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The mere mention of head lice can make many people instantaneously feel itchy, uncomfortable, and filled with dread. However, understanding what causes head lice and how to treat it with medications and home remedies can go a long way in setting a mind at ease over the dreaded diagnosis. Let’s take a closer look at what head lice is and what can be done to treat it.
What are head lice?
Head lice are tiny, rice-sized, blood-sucking parasitic insects that live on the scalp. They attach themselves to the scalp to feed, where they also lay tiny eggs called nits. Head lice are passed along when someone comes into direct contact with a host—for example, when two children are playing and they make head-to-head contact or if an item like a hat or hairbrush is shared with someone who has been infected with lice.
The symptoms of head lice include an itchy head, visible insects on the scalp, and white nits—or tiny eggs—close to the hair root and along the hairline. An infestation of head lice is known medically as pediculosis. Because head lice are generally passed from very close contact, head lice are most prevalent amongst preschool and elementary-aged children and their families or caregivers.
Head lice are wingless and cannot jump or fly. They move around by crawling and can only move from host to host through direct bodily contact or transference through personal items like jackets, hats, combs and brushes, bedding, etc. It’s important to not only treat head lice on the scalp but to also thoroughly delouse the environment such as clothing, blankets, scarves, and coats as well.
How is a head lice infestation diagnosed?
Since head lice are so prevalent among children and in school environments, an initial diagnosis of head lice is often made by a school nurse, administrator, or teacher. Often, the first symptom noticed is a persistent itchy scalp or scratching. If lice are suspected, a visual inspection of the head and dry hair or hair lubricated with conditioner should then be performed by combing through the hair and looking for either live lice or nits on the hair shaft within a quarter-inch of the scalp. A nit comb might be necessary to thoroughly examine the scalp section by section.
Though a doctor’s diagnosis isn’t necessary, an appointment with a pediatrician, primary care provider, or your healthcare professional can help confirm the presence of live lice. They can sometimes be confused with empty or dead nits which can be present after an infestation (but not lead to a reinfestation), or something innocuous in the hair such as dandruff.
Your doctor will likely examine your or your child’s hair using a lice comb or specialized blue light known as a Wood’s light, that can make nits more visible to the naked eye. If nits or lice are found, your doctor will most likely prescribe an over-the-counter treatment to kill lice and nits known as a pediculicide.
If no nits or lice are found, but itching or an outbreak at school persists, you may want to schedule a follow-up appointment to do a thorough recheck.
Head lice treatment options
In most cases, head lice is treated with an over-the-counter anti-parasite shampoo. Since lice are becoming increasingly resistant to medicated treatments, you’ll want to combine shampooing with careful and attentive wet-combing with a nit comb to help dislodge and remove any living lice or nits. It may take more than one treatment in order to successfully eradicate an infestation and to prevent a reinfestation. Meaning, you may still spread lice to others in the home or school after one treatment.
Additionally, preventative measures can also be taken if a family member has been diagnosed with a lice infestation or if there is an outbreak at school. You’ll want to fully launder and clean all fabrics in hot water—i.e., bedding, clothing, jackets, scarves, hair accessories, etc.—and surfaces that might have come into contact with the infested person.
Lice medication
Lice medication falls into three categories: over-the-counter (OTC) antiparasitic shampoos, prescription pediculicide shampoos, and pediculicide prescription lotions. OTC shampoos are generally the first line of defense, but if the infestation persists, your doctor may prescribe a medicated treatment that can kill head lice and nits.
Over-the-counter antiparasitic lice shampoo
Over-the-counter antiparasitic shampoos such as Nix and Rid are made of a compound—or a synthetic version, permethrin, that is toxic to lice. Hair is first washed with a regular shampoo and then the antiparasitic shampoo should be used according to the package directions. Side effects can be a dry, itchy scalp, or redness.
Prescription lice pediculicide shampoos
Depending on the age of the infected person, your doctor may prescribe a pediculicide shampoo that can help kill both nits and lice, especially those that are resistant to OTC treatment. These include Ovide (malathion), a medicated treatment that is shampooed in and then left on overnight before being rinsed out.
A last resort option is lindane; it is recommended only when other treatments have not worked, due to the risk of serious side effects. In rare cases, it has caused seizures and death. Lindane should not be used in children or pregnant or breastfeeding women.
Prescription lice pediculicide lotions
Another option your healthcare provider could recommend is a prescription-strength lice killing lotion such as Sklice lotion or Natroba (spinosad). These lotions are applied to dry hair and scalp and left in for 10 minutes before being washed away. Side effects could include dry scalp, irritation, and itchiness. Another option is Ulesfia (benzyl alcohol). It works by smothering nits and works best if combined with combing of the hair.
What is the best lice medication?
Like all prescribed medications, consult your healthcare provider or pharmacist for prescription medication recommendations. Depending on the severity of your case and your history with head lice, your doctor may prescribe either a medicated shampoo, lotion, or benzyl alcohol, along with repeated combing of the hair to remove nits from the hair shaft.
| Best medications for lice | ||||
|---|---|---|---|---|
| Drug name | Drug class | Drug administration | Standard dosage | Most common side effects |
| Lindane | Pediculicide | Shampoo | 30-60ml (depending on hair length) of 1% administered topically once. | Stinging, burning, redness, itching, dryness of the skin, rash, dizziness, drowsiness |
| Sklice (ivermectin lotion) | Pediculicide | Topical lotion | Up to 117gm of 0.5% topical lotion applied directly to the scalp | Burning, stinging, itching, redness, dryness, eye irritation |
| Ulesfia (benzyl alcohol) | Pediculicide | Topical lotion | ½ to six 8-ounce bottles (depending on hair length), repeat in 7 days | Burning, itching, irritation, stinging, dryness, eye irritation |
| Ovide (malathion) | Pediculicide | Topical lotion | 59ml of 0.5% topical lotion applied as a thin layer over scalp as directed, may repeat in 7 days if necessary | Scalp itching, burning, dryness |
Dosage is determined by your doctor based on your medical condition, response to treatment, and age. Other possible side effects exist. This is not a complete list.
What are common side effects of lice medication?
All medications have the potential for side effects, and head lice medications may as well. However, medication side effects are generally infrequent. They are usually well-tolerated if used moderately and according to the label. The most common side effects of lice medication are irritation of the scalp, itchiness, and redness. Eye irritation may occur. Be sure to wash hands after applying the product.
In extremely rare occasions, an allergic reaction may occur. If this happens, stop use and contact your doctor immediately. This list is not exhaustive, so talk to a healthcare professional about possible side effects for your specific prescription. As with all side effects, you should contact your pediatrician, doctor, or pharmacist should they continue or worsen.
What are the best home remedies for lice?
Depending on how early lice is caught, it could be possible to treat it at home with everyday items you might already have at home. If discovered immediately, it might even be possible to treat it simply by combing out hair with a nit comb in the morning and again in the evening every day for a few weeks. Keep in mind, however, that most of these treatments have little impact on killing nits, so you may have to keep retreating as eggs hatch. If home remedies do not eradicate head lice, it is best to consider medicated products. Consult your healthcare professional for a recommendation.
Popular head lice home remedies that can help contain the spread of lice include:
Wet combing
A study by The British Medical Journal observed that wet combing infested hair can be more effective than simply dry combing. What is wet combing? Wet combing means diluting hair conditioner with a small amount of water and then dampening the hair with it. Not only does this help make lice and nits more visible, the conditioner acts as a lubricant that can help move the lice and eggs along the hair shaft and help ease the removal process. Wet combing requires combing through hair individually, however, and can be a bit tedious. Be certain to fully sterilize the comb after use by soaking in a bleach solution, or boiling for at least ten minutes.
Olive oil or almond oil
Another home remedy option is to smother the lice with a food-grade oil such as olive oil, almond oil, or coconut oil. Once you let the oil sit on the hair, you can then follow the same instructions as wet combing. After, you’ll want to wash the hair thoroughly with regular shampoo and be certain to throw any towels utilized into the wash on high heat. Sterilize nit comb after use.
Vaseline or mayonnaise
Similar to using oils to smother lice, you can try using petroleum jelly (Vaseline) or mayonnaise to the same effect. Some studies have shown petroleum jelly to be much more effective at smothering lice than other home remedies. Keep in mind, however, that smothering only works on live lice so you’ll either have to repeat the treatment when nits hatch or combine it with thorough combing with a fine-toothed comb in order to keep lice at bay.
Essential oils
Some people have had success utilizing essential oil treatments on the hair to kill lice before fully combing it out to remove all lice and nits. The essential oils that may be the most effective are tea tree oil, lavender oil, clove oil, eucalyptus oil, peppermint oil, nutmeg oil, red thyme oil, cinnamon oil, and neem oil. Essential oils should not be applied directly to the skin; they must be diluted first. Mix 15-20 drops of essential oil with several ounces of olive oil to dilute. Apply directly to the scalp either with a comb or a cotton ball and then leave on overnight. Shampoo out and follow with a thorough comb-out to remove nits and lice.
Apple cider vinegar
There is some debate surrounding the effectiveness of vinegar on head lice. However, it has been found that vinegar might help loosen the adhesive grip of nits on the hair shaft and help aid in their removal. To utilize, saturate the hair and scalp with vinegar and allow to dry. Then, spritz the hair with a diluted conditioner mixture and wet comb thoroughly. Follow by shampooing in warm water.
Frequently asked questions about lice
How do you get rid of lice fast?
Unfortunately, there’s no quick treatment for lice. However, by treating the issue holistically, that means by using a prescription pediculicide—shampoo or lotion—in combination with frequent nit comb-outs and meticulous cleaning of personal items that may be infected, it is possible to be free of lice within a few days.
How long does it take to get rid of lice?
Depending on the strength of the treatment used, head lice could be completely killed after one treatment. However, some treatments are less effective at killing lice eggs than others, and there is risk of reinfestation from personal items touched or worn by the infected person within two days. Often, a second treatment may be necessary.
Can head lice live on pillows?
Yes, head lice and nits can survive on pillows and bedding for days. It is important that when you’re treating a head lice infestation, all clothing, bedding, towels, outerwear, etc. is also treated properly to disinfect it. The Centers for Disease Control and Prevention (CDC) recommends that you launder anything that was worn or used in the past two days in the hot water cycle (130 F) and dry it on high heat since a louse and nits can’t survive temperatures over 128° F that are sustained for at least five minutes.
Anything that isn’t machine washable should be sent to the dry cleaners or sealed in plastic bags for at least two weeks.
What is the most effective treatment for head lice?
The most effective treatment for head lice is a prescription head lice shampoo or lotion from your doctor combined with meticulous combing and thorough cleaning of all personal items that came into contact with the infected person.
Is there a prescription for head lice?
Most doctors recommend trying an over-the-counter lice shampoo as a first-line of defense against head lice, but if that proves ineffectual, there are prescription medications your doctor may prescribe. These include lice shampoo such as Ovide (malathion) or lice lotions like Sklice or Natroba (spinosad).
Does lice shampoo damage your hair?
Prescription-strength lice shampoos contain harsh pesticides that can cause dry scalp or even irritation and rashes. However, the shampoo itself hasn’t been found to damage hair beyond temporary dryness since users are asked to nix hair conditioner after shampoo treatment of head lice.
Does apple cider vinegar kill lice?
As noted above, there is debate about whether apple cider vinegar is effective at killing head lice but it may help to loosen nits from the hair shaft.
Does Vaseline kill lice?
Smothering head lice in petroleum jelly can help kill live lice, but does little in the way of preventing egg-laying which causes ongoing lice infestation. Petroleum jelly, while very messy, can be effective in helping lubricate the hair shaft for removal of nits and dead lice when manually combing the hair.