White Spots on the Hair: Does This Woman Have Head Lice?

Authors:
Karlyn Pollack, BS, and Barbara B. Wilson, MD

Citation:
Pollack K, Wilson BB. White spots on the hair: does this woman have head lice? Consultant. 2018;58(5):e170.

An otherwise healthy 26-year-old woman presented for evaluation of her hair. A few weeks earlier, she had noticed some white spots along her hair shafts and was concerned that she might have a head lice infestation. She denied having scalp pruritus and denied having problems with hair loss or breakage.

On physical examination, the patient was a healthy-appearing white woman with long blond hair. Her scalp appeared normal, without redness or scaling. There was no evidence of alopecia or hair fragility on gentle hair pull. No head lice were noted. On the bilateral posterior aspects of her scalp, numerous white, reflective bands, 2 to 3 mm in length, were distributed along the hair shafts. The bands were distributed primarily on the distal two-thirds of the hair and were firmly adherent to the hair shaft (Figure 1).

A few hairs were snipped off and examined under the microscope, the results of which are shown in Figure 2 (magnification ×10).