Nits or Dandruff: How to tell the difference

Different signs and symptoms of head lice vs dandruff?

Itching is a characteristic symptom of both head lice and dandruff.  However, there are other signs and symptoms of head lice that can help you differentiate nits versus dandruff.

Head lice symptoms include:

• - A tickly feeling or moving sensation on the head – caused by the movement of the head lice⁴
• - Finding head lice and nits in the hair (usually close to the scalp behind the ears, near the temples and nape of the neck)
• - Peppery pillow or scalp – a pepper like dust may be found and is caused by louse droppings.
• - Small red bumps or sores – these sores may be caused by an excessive allergic reaction to head lice bites¹
• - Oozing crusty sores – Excessive scratching can lead to a bacterial infection which causes oozing, crusty sores to develop.
• - Swollen lymph nodes (glands) on the back or front of the neck and fever which may indicate a bacterial infection1
• - Difficulty sleeping – loss of sleep can occur due to relentless itching ¹
• - Irritability – usually due to the annoyance of itching or loss of sleep1
• - Anxiety – some people feel very anxious or stressed due to the stigma associated with head lice¹

Dandruff symptoms include:

• - An itchy scalp
• - Flaky skin that is either very oily or very dry
• - White or yellowish flakes on clothes
• - Red patches on the scalp
• - Symptoms that worsen with stress or in the winter and dry weather

What causes nits and dandruff?

Although nits and dandruff are common conditions to affect the scalp, the causes of each condition are completely different, and neither are caused by a lack of personal hygiene.²

Nits are eggs laid by parasitic insects the spread from person to person through close contact.¹There is also a small chance of catching head lice and nits from another infected persons clothing, bedding, hairbrushes, and other personal items.⁶

Unlike head lice and nits, dandruff is not contagious.⁵ We are still learning more about what causes dandruff despite it being a very common condition, but what we know so far is that dandruff can be caused by:

1. Seborrheic dermatitis – a skin condition which usually affect areas that are rich in sebaceous glands (scalp, ears, eyebrows, face, and chest). Cradle cap is a type of dandruff common in newborns.⁵
2. Malassezia yeasts – a fungus which can irritate our scalp causing it to excessively shed skin³
3. Ringworm – a fungal infection known also known as tinea capitis can exacerbate dandruff and result in a red or silver rash on scalp, sometimes with patchy hair loss
4. Genetic factors – dandruff tends to run in families
    

How do you diagnose head lice versus dandruff?

It is not easy to base the diagnosis of head lice or dandruff by the symptom of itchiness alone, as some people with these conditions do not experience itchiness and some do not have any symptoms at all. Without the itchy symptom these conditions can sometimes go undiagnosed.

The key method to diagnose head lice vs. dandruff is a scalp examination where a living, moving head louse is found.  If a nit is found, this does not always mean there is an active infestation of head lice.⁷ This is why treatment is not recommended for head lice until a louse is found.

Sometimes dandruff flakes can be confused as nits, and vice versa.  The way to tell the difference between nits and dandruff is that dandruff is much more easily removed from the hair, whereas nits are glued to the hair shaft.  If you can remove the white speck easily then it is dry skin (dandruff), if not, it could be a nit.

Dandruff and head lice treatment

The treatment for these two conditions is very different, hence it is important to correctly diagnose.  

If you have found a living louse moving about your child’s head, then don't panic. There are simple steps you can follow if you find your child has head lice. You can also use the following treatments:

1. Insecticide treatments (available in your pharmacy only) kill head lice and eggs by chemical means⁴
2. Non-insecticide treatments, which are widely available over the counter in pharmacies and supermarkets, eliminate head lice and eggs by physical means such as suffocation or dehydration⁴
3. Wet detection combing – the physical removal of head lice and eggs by methodically combing the hair with fine-tooth comb (nit comb)⁴

If there are no bugs crawling about your head but an excessive amount of dry skin on the scalp and your clothes, then the following treatments can be used to manage the presence of dandruff:

1. Anti-dandruff shampoos containing ingredients like zinc pyrithione, salicylic acid or selenium sulphide (widely available in supermarkets and pharmacies⁵
2. Coal tar preparations (ask your local pharmacist) ⁵
3. Ketoconazole shampoo (ask your local pharmacist)⁵

If you need help examining the scalp for head lice or dandruff, you could visit your local pharmacy for more advice.

Important differences between nits and dandruff

1. Cause – nits are caused by parasitic insects called head lice and dandruff can be caused by yeast, fungal infections, and dry skin conditions like seborrheic dermatitis.
2. Location – dandruff can be present anywhere or the scalp whereas head lice like the lay their eggs (nits) at the nape of the neck, behind the ears and near the temples where it is warmer⁸
3. Appearance – nits are attached directly to the hair (live eggs within 1cm of scalp, hatched eggs after 1cm), whereas dandruff flakes are not attached to the hair and can easily be removed
4. Who is affected – dandruff usually starts in adolescents, head lice and nits tend to affect school-aged children
5. Contagion – head lice and nits are contagious, dandruff is not contagious

There can be a stigma around having head lice or dandruff, yet neither of these conditions are dangerous.  Although both these conditions can be perceived as a nuisance, there are over-the-counter treatments that can help you manage both.