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Head Lice (cont.)

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What OTC medications are available to treat head lice?

Many head lice medicines are available at your local drugstore. 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 only kill crawling lice, not unhatched nits. A second treatment is recommended in seven to 10 days to kill any newly hatched lice. Treatment failures are common.
  2. Permethrins (NIX): Permethrins are similar to natural pyrethrins. Permethrins are safe and effective and may continue to kill newly hatched eggs for several days after treatment. A second treatment may be needed in seven to 10 days to kill any newly hatched lice. Treatment failures are common.
  3. Dimethicones (silicone oils, Hedrin, NYDA) coat surfaces and act as a physical barrier asphyxiating the louse and have been shown to be variably effective in studies depending upon the formulation.

What is the prescription drug used to treat head lice?

Lindane shampoo (formally known as Kwell) is a prescription drug and is one of the most common treatments for head lice. When used as directed, the drug is probably safe. Overuse, misuse, or accidentally swallowing Lindane can be toxic to the brain and nervous system, and because of this, only a single application is recommended.

Malathion (Ovide) is another prescription drug that has recently been recommended as a first-line agent for the treatment of head lice. It is a combination drug and is mixed with isopropyl alcohol (rubbing alcohol) and terpineol (a naturally occurring tea tree oil extract), both of which have been shown to have some ability to kill lice. When used as directed, it is considered safe and has been available over the counter for many years in other countries such as the United Kingdom.

Ivermectin (oral medication) has been used to treat helminthic infestations (worms) for many years. A March 2010 New England Journal of Medicine research article compared the use of ivermectin vs. malathion for "difficult-to-treat head lice" and found that a treatment with oral ivermectin resulted in a 7%-10% higher eradication rate over topical malathion. There is evidence that in resistant head lice infestations, oral ivermectin may be better than malathion. (Oral ivermectin is not currently licensed for treating head lice.)

Are any home remedies effective at getting rid of head lice?

Occlusion therapy, nit combing, and hair removal have not been proven to be fully effective in completely eradicating head lice.

Home remedies that have been tried include vinegar, mayonnaise, petroleum jelly, olive oil, butter, rubbing alcohol, and prolonged water submersion. These all fail to eliminate infestation, because these therapies do not kill all of the eggs or lice. This is believed due to the specialized way the parasite "breathes."

Hair removal has never been proven to be effective, but since the louse requires a hair shaft to lay its eggs, it should prevent the lice from multiplying. This is not always considered a desirable option for many children.

Medically Reviewed by a Doctor on 7/18/2014


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