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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Lice Medications

Follow the doctor's instructions for prescription anti-lice agents, if prescribed.

• Do not apply to eyes, face, or mucous membranes.



• Discuss treatment with the doctor if you are pregnant.



• Common prescription anti-lice agents



• Elimite cream (permethrin 5%) may be used in children over 2 months of age.



• Kwell shampoo or cream (lindane 1%) is generally considered at "last ditch" medication due to the possibility of neurotoxicity enhanced by absorption through open sores or excessive application. Guidelines recommend that patients weight at least 110 pounds to use this treatment.



• Ovide lotion (malathion 0.5%) may be used in children over 6 years of age. There are few side effects (stinging when open sores are exposed). It is an alcohol-based preparation and thus hair dryer and curling iron use should be avoided due to a potential flammable reaction.


o Ulesfia (benzyl alcohol 5%) is a new product useful for head lice only and may be employed for patients over 6 months of age. Since it does not kill the nits, a repeat application is necessary seven days after the initial treatment.


• If you have ragweed allergies, avoid permethrin (Elimite, Nix) and pyrethrin (Rid, A-200) products.



• Lindane is considered a second-line treatment if other medications fail or are not tolerated. It is not very safe in children and may cause neurotoxicity (dizziness, seizures).



• Studies in 2001 demonstrated that combination therapy using topical 1% permethrin (Nix) and the oral antibiotic trimethoprim/sulfamethoxazole (Septra or Bactrim) was effective for head-lice infestations which were poorly responsive to traditional therapies.