Head Lice (cont.)
David Perlstein, MD, MBA, FAAP
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
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.
In this Article
- Head lice facts
- What are head lice?
- How common is head lice infestation?
- Who is at risk for getting head lice?
- How in the world does a child get head lice?
- What do head lice look like?
- Where are head lice most commonly found?
- What are the signs and symptoms of head lice infestation?
- How is a head lice infestation diagnosed?
- What is the treatment for a head lice infestation (pediculosis)?
- My child has head lice. I don't. Should I treat myself to prevent being infested?
- Should my pets be treated for head lice?
- My child is under 2 years of age and has been diagnosed with head lice. Can I treat my child with prescription or over-the-counter (OTC) drugs?
- What OTC medications are available to treat head lice?
- What is the prescription drug used to treat head lice?
- Are any home remedies effective at getting rid of head lice?
- Which head lice medicine is best for me?
- What are the rules with head lice medicines?
- How can I prevent head lice?
- Should household sprays be used to kill adult lice?
- Should I have a pest-control company spray my house?
- What is the prognosis of a head lice infestation?
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:
- 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.
- 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.
- 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.)
Learn more about: Ovide
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.
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