Head Lice

  • Medical Author:

    Dr. Eddie Hooker is currently an Assistant Professor in the Department of Health Services Administration at Xavier University in Cincinnati, Ohio. He is also an Associate Clinical Professor in the Department of Emergency Medicine at the University of Louisville and at Wright State University. His areas of expertise include emergency medicine, epidemiology, health-services management, and public health.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuideLice & Nits: How to Get Rid of Head Lice

Lice & Nits: How to Get Rid of Head Lice

What OTC medications are available to treat head lice?

Many head lice medicines are available at drugstores. Each OTC product usually contains one of the following active ingredients:

  1. Pyrethrins (often combined with piperonyl butoxide, in brand name products: A-200, Pronto, R&C, RID, Triple X): Pyrethrins are natural extracts from the chrysanthemum flower. Though safe and effective, pyrethrins are not ovicidal (egg-killing) and can only kill crawling lice, not unhatched nits. It is applied to dry hair and allowed to remain for 10 minutes but no longer. After 10 minutes, the hair should be brought to a lather with warm water and then rinsed clear. Finally, towel dry (no hair dryer). A second treatment is recommended in seven to 10 days to kill any newly hatched lice. Treatment failures are common due to, in part, the development of resistance. They should not be used in people allergic to chrysanthemum or ragweed. Pyrethrins are approved for use on individuals 2 years of age or older.
  2. Permethrins 1% (NIX): Permethrins are similar to natural pyrethrins. Permethrins were introduced in 1986 and are safe and effective and may continue to kill newly hatched eggs for several days after treatment. The person should first wash their hair using a shampoo without a conditioner and towel dry the hair until it is still damp but not soaking wet. Apply the NIX to the damp hair and scalp. Make sure to get behind the ears and neck. Leave NIX in hair for 10 minutes but no longer. Rinse hair completely and towel dry. A second treatment may be needed in seven to 10 days to kill any newly hatched lice. Treatment failures are common, but NIX can be used on children as young as 2 months of age.
  3. Dimethicones (LiceMD, silicone oils, Hedrin, NYDA): Dimethicones are a type of silicone oil. These products are believed to work by coating surfaces and acting as a physical barrier that asphyxiates the louse. Unfortunately, there has been very limited research on their effectiveness. Nevertheless, some limited studies have shown moderately good rates of killing the lice. These dimethicones are biologically inert and are considered non-toxic in humans.
  4. Other agents: There are a number of other agents that have been used to treat lice. Some agents mix coconut oil and tea tree oil with permethrins or pyrethrins. It is not clear if these agents work alone or only in combination with other pediculocides. Other home remedies include using olive oil, mayonnaise, and even vinegar. However, there are no studies proving their efficacy.
Reviewed on 1/20/2017
References
REFERENCES:

American Academy of Pediatrics. "Pediculosis Capitis (Head Lice)." Red Book, 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.

Chosidow, O. "Oral Ivermectin Versus Malathion Lotion for Difficult-to-Treat Head Lice." New England Journal of Medicine 362 Mar. 2010: 896-905.

Devore, C.D., G. Schutze, J. Okamoto, M. Allison, R. Ancona, E. Attisha, and M. Minier. "Head lice." Pediatrics 135.5 (2015): e1355-e1365.

Feldmeier, H. "Treatment of pediculosis capitis: a critical appraisal of the current literature." American Journal of Clinical Dermatology 15.5 (2014): 401-412.

United States. Centers for Disease Control and Prevention. "Head Lice." Dec. 28, 2016. <https://www.cdc.gov/parasites/lice/head/>.

IMAGES:

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4."Male human head louse" by Gilles San Martin

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6."Bugbuster" by Thanks for the polite permission of the Community Hygiene Concern, Joanna Ibarra

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