Adult Head Lice Treatment (Pediculosis Capitis)
MD-only head lice evaluation and treatment by secure online video visit, $49 flat-fee, no insurance required.
Head lice are tiny insects that live on scalp hair and feed on small amounts of blood. They spread mainly through close head-to-head contact and are common in households with school-aged children, but adults can be affected as well. Symptoms may include scalp itching, a crawling sensation, or visible nits attached to hair shafts near the scalp. TeleDirectMD physicians evaluate whether your symptoms fit head lice, explain how to confirm lice versus dandruff or hair debris, and recommend evidence-based treatment and household steps. If there is eye involvement, severe skin infection, or the diagnosis is uncertain, in-person evaluation is required.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
- Adults 18+ only, video visits only
Last reviewed on January 21, 2026 by Parth Bhavsar, MD
Online MD-Only Head Lice Care
- Adults 18+ with suspected or confirmed head lice or nits
- Guidance on OTC and prescription options when appropriate
- Retreatment timing and nit-combing instructions
- Household contact guidance to prevent reinfestation
Adults 18+ only. TeleDirectMD does not prescribe controlled substances. Eyelash or eyebrow involvement, severe skin infection, or eye symptoms require urgent in-person evaluation.
What Is Head Lice?
Head lice, also called pediculosis capitis, are parasites that live on the scalp and hair. They lay eggs called nits that stick firmly to hair shafts, usually close to the scalp. Lice do not jump or fly. Spread is mainly through direct head-to-head contact and sometimes through shared items like hats, brushes, or hair accessories.
Many adults first notice itching, but itching is not required for diagnosis. The most reliable confirmation is seeing a live louse or finding nits that are strongly attached near the scalp. TeleDirectMD can help you confirm the diagnosis and choose the safest, most effective treatment plan for your situation.
Symptoms and Red Flags
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Visible live lice on scalp hair | Confirmed head lice | Yes, often | No |
| Nits firmly attached near scalp, especially behind ears or at nape of neck | Likely head lice eggs | Yes | No |
| Itching, crawling sensation, mild scalp irritation | Common symptoms | Yes | No |
| Honey-colored crusting, pus drainage, increasing scalp pain | Possible bacterial skin infection from scratching | No | Urgent evaluation |
| Swollen lymph nodes with fever | Possible infection | No | Urgent evaluation |
| Eyelash or eyebrow infestation | Needs careful in-person assessment | No | Urgent evaluation |
| Eye redness, eye pain, vision changes | Eye condition requiring urgent care | No | Emergency evaluation same day |
| Diagnosis unclear, only scalp flaking without nits or lice | Could be dandruff, dermatitis, or hair debris | Sometimes, triage | In-person if persistent or worsening |
Itching can persist for days after successful treatment due to skin irritation. New live lice after correct treatment may suggest reinfestation or resistance.
Differential Diagnosis
Not every itchy scalp is head lice. TeleDirectMD evaluates symptoms and what you are seeing on the hair to help distinguish lice from other common conditions.
Common Look-Alikes
- Dandruff or seborrheic dermatitis
- Hair product residue
- Psoriasis of the scalp
- Contact dermatitis from hair dye or shampoos
- Scabies, including scalp itch in some cases
Clues Supporting Head Lice
- Live lice seen moving on hair or scalp
- Nits firmly attached near the scalp, not easily brushed off
- Household exposure, especially children with confirmed lice
- Itch and irritation behind ears or at the back of the neck
Telehealth Eligibility
When a Video Visit Is Appropriate
- Adult 18+ with visible lice or typical nits near scalp
- Mild to moderate scalp itching without severe pain
- No fever or signs of skin infection
- No eye symptoms and no eyelash involvement
- Able to follow retreatment timing and household steps
Red Flags Requiring In-Person or ER Care
- Severe scalp pain, pus drainage, honey-colored crusting, rapidly worsening redness
- Fever or swollen lymph nodes with scalp infection signs
- Eyelash or eyebrow involvement
- Eye redness, eye pain, light sensitivity, vision changes
- Diagnosis uncertain after attempted confirmation
If any red-flag symptoms are present, seek urgent in-person or emergency care. TeleDirectMD is not an emergency service.
Treatment Options
Successful treatment depends on selecting an effective product, applying it correctly, and using correct retreatment timing when needed. Household measures reduce reinfestation. Not every plan requires deep cleaning of the home. Focus on items that had close head contact recently.
Core Steps That Improve Success
- Confirm the diagnosis if possible by identifying live lice or true nits
- Use the product exactly as directed, including contact time
- Comb wet hair with a fine-tooth nit comb to remove nits and reduce persistence
- Retreat on the correct schedule when the product requires it
- Treat close household contacts only if they have live lice or nits close to scalp, unless a clinician advises otherwise
Household and Environmental Measures
- Wash and dry bedding, hats, and clothing used in the previous 48 hours on hot settings when possible
- Soak combs and brushes in hot water
- Items that cannot be washed can be sealed for 2 weeks
- Vacuum upholstered furniture and car headrests if head contact occurred
TeleDirectMD uses guideline-based treatment selection. Prescription options may be considered if OTC therapy fails, if reinfestation is unlikely, or if the case is persistent.
Medication Options
| Medication | Dose | Duration | When used |
|---|---|---|---|
| Permethrin 1% lotion OTC | Apply to hair and scalp as directed, then rinse | Repeat 1 time in 7 days to 10 days | Common first-line OTC option when appropriate |
| Pyrethrins with piperonyl butoxide OTC | Apply as directed, then rinse | Repeat 1 time in 7 days to 10 days | Alternative OTC option in select cases |
| Ivermectin 0.5% lotion | Apply to dry hair as directed, then rinse | Single application in many cases | Prescription option, often used after OTC failure or when treatment resistance is suspected |
| Spinosad 0.9% suspension | Apply to dry hair and scalp as directed, then rinse | Single application in many cases | Prescription option that may be used for persistent cases |
| Malathion 0.5% lotion | Apply as directed, then rinse | Repeat only if instructed | Prescription option in select cases, flammable and requires strict safety handling |
Treatment choice depends on prior attempts, timing, local resistance patterns, and safety considerations. If you have scalp infection signs, in-person care is required before focusing on lice treatment alone.
Home Care and Return to Work
Many adults can continue normal activities once treatment starts, depending on workplace policies. The main goal is preventing spread and avoiding reinfestation.
- Avoid head-to-head contact until treatment has started and combing has been performed.
- Do not share hats, brushes, hair accessories, or pillows during the active period.
- Retreatment timing matters. Follow your plan exactly.
- Itch can persist temporarily even after lice are eliminated.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual care for adults using secure video visits to evaluate suspected head lice and recommend treatment when clinically appropriate. Visits are $49 flat-fee with no insurance required and are available in 25+ states. TeleDirectMD is not an emergency service. Eye symptoms, eyelash involvement, fever, or signs of skin infection require urgent in-person evaluation.
Adult Head Lice FAQs
Can TeleDirectMD treat head lice online?
Yes, for many adults 18+ with suspected or confirmed head lice and no red flags. Your MD reviews what you are seeing on the scalp and hair and provides an evidence-based treatment and household plan.
How can I confirm head lice at home?
The most reliable confirmation is seeing a live louse. Nits are tiny eggs that are firmly attached to hair shafts near the scalp and do not brush off easily like dandruff.
Do I need to treat everyone in the household?
Not always. Close contacts should be checked. Treatment is typically recommended for people with live lice or nits close to the scalp. Your plan may vary based on the household situation.
Do I need to deep clean the whole house?
Usually no. Focus on items that had close head contact in the previous 48 hours, such as bedding, hats, and hair accessories. Vacuuming upholstery and washing contact items is typically sufficient.
Why is retreatment sometimes needed?
Some products do not kill all eggs. Retreatment targets newly hatched lice before they can lay more eggs. The timing depends on the product used.
Is nit combing required?
Combing improves success because it removes nits and can reduce persistence and confusion about reinfestation. A fine-tooth comb used on wet, conditioned hair is often most effective.
Why am I still itching after treatment?
Itching can persist for days after successful treatment due to scalp irritation. New live lice after correct treatment may indicate reinfestation or resistance.
When should I use a prescription treatment?
Prescription options may be considered if OTC treatment fails despite correct use, reinfestation is unlikely, or lice resistance is suspected. Your MD will review prior treatments and choose an appropriate option.
When do I need urgent in-person care?
Seek urgent care for eyelash or eyebrow involvement, eye symptoms, fever, severe scalp pain, pus drainage, honey-colored crusting, or rapidly worsening redness.
What makes TeleDirectMD different for head lice care?
TeleDirectMD provides MD-only video visits for adults at a $49 flat fee in 25+ states. We focus on accurate diagnosis, correct retreatment timing, practical household guidance, and clear escalation steps.
Seeing nits or lice in your household?
$49 flat fee. Adult-only video visits. MD-only care. Evidence-based treatment plans with retreatment timing and household guidance to prevent reinfestation.