HEAD LICE TREATMENT
There are several options for getting rid of head lice, including creams and liquids, combing, and oral medicine (pills). It is important to follow directions carefully to be sure that the treatment works.
If you are sure that your child (over age two years) has head lice, you can use a nonprescription lice treatment (see 'Insecticides' below). Examine family members and close contacts at the same time and treat them if needed. If your child is under age two years, contact the child's doctor or nurse for treatment advice.
Insecticides — A topical insecticide (pediculicide) is a substance, usually a lotion or gel, that is applied to the scalp to kill lice. Available insecticides include:
●Permethrin (Nix, Rid)
●Pyrethrin (A-200, Pronto, Tisit)
●Malathion (Ovide, prescription required in the United States)
●Benzyl alcohol (Ulesfia, prescription required)
●Spinosad (Natroba, prescription required)
●Topical ivermectin (Sklice, prescription required)
Follow the manufacturer's instructions for applying the insecticide carefully. Typically, you wash the hair with shampoo, rinse it, and towel-dry it. Apply the insecticide cream or gel liberally to the scalp and leave on for 10 minutes before rinsing with water. Malathion (Ovide) should be left on the scalp for 8 to 12 hours or overnight. Malathion has a bad smell, which can be hard for some people to tolerate. Malathion is also flammable and should never be applied in close proximity to fire or electric heat sources (such as a lit cigarette, curling iron, or hair dryer).
A second treatment is needed with permethrin, pyrethrin, and benzyl alcohol 7 to 10 days after the first treatment. This is because some lice are able to survive the first treatment. A single application of malathion often is sufficient. However, malathion should be reapplied if live lice are seen seven to nine days after treatment. Treatment with spinosad should be repeated if live lice remain after seven days. Topical ivermectin is given as a single treatment; patients should consult with a healthcare provider before repeating treatment.
Wet-combing — Wet-combing is a way to remove lice from the hair with careful and repeated combing. It is a good option for treating very young children or if you want to avoid using insecticides. However, wet-combing is time consuming and must be repeated multiple times over a period of a few weeks.
Wet the hair and add a lubricant, such as hair conditioner or cream rinse, vinegar, or olive oil. See above for a description of how to wet-comb (see 'Head lice diagnosis' above). The combing session should take 15 to 30 minutes, depending how long and thick the hair is. Comb every three to four days for two weeks AFTER you find any large, adult lice.
Oral medicines — A medicine taken by mouth called ivermectin might be prescribed for people whose lice are resistant to topical insecticide treatment.
Other treatments — Studies have examined lotions and other materials (olive oil, butter, mayonnaise, petroleum jelly [Vaseline]) that are applied to the head, and then allowed to dry, with the goal of suffocating lice. However, lice are difficult to suffocate; wet-combing probably works as well and is less messy.
Lice treatments that use gasoline or kerosine are toxic and can lead to serious injury and should not be used.
We do not recommend any of these treatments.
PREVENTING HEAD LICE SPREAD