Take Care with Head Lice Treatments
Head lice have tormented
humans for thousands of years. These little bugs live on the scalp
and feed on blood. Their eggs, called “nits”, attach to hair. The
most common victims are children from about three to twelve years
old. They affect all income and social classes.
Lice don’t cause illness,
but they do cause itching – a lot of itching. Scratching that itch
can break the skin and cause an infection.
Lice on the scalp can jump
from one head to another close-by head. Then, the cycle of
infestation, egg-laying, and itching starts on someone else. That’s
why children are sent home from school if they have active lice
infestations. Otherwise, the lice can move from child to child.
Diagnosis of lice is not
complicated. Often the tiny lice can be seen on the scalp. That is
enough to diagnose an active lice infestation. These lice must be
removed and/or treated in some way. Otherwise, they will continue to
cause itching. And, they will continue to lay eggs.
Lice jump around. But
their eggs, or nits, attach firmly to strands of hair. The hard nits
have tiny pores. These allow air to enter until the new lice hatch
in several days. A nit attached to the hair at scalp level is likely
alive. It must be treated and/or removed so it doesn’t hatch. Once
the nit has grown away from the scalp, the louse probably has
already hatched. In that case, no treatment may be needed.
Treatment of head lice
involves removing lice and nits, then treating with some type of
lice medicine. (Lice medicines are called “pediculicides”, because
the Latin name for head lice is Pediculosis humanus var.
Combing the hair with a
very fine-toothed comb removes some lice and also removes nits from
the hair strands. This is an important but tedious process, because
every hair needs to be combed. Occasionally, this is enough to stop
Most often, treatment with
a chemical pediculicide also is needed. The first treatment is used
to kill active lice. The treatment must be repeated if all the lice
don’t die with the first treatment. Additional treatment may be
needed in about seven to nine days to kill lice that hatch from
Choosing a pediculicide is
tricky. From time to time, lice develop resistance to particular
chemicals. A treatment that works for a while may become ineffective
over time as the lice adapt. If your child has lice, consult your
pediatrician or the school nurse about the best treatments. If one
type of treatment doesn’t work, ask about the next treatment to try.
Using the same treatment again might not work.
Here are some of the
common treatments. Note that any of them might cause skin
irritation. If they get into the eyes, they can irritate the eyes,
piperonyl butoxide. This combination of substances can be
bought without a prescription. Pyrethrin is a pesticide based on
chrysanthemums. Piperonyl butoxide is added to help the
pyrethrin work for a longer time. This treatment kills live lice
but not nits. The product must be applied more than once, first
to kill the existing lice and then to kill newly-hatched lice.
There are several brands, including A-200®, Clear®, Pronto®, and
This is like pyrethrin, but is synthetic. Permethrin is approved
for use on infants older than two months and in pregnant women.
Products with 1 percent permethrin are available without a
prescription; one brand name is Nix®. A stronger product is
available by prescription; it is approved to treat scabies but
some physicians prescribe it for lice.
pesticide kills live lice and some of their eggs. It is a
prescription medicine that can be used on children aged six and
over. A brand name is Ovide®.
This lotion suffocates lice but not their eggs. It is available
by prescription and can be used on children as young as six
months. The brand name is Ulesfia®.
Spinosad is a
bacterial ingredient found in a lotion called Natroba®. This is
different from other lice medicines in that combing is not
Many people try home
remedies. They may want to avoid chemicals or available treatments
haven’t worked. Unfortunately, home remedies don’t work well,
either. Vinegar, isopropyl alcohol, olive oil, mayonnaise, melted
butter, and petroleum jelly have been studied and found ineffective.
An Australian study found that tea tree oil and lavender oil were
quite effective, but these products are not on the approved and
recommended list published by the Centers for Disease Control.
There are conflicting
recommendations about how much effort to put into laundering,
vacuuming, etc. when a child brings home a case of head lice. In
general, clothing, hats, and linens worn within the previous few
days should be laundered in hot water. Upholstered furniture and
rugs can be vacuumed. Since lice and their eggs can’t live for long
without a human host, any that fall off will die within a day or
Consult your pediatrician,
school nurse, or pharmacist about which lice medicine to use. Call
the poison center if a child swallows lice shampoo or medicine. Also
call if someone splashes these products into the eyes. The 24 hour
Parasites – Lice -head lice. Atlanta: Centers for Disease Control
and Prevention. Head lice – treatment; 2010 Nov 2 [cited 2012 June
30]; [about 5 screens].
Barker SC, Altman PM. A randomized, assessor blind, parallel group
comparative efficacy trial of three products for the treatment of
head lice in children – melaleuca oil and lavender oil, pyrethrins
and piperonyl butoxide, and a “suffocation” product. BMC
Dermatology. 2010;10(6). Accessed June 28 2012. 7 pages.
Diamantis SA, Morrell DS,
Burkhart CN. Treatment of head lice. Dermatologic Therapy.
Takano-Lee M, Edman JD,
Mullens BA, Clark JM. Home remedies to control head lice: assessment
of home remedies to control the human head louse, Pediculus
humanus capitis (Anoplura: Pediculidae). J Ped Nurs.