Home Treatment

Home treatment with nonprescription medicines can usually get rid of lice. These medicines include:

• Permethrin 1% creme rinse (such as Nix).
• Pyrethrins and piperonyl butoxide hair products (such as A-200, Pronto, and Rid).

If nonprescription methods are not working, a stronger medicine may be needed. Your doctor may prescribe a more concentrated (5% instead of 1% nonprescription) form of permethrin (Elimite) or a different medicine.

Many doctors recommend using a lotion or shampoo to kill the eggs and lice. In Britain, where lice have become resistant to medicated lotions and shampoos, one study found that using special fine-toothed combs with a conditioner helped get rid of head lice.² You may choose to remove the eggs through combing to improve your or your child's appearance. Cleaning combs, brushes, clothing, and other objects can help prevent lice from spreading to other members of your household.

Medications

There are both over-the-counter medicines and prescription products to treat head lice and pubic lice. Most products come as a shampoo, creme rinse, or lotion (topical treatment) that is applied to the affected areas, left on for a period of time, and then rinsed off. Doctors sometimes prescribe a pill to treat lice when two or more approved topical medicines have not worked.

Permethrin 1% creme rinse (such as Nix) is a common first method of treating lice. It is safe and effective and continues to kill lice and their eggs (nits) even after the cream has been rinsed off. This product is available without a prescription.

When treating lice with medicine, keep in mind:

• A second treatment 7 to 10 days after the first treatment is usually recommended to ensure that any newly hatched lice are also killed.
• Itching may persist even after successful treatment. Do not reapply medicated products unless you are advised to do so by a doctor. Excess use of these products may increase the risk of negative side effects such as nausea, headaches, or more serious side effects.

If lice infest the eyelashes, applying petroleum jelly (such as Vaseline) to the eyelashes several times a day for a week can kill the lice.

Because body lice live in clothing, not on the body, drugs are generally not needed unless the person is severely infested. The most common way to kill body lice and eggs is to wash clothing and bedding in hot water [130°F (54.44°C) or higher] in a washing machine.

Medication Choices

Over-the-counter products for head or pubic lice

• Permethrin creme rinse 1% (such as Nix) is a common first choice for treating head lice. It kills lice and their eggs for 2 weeks or more after it has been rinsed off.
• Shampoos containing pyrethrins and piperonyl butoxide (such as A-200, Pronto, Rid) are left on the hair for 10 minutes and then rinsed out. A second treatment is needed 1 week after the first to kill newly hatched lice.

Check the product label. Be sure to follow the directions about proper use and safety. And talk to your doctor or pharmacist about whether these products are safe for young children.

Prescription products for head or pubic lice

• Permethrin cream 5% (Elimite) is used to treat head lice or pubic lice. It is applied to the skin or scalp, left on for 8 to 14 hours, and then rinsed off.
• Malathion lotion (Ovide) is used to treat head lice. It is applied to hair on the head, left on for 8 to 12 hours, then rinsed off. If lice are still present 7 to 9 days later, a second treatment must be done.
• Benzyl alcohol 5% (Ulesfia) is used to treat head lice. It is applied to the hair on the head, left on for 10 minutes, and then rinsed off.
• Spinosad (Natroba) is used to treat head lice. It is applied to the hair on the head, left on for 10 minutes, and then rinsed off.
• Lindane shampoo is used to treat head lice or pubic lice. It should only be used when other products fail to get rid of lice or when a person cannot use any of the other products. Lindane contains potentially harmful toxins that can cause negative side effects when it is not used properly.

A pill, such as ivermectin, is sometimes prescribed to treat lice when the person does not respond to two or more topical treatments (treatments applied directly to the affected area).³

Antihistamines (both prescription and nonprescription) can treat the itching that often occurs with lice. These medicines may cause drowsiness. Don't give antihistamines to your child unless you've checked with the doctor first.

If there is a serious skin infection, antibiotics may be needed.

Prescription medicines such as crotamiton or trimethoprim sulfamethoxazole (Bactrim, Septra) are sometimes used to treat head and pubic lice.⁴

What to Think About

It is not necessary to remove lice eggs from hair after treatment with topical medicines, but some people may wish to remove them for cosmetic reasons.

Most products used to treat lice may cause side effects if they are not used properly. Never use a product more than two times (with less than 7 days between uses) without first consulting a doctor.

There is some concern that lice are becoming resistant to (can no longer be killed by) permethrin or other medicine used to treat lice infestations. It is also possible that lice may persist after treatment because the medicine was not used properly or because the person was reinfected by someone else who was still infected with lice.

Wet combing is an option for infants who can't use lice medicines.