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Phantom Lice: Alternative Issues that Can Cause Itching

It’s easy to panic the first time you see your child come home from school and scratch their head, even if only for a moment, but especially if it becomes a more common occurrence. Fears of lice, and more recently of the storied “superlice,” make us anxious about the long road ahead: nit removal, laundry, and worries about the bug spreading to others in their class―or even at home!

However, don’t worry just yet. A lice infestation can be confirmed through a wet combing test, developed by Dr. Dale Pearson, that seeks to pull nits and eggs to the surface. If you find any, you’re dealing with a lice infestation. But what if you don’t? There are a number of other reasons why that scratching could be happening. Here, we’ll explore several, along with some remedies that can help keep the itching to a minimum.

Dandruff or Dry Skin

Dandruff or dry skin, paired with persistent scratching, cause the most alarm and comparisons to lice because itchiness is paired with particles that fall from the head, but they’re not lice. What you’re seeing is dry skin being dislodged from the scalp. Dandruff is a symptom of a condition called seborrheic dermatitis, also called seborrhea. Mild cases can be treated with over the counter medicated shampoos, while more persistent or severe cases may require a prescription shampoo or creams containing steroids.



Eczema refers to a group of conditions, all which present with itchiness, dryness, and occasionally redness and bumps or sores. Most often, eczema is used to describe a condition called atopic dermatitis; this condition prevents the “skin barrier” from properly holding the skin together, causing it to crack and fall away.

While it can present on the scalp, it can also show up anywhere on the body. It is especially common on hands and in “bending areas” like the backs of knees or elbows. As with dandruff, steroid creams can be used to reduce symptoms. Additionally, many find it can be triggered by stress, so finding ways to manage stress can reduce the severity and frequency of flare-ups.


Perhaps the most severe cause of scalp itch, psoriasis is a chronic disease of the immune system that leads to cracked skin, dry patches, and occasional bleeding if the dryness gets too bad. It is caused by an autoimmune response that triggers excessive skin cell growth, and causes a sort of skin flaking that can be mistaken for dandruff or even lice. Doctors can prescribe a number of creams or medicated shampoos to help deal with the symptoms of psoriasis, containing salicylic acid or corticosteroids. Supplements of vitamin A and D can also be prescribed to help deal with the itchiness and flaking. And, in extreme cases, UV lighting can be used as an in-office treatment to ease the symptoms. 


Often seen as a pre-pubescent affliction caught by being barefoot, ringworm is another possible culprit for your itchy scalp. Contrary to popular belief, it knows no age limit and can be caught at any time in fashions not unlike lice: sharing of hairbrushes, clothing, or even pillows can spread it. It can also be caught in soil (be careful while gardening) and through animals (ensure that your pets are medicated to combat it!).

It can be treated with anti-fungal shampoos, just like dandruff or eczema, but there are also prescription oral medications that can speed up its course. If you have pets and contract ringworm, be sure to get them checked as well. If they have it, they may pass it to you again, so it’s best to ensure that the whole home is threat-free.


Scalp Buildup

After mentioning several somewhat serious causes of itchiness, it’s likely also worth noting one more innocuous one: product buildup. If you’re not washing your hair often enough, or not exfoliating the scalp properly when you do, buildup accumulates on the scalp. Composed of dried sweat, dead skin, and even remnants of hair product, the scalp will start to itch as a sign to remove it. Clarifying shampoos are a quick fix for this problem, as can deliberate attempts to exfoliate the scalp lightly with fingernails or a brush when washing.

The next time your child arrives home with a bit of an itchy head, keep in mind that lice may not be the culprit. Consider the environment of the classroom, as well as pre-existing conditions, and check the scalp for lice before starting a round of treatment. Be ready for the possibility of managing nits, but also thoroughly investigate the possibility that an itchy scalp is something else entirely.

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