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Treating Head Lice

IMAGE Head lice are small insects that feed on blood found on the human scalp. They are most often found on the scalp, behind the ears, and near the neckline at the back of the neck. The lice hold onto hair with the hook-like claws they have at the ends of each of their 6 legs.

Preschool and elementary school children and their families are at the greatest risk of exposure to head lice. Girls get head lice more often than boys and women more than men.

The Signs

If you're wondering whether someone has head lice, these signs are a good indication:

  • Feeling of tickling or crawling in hair
  • Itching or scratching
  • Irritability, especially at night
  • Sores on the head due to scratching
  • Eggs or lice seen in the hair or on the scalp

Where the Little Critters Come From

The most common causes of head lice include:

  • Having head-to-head contact with an infested person
  • Using infested combs, brushes, or towels
  • Lying on a bed, couch, pillow, carpet, or stuffed animal that has recently been in contact with an infested person

Taking a Sick Day

According to the American Academy of Pediatrics, it is not necessary for a child to miss school due to head lice. The child can finish the school day, go home and receive treatment, and return the next day. However, each school district may have its own policy, so check with school nurse before sending your child to school.

How to Get Rid of Head Lice

When you find head lice, spring into action as quickly as you can. Your first priority should be to get rid of lice eggs, called nits, in order to end the life cycle.

Apply Head Lice Medicine

Shampoos and lotions are available to treat head lice. It is important to use the right products.

Examples of medications used to treat head lice include:

  • Over-the-counter products, such as those containing pyrethrin or permethrin
  • Prescription products, such as lindane and malathione—These may be prescribed because some cases of head lice are resistant to pyrethrin and permethrin.

Note: If your child is under 2 years of age or you are a pregnant or nursing mother, be sure to check with the pediatrician before applying head lice medication.

Follow medication directions carefully. If the lice return, check with your doctor before beginning another course of treatment.

Use Caution With Lindane

The Food and Drug Administration (FDA) includes a warning on prescription shampoos and lotions containing lindane. In rare cases, it can cause serious side effects, including seizure and death. Those especially at risk include:

  • Infants
  • Young children
  • Elderly
  • People weighing less than 110 pounds
  • People with certain skin conditions

Use a Fine-Toothed Comb

A fine-toothed comb designed to capture and remove the lice and nits often comes with medicated shampoos and lotions. The teeth of the comb should be long and tapered and set so close that combing removes virtually all lice and nits. This comb can also be used to check for lice after treatment.

Wash Household Items

Wash all bedding and clothing in hot water and dry them in a dryer using high heat. Vacuum floors, beds, chairs, car seats, and headrests—any place that the person with lice has been. Soak combs and brushes in hot water for 5-10 minutes. Items that cannot be washed, such as stuffed animals, can be sealed in a plastic bag for 2 weeks.

Beware Unproven Treatments

Herbal Remedies

There are many unproven head lice remedies. The problem with using herbal remedies is that if they do not work, the head lice population can increase unchecked, worsening the infestation and associated symptoms. Further, they are not regulated by the FDA.

Some herbal remedies, though, have shown to be effective in clinical trials. An example is a spray that contains coconut oil and anise. If you are unsure of which product to use, talk to the doctor.

Other Treatments

Others are experimenting with suffocating the head lice by covering the hair with petroleum jelly, mayonnaise or olive oil and wrapping the head in plastic wrap overnight. There is no evidence that these methods work either. Though the multiple shampooing required to remove the oil from the hair may help with removal, it can also irritate an already itchy head.

Tips for Preventing Head Lice

There are ways to prevent getting head lice. Some steps you can take include the following:

  • Avoid head-to-head contact
  • Do not share clothing or hair accessories
  • Do not share combs, brushes, or towels

Keep Checking

Some people report that despite vigilance and treatment, the lice keep coming back. Be sure to continue checking for lice regularly. If the treatment did not work, let your doctor know as another medication may need to be used. As much as no one wants to reveal that they have head lice, it is important to warn friends who may have been exposed. After spending weeks to eliminate the lice, you do not want your child to pick it up all over again.

  • Centers for Disease Control and Prevention

    http://www.cdc.gov

  • National Institute of Allergy and Infectious Diseases

    http://www.niaid.nih.gov

  • Canadian Paediatric Society

    http://www.cps.ca

  • Health Canada

    http://www.hc-sc.gc.ca

  • Dodd CS. Interventions for treating head lice. Cochrane Database Syst Rev. 2001;(2):CD001165.

  • FDA Public Health Advisory: safety of topical lindane products for the treatment of scabies and lice. Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm110845.htm. Updated December 7, 2015. Accessed February 1, 2017.

  • Head lice. Centers for Disease Control and Preventionwebsite. Available at: http://www.cdc.gov/parasites/lice/head/index.html. Last updated September 24, 2013. Accessed February 1, 2017.

  • Head lice. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116514/Head-lice. Updated May 27, 2015. Accessed February 1, 2017.

  • Head lice: what parents need to know. Healthy Children—American Academy of Pediatrics website. Available at: https://www.healthychildren.org/English/health-issues/conditions/from-insects-animals/Pages/Signs-of-Lice.aspx. Updated May 5, 2015. Accessed February 1, 2017.

  • Hensel P. The challenge of choosing a pediculicide. Public Health Nurs. 2000;17(4):300-304.

  • Lindane. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T233229/Lindane. Updated December 7, 2016. Accessed February 1, 2017.

  • Meinking TL, Serrano L, et al. Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States. Arch Dermatol. 2002;138(2):220-224.

  • Mumcuoglu KY. Prevention and treatment of head lice in children. Paediatr Drugs. 1999;1(3):211-218.

  • Richardson M, Elliman D, et al. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J. 2001;20(4):380-391.

  • 12/14/2009 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116514/Head-lice: Burgess IF, Brunton ER, et al. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr. 2010;169(1):55-62.