your child may head to a day camp or daycare center. Here’s what you need to know to protect your children from two common contagious bug infestations: head lice and scabies. People often confuse scabies and body lice bites because both conditions can cause intense itching and skin irritation.

The above image shows what lice on the scalp can look like compared to a scabies infestation. How do scabies and lice differ? While both are parasitic infestations, scabies is caused by microscopic mites burrowing into the skin, while lice are tiny insects infesting hair. Scabies and body lice bites are different because of how they feed. Scabies feed on fluids within the skin, while body lice feed on blood from the surface of the skin.

In this article, we’ll compare head lice infestations and scabies, comb through their distinct characteristics, and offer practical advice to prevent them from returning.

What are head lice?

Head lice infestations are most common among preschool and elementary school-age children and their family members and caregivers. According to the CDC, an estimated six million to 12 million head lice infestations occur yearly in the United States among children aged three to 11. Head lice do not cause disease, so it isn’t considered a public health threat.

Head lice, typically greyish-white and up to one-eighth of an inch long, begin as eggs or "nits" attached to hair near the scalp. After hatching, nymphs and adults feed on blood through the scalp, causing discomfort and itching, particularly at night.

Head lice vs body lice

Head lice are tiny insects that infest the scalp and hair, feeding on blood and laying eggs (nits) close to the scalp, while body lice infest clothing and bedding, only moving to the skin to feed on blood. Body lice lay their eggs (nits) in the seams of clothing.

How do you get head lice?

The most common way to get head lice is through head-to-head contact with a person who already has head lice. This type of contact is common among children playing at home or at daycare centers, preschools, and elementary schools. Per the CDC, some signs and symptoms of head lice may include:

Head lice are found almost exclusively living among hairs on the human head. Lice can survive short periods on hats, brushes, combs, pillows, or towels. However, they’ll die within 24 to 48 hours when they are away from their human host.

When exploring the differences between scabies and body lice bites, it's important to note that both cause intense itching and skin irritation, but there are differences in how they feed.

How to treat lice

Head lice infestations can be asymptomatic, with itching being the most common symptom due to an allergic reaction to louse bites, often appearing four to six weeks after the initial infestation. If signs of head lice are observed, seeking medical evaluation and treatment from a physician is advised.

How to help control and prevent the spread of head lice

Here's what you can do to get rid of and help prevent the spread of head lice:

• Use a fine-toothed comb, such as a nit comb (often found in lice medicine packages), to remove lice and some nits from the hair shaft. Many flea combs for cats and dogs are also effective for removing lice.
• Avoid head-to-head contact during play and other activities at home, school, daycare centers, and camp.
• Do not share clothing. This includes hats, scarves, coats, sports uniforms, hair ribbons, or barrettes.
• Do not share combs, brushes, or towels. Any combs or brushes used by an infested person can be disinfected by soaking them in hot water (at least 130°F) for five to 10 minutes.
• Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person.
• Machine-wash and dry clothing, bed linens, and other items an infested person wore or used during the two days before treatment using the hot water (130°F) laundry cycle and the high-heat drying cycle. Clothing and items that are not washable can be dry-cleaned or sealed in a plastic bag and stored for two weeks.
• Vacuum the floor and furniture, particularly where the infested person sat.
• Do not use fumigant sprays or fogs; they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin.
• Because lice infest people, a pest management professional cannot assist in dealing with lice.

What is scabies?

Scabies is an infestation of the skin caused by Sarcoptes scabiei var. hominis, the human itch mite. Not to be confused with bird mites or clover mites, adult scabies mites are less than half a millimeter long and look like tiny black dots on the skin.

Scabies bites typically appear as small, raised bumps or red, pimple-like rashes on the skin. These bites often occur in clusters, particularly in areas where the skin is thin or where the mites have burrowed. The itching associated with scabies bites is intense and worsens at night. Scabies treatment is typically necessary to effectively eliminate the infestation.

Female scabies mites burrow into the skin, laying 10 to 25 eggs and creating track-like burrows that are tiny, raised lines. After hatching, the larvae migrate to the skin's surface, where they mature and may spread to other areas or individuals.

In adults and older children, scabies mites are most often found:

• Between the fingers
• In the folds of the wrists, elbows, or knees
• In the armpits
• Around the waistline and navel
• On the breasts or genitals

In infants and very young children, scabies are most often found on the:

• Face
• Head
• Neck
• Palms of the hands
• Soles of the feet

How do you get scabies?

Scabies mites crawl from one person to another during direct, prolonged skin-to-skin contact — meaning you’re not likely to get scabies from a brief handshake or hug. Scabies may also come from sharing the clothing, towels, or bedding of an infested person.

People in institutions like nursing homes or childcare facilities are at risk for scabies. Scabies in kids can be particularly challenging due to their close skin-to-skin contact during play and activities. If your child comes home from daycare with scabies, notify the staff.

So, scabies vs lice, what’s the difference? Scabies is caused by the Sarcoptes scabiei mite, leading to intense itching and a rash in skin folds, while lice are small insects infesting the scalp or body hair, causing itching.

How to treat scabies

Talk to your doctor when you see signs and symptoms that may indicate scabies. Your doctor will examine your skin for scabies, determine the causes of these signs and symptoms, and prescribe the proper scabies treatment.

If a person has never had scabies, symptoms can take four to eight weeks to become apparent. Even if the infested person does not have symptoms yet, they can still spread scabies during this time. If you have had scabies before, symptoms appear much faster, typically one to four days after exposure. According to the CDC, common scabies symptoms are:

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  Intense itching that is usually worse at night

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  A pimple-like itchy rash, scales, or blisters

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  Open sores from scratching the rash

Effective scabies treatment typically involves applying topical medications a healthcare professional prescribes to eradicate the infestation. Doctors often recommend scabies treatment for all household members, even those without symptoms, at the same time.

How to help get rid of and control scabies

Scabies mites can live away from a human host for 72 hours. To get rid of scabies in your home or childcare center:

• Wash all clothing, bedding, and towels the affected person uses in hot water and dry them on high heat to kill any remaining mites.
• Place items that can’t be washed in a sealed plastic bag for seven days.

Recognizing the distinctions between scabies and lice infestations is essential for accurate diagnosis, effective treatment, and preventing their spread within communities.