Dr Tom Smith 

Doctor, doctor: I fear outbreak of nits at my daughter’s school

She has eczema – could treatment for lice make it worse? Dr Tom Smith has the answer
  
  

Itchy red head, Doctor Doctor, 26 March
How does one get rid of nits without further irritating an already itchy scalp? Photograph: Aaron Tilley for the Guardian Photograph: Aaron Tilley for the Guardian

My four-year-old red-headed, fair-skinned daughter has a dry itchy scalp and eczema on her wrists. I fear an outbreak of nits at her school because I'm told over-the-counter treatments contain abrasive chemicals that could make the condition worse. Are tea tree oil conditioner and a nit comb an alternative? Or can you recommend other treatments that won't irritate her scalp?
You write that you "fear" nits at her school. I assume, therefore, that she doesn't have head lice herself and there are no nits in her hair. Don't worry unless you actually see them. If she does get infected, it would be best to discuss it with a doctor, who will prescribe an anti-louse therapy that is suitable for a child with eczema. Although I haven't come across any bad reactions to routine anti-louse treatments, even when there is a pre-existing skin disorder, if the skin is broken, it is worth asking for advice. I don't know of definitive evidence that tea-tree oil kills lice and nits.

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