How to Get Rid of Lice

Head lice are parasites that live on human heads. They do not spread diseases but can be annoying. Please continue reading to find out the best ways to treat head lice.

What are head lice?

Head lice are wingless parasitic insects that feed on human blood. They can crawl, but they cannot fly or hop. Head lice live on the human scalp and can also be found in the eyelashes and eyebrows. They are common among preschool children who attend elementary school or childcare and members of their household.

Other types of lice include body lice, common in people who do not bathe or wash their clothes regularly, such as homeless individuals. Pubic lice are found in the pubic hair and other parts of the body with coarse hair, such as the chest, eyelashes, and eyebrows.

Can head lice live on pillows and sheets?

Head lice spread from person to person through close head-to-head contact, for example, among children at school, daycare, on playgrounds, at sporting activities, sleepovers, and camps.

Besides close contact, less commonly, head lice can also spread through shared clothing and belongings, such as hats, scarves, coats, sports helmets and uniforms, headphones, hair accessories like ribbons and clips, combs and hairbrushes, towels, and stuffed animals. Essentially any items that were recently used or worn by a person who has head lice. Additionally, beds, couches, pillows, sheets, and carpets that have been in contact with an affected person can spread head lice.

What are symptoms of head lice?

The main symptom of head lice is intense itching of the scalp. There can also be a tickling sensation from the movement of the lice on the scalp. Sometimes it is possible to see the lice in a child’s hair (adult lice are about the size of a sesame seed). In addition, nits (lice eggs) may be visible on the hair shafts near the ears and the nape of the neck, although they are tiny and difficult to distinguish from dirt or dandruff (if they are difficult to brush out from the hair, you should suspect head lice). Lastly, scratching can lead to sores on the scalp, which may become red and swollen if they are infected. In people with body lice or pubic lice, bite marks are sometimes visible on the waist, groin, pubic area, and upper thighs.

Do lice go away on their own?

Head lice do not go away on their own. However, they need a human scalp to survive and die within 1-2 days if they fall off and cannot get a blood meal. The nits (eggs) can only hatch under ideal conditions, such as those on the human scalp, and they also die within a week if they fall off.

Is treating head lice necessary?

It is necessary to treat head lice even though they do not cause diseases. This is because head lice cause intense itching, which can be annoying and may even interrupt sleep. Moreover, excessive scratching can lead to complications such as secondary bacterial infections.

It’s important to treat every member of a household who shows signs of active head lice infestation at the same time. People who share a bed with an affected person should be treated preventively, even if they don’t have an active infection.

How can I tell if my child has head lice?

You can tell your child has head lice if you find a live louse in your child’s hair. However, even adult lice are tiny and difficult to see. A fine-tooth comb or a magnifying glass may help you find crawling lice. You may also be able to find nits (eggs) attached firmly to the base of a hair shaft. If you are not sure whether your child has head lice, a healthcare provider can make a diagnosis.

What is the best head lice treatment?

Over-the-counter medications for head lice

Pyrethrins and piperonyl butoxide: Brand names Pronto, Rid, R&C, A–200, and Triple X. They are approved for use in people 2 years of age and older.
Permethrin lotion 1%: Brand name Nix. This product continues working for several days after application and may kill lice that are newly hatched. Permethrin is approved for use in people 2 months of age and older.

These OTC products only kill live lice but not unhatched eggs. Therefore, a second treatment is required on day 9 or 10 to kill lice that are newly hatched before they can produce more eggs. Follow the label instructions on your head lice medicine carefully. If you see crawling lice after the full course for treating lice, contact your healthcare provider.

Note: Do not place head lice medicine and a shower cap on a young child’s head and leave them unattended—this can be a suffocation hazard.

Prescription treatments for head lice

Benzyl alcohol lotion 5%: Brand name Ulesfia. It kills lice but not eggs. A second treatment is required on day 7 to kill newly hatched lice before the female louse can produce more eggs. This product is approved for use in people 6 months of age and older. The safety of this drug has not been established in people over the age of 60. It can irritate the skin.
Ivermectin lotion 0.5%: Brand name Sklice. It is used to treat lice in people 6 months of age and older. It can kill a live adult louse but will not kill nits. However, it may reduce the survival rate of newly hatched lice. Most patients need a single application on dry hair without use of a special nit comb. Do not repeat a treatment without talking to your healthcare provider. Ivermectin is also available in tablet form, but the tablets are not an FDA-approved lice treatment. The tablets should not be given to pregnant women or children who weigh less than 15 kg.
Malathion lotion 0.5%: Brand name Ovide. This product kills live lice and is partially effective against lice eggs. A repeat treatment on day 7-9 may be needed if crawling lice are visible. Malathion is approved for use in people 6 years of age and older. It can result in irritated skin. The lotion is flammable and should not be used near heat sources, including hair dryers and curling irons. It should be applied to dry hair only.
Spinosad 0.9%: Brand name Natroba. This is a topical suspension that kills live lice and unhatched eggs. Only one treatment is usually needed. The use of a lice comb is not required. Treatment should only be repeated if live lice are seen after day 7 of the first treatment. This product is approved for lice treatment in people 6 months of age and older.

Always use prescription treatment exactly as advised. Do not repeat a treatment without talking to your provider. If the medication causes an allergic reaction, contact your provider. Do not use other treatments along with the prescription treatment without checking with your healthcare provider.

Second–line treatment of head lice

Your doctor may prescribe lindane shampoo 1% if a first-line treatment is not effective in killing lice or you cannot tolerate safer head lice treatments. Misuse, overuse, or accidental ingestion of this product is toxic to the nervous system. This product is not intended for removing lice in infants, children, pregnant or breastfeeding women, elderly individuals, those who weigh less than 110 pounds, people with HIV, those who have a seizure disorder, and people with skin irritation or sores on the scalp. Retreatment is not recommended.

What kills lice naturally?

Home remedies for head lice include petroleum jelly, mayonnaise, olive oil, lavender oil, tea tree oil, and other essential oils; however, there is no scientific evidence that any of these is an effective head lice treatment. Other alternative treatments include using heat to dehydrate the lice and eggs with a special machine; however, you cannot do this at home with a hair dryer.

How do you get rid of head lice permanently?

The best way to permanently combat lice is to:

Check every member of the household for lice and nits and treat everyone who is affected.
Use over-the-counter treatments such as lice shampoo to suffocate lice. Read the package instructions carefully. Make sure you repeat the treatment on day 9 or 10 as recommended for complete removal of head lice (the life cycle of head lice is such that nits hatch around this time). However, do not overuse head lice products. Use a regular shampoo until the next recommended treatment.
Check the age recommendation on the package and use the appropriate product on your child’s head.
Use a fine-toothed comb for wet combing. Head lice are easier to remove from wet hair. Repeat this every 3-4 days for two weeks or more. This is the first-line treatment for infants younger than 2 months who cannot use other prescription or OTC treatments.
Wash all personal items such as clothing, bedding, and stuffed toys on a hot cycle (at least 130F or 54C) and dry them on a high setting for 20 minutes or more.
Wash combs and hairbrushes in very hot water and soap. You can also soak combs and hairbrushes in rubbing alcohol for an hour.
If any items cannot be washed, seal them in an airtight bag for 2 weeks.
Clean your carpets and furniture with a vacuum cleaner.
Take precautions to prevent lice, such as encouraging your kids to avoid head-to-head contact. Hair length does not matter because most lice are found in the first quarter-inch of a hair shaft.
Household pets do not need head lice treatment.