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A 13-year-old female came to us with the complaint of severe itching in her scalp, low-grade fever, loss of weight, and enlarged occipital lymph node. The patient was having very severe infestations of lice in her scalp. The patient was very anxious and irritated because of her itching. We excluded all the options for sexual, mental, and physical abuse by having proper examination and history taking in the absence of any guardian after taking permission from guardians. The patient was having lice and nits only on her scalp, other parts of body hairs were spared from the lice infestations. The patient was maintaining proper hygiene and belongs to an upper socioeconomic family. Along with this patient’s mother informed us about her diagnosis of atopic dermatitis. The patient has been diagnosed with atopic dermatitis since she was at the age of 3. Lice infestation is a very common problem in low socio-economic societies and generally, it is considered the person who has the lice infestations must be unhygienic, in reality, it has been seen very often in very neat and clean people. Very severe lice infestations depend on many factors not only in neglected, homeless, or nonhygienic people, it depends on sebum production, many skin diseases e.g. hyperhidrosis, etc