True or False

Over-the-counter (OTC) head lice treatments sometimes are not the most effective.

True. Here's why: Head lice can be resistant to the active ingredients in over the counter (OTC) treatments in some communities. These are the ones you can buy in the store without a prescription. If head lice are resistant it means the treatments may not kill them. The likelihood of resistance varies across the country. Your pediatrician can assist in helping you choose an appropriate treatment option before you do so on your own.

Prescription treatments always cost more than OTC treatments.

False. Here's why: Parents sometimes treat their children with OTC treatments up to 5 times before seeking help from their pediatrician. You should consider the cost of potential multiple treatments, plus the cost of other infestation-related activities when choosing a treatment option. That having been said, prescription medications are usually more expensive to purchase and may not always be covered by health insurance. So, it is a good idea to check your coverage when you are making your decision.

All head lice treatments call for 2 applications.

False. Here's why: Several prescription treatments suggest using only 1 application. Sometimes, a third treatment is needed if live lice persist following the second treatment.

Prescription head lice treatments involve being left on the scalp and hair for 8 to 12 hours.

False. Here's why: Some prescription products have application times as short as 10 minutes followed by a simple rinse with water. That is why it is essential for parents to read and follow manufacturer instructions exactly as written.

All head lice treatments instruct users to nit comb.

False. Here's why: There are some prescription products that don't call for nit combing. Nits are lice eggs. Even when nit combing is not required to get rid of an infestation, you may choose to comb out nits while hair is wet with a fine tooth comb. Removing nits may help to decrease embarrassment to your child or adolescent, as well as eliminate potential conflicts with school officials that you have not treated your child.

Due to stronger ingredients, prescription head lice treatments should only be used as a last resort.

False. Here's why: Prescription medications have different active ingredients than the OTC products and may need to be used in the initial treatment of head lice in some communities based upon local resistance patterns. Many newer prescription treatments can be used safely when prescribed by a pediatrician and carefully applied according to instructions. Several prescription treatments are safe to use on children as young as 6 months of age.

Home remedies to treat head lice are safe and effective.

False. Here's why: Mayonnaise, olive oil, margarine, butter, and similar substances have not been proven as effective head lice treatments. Substances like gasoline or kerosene have not been clinically proven and are flammable and carry substantial risk. When your child has head lice, it is best to call your pediatrician before treatment. Like any other health concerns you have about your child, consulting your pediatrician first can help you decide whether an OTC or prescription treatment is best for your child.

Once I apply lice treatment, it is ok to place a shower cap or plastic bag on my child's head and leave my child alone until the treatment is complete.

False. Here's why: It is dangerous to place anything made of plastic on a child's head because it sends a message that it is ok for them to do when you may not be around. If left unattended a child might fall asleep with the plastic bag on his or her head and it could slip over his or her nose or mouth and suffocate. While treating for head lice can be an annoyance, it can also be a close time for a parent and child to spend quiet time together and bond during a close and caring encounter. Similarly, a child should never be left unattended with any wet chemicals on his/her head to avoid drippage of the chemical into the eye.​

General Guidelines

Treatment for head lice is recommended for persons diagnosed with an active infestation. All household members and other close contacts should be checked; those persons with evidence of an active infestation should be treated. Some experts believe prophylactic treatment is prudent for persons who share the same bed with actively-infested individuals. All infested persons (household members and close contacts) and their bedmates should be treated at the same time.

Some pediculicides (medicines that kill lice) have an ovicidal effect (kill eggs). For pediculicides that are only weakly ovicidal or not ovicidal, routine retreatment is recommended. For those that are more strongly ovicidal, retreatment is recommended only if live (crawling) lice are still present several days after treatment (see recommendation for each medication). To be most effective, retreatment should occur after all eggs have hatched but before new eggs are produced.

When treating head lice, supplemental measures can be combined with recommended medicine (pharmacologic treatment); however, such additional (non-pharmacologic) measures generally are not required to eliminate a head lice infestation. For example, hats, scarves, pillow cases, bedding, clothing, and towels worn or used by the infested person in the 2-day period just before treatment is started can be machine washed and dried using the hot water and hot air cycles because lice and eggs are killed by exposure for 5 minutes to temperatures greater than 53.5°C (128.3°F). Items that cannot be laundered may be dry-cleaned or sealed in a plastic bag for two weeks. Items such as hats, grooming aids, and towels that come in contact with the hair of an infested person should not be shared. Vacuuming furniture and floors can remove an infested person’s hairs that might have viable nits attached.

Over-the-counter Medications

Many head lice medications are available “Over-the-counter” without a prescription at a local drug store or pharmacy. Each Over-the-counter product approved by the FDA for the treatment of head lice contains one of the following active ingredients. If crawling lice are still seen after a full course of treatment contact your health care provider.

Pyrethrins combined with piperonyl butoxide;

Brand name products: A–200*, Pronto*, R&C*, Rid*, Triple X*.

Pyrethrins are naturally occurring pyrethroid extracts from the chrysanthemum flower. Pyrethrins are safe and effective when used as directed. Pyrethrins can only kill live lice, not unhatched eggs (nits). A second treatment is recommended 9 to 10 days after the first treatment to kill any newly hatched lice before they can produce new eggs. Pyrethrins generally should not be used by persons who are allergic to chrysanthemums or ragweed. Pyrethrin is approved for use on children 2 years of age and older.

Permethrin lotion, 1%;

Brand name product: Nix*.

Permethrin is a synthetic pyrethroid similar to naturally occurring pyrethrins. Permethrin lotion 1% is approved by the FDA for the treatment of head lice. Permethrin is safe and effective when used as directed. Permethrin kills live lice but not unhatched eggs. Permethrin may continue to kill newly hatched lice for several days after treatment. A second treatment often is necessary on day 9 to kill any newly hatched lice before they can produce new eggs. Permethrin is approved for use on children 2 months of age and older.

When treating head lice

Do not use extra amounts of any lice medication unless instructed to do so by your physician and pharmacist. The drugs used to treat lice are insecticides and can be dangerous if they are misused or overused.

All the medications listed above should be kept out of the eyes. If they get onto the eyes, they should be immediately flushed away.

Do not treat an infested person more than 2–3 times with the same medication if it does not seem to be working. This may be caused by using the medicine incorrectly or by resistance to the medicine. Always seek the advice of your health care provider if this should happen. He/she may recommend an alternative medication.

Do not use different head lice drugs at the same time unless instructed to do so by your physician and pharmacist.

Resources:

CDC treatment of Lice information