The 8 Best Lice Treatments of 2023 to Use at Home

What to Look for In a Lice Treatment

Method and Severity

“Most lice treatments are topical insecticides that either directly kill the louse, or egg, or both. Prescription treatment benzyl alcohol works by smothering the lice. Different products (both over-the-counter and prescription) have different ways of killing the lice based on the mechanism of action of the product. Many treatments need to be reapplied in seven days due to the life cycle of nit to louse. In addition to medication, combing the hair with a fine-tooth comb every three to four days for several weeks may clear the infection, but studies show it may not be as effective as the medications.

“Lice can infect both children and adults at all socioeconomic levels; however, children are more often infected compared to adults. This may be because of the mode of transmission (direct contact or possibly sharing hats). There is no difference in the mechanism of treatment for adults and children, but adults may need more product due to larger head sizes. We also have more safety concerns with younger children who may absorb more product relative to their size.

“Unless there is widespread resistance in the community, over-the-counter preparations made with permethrin are the first-line treatment. In some communities, lice are becoming resistant to that treatment. If a prescription is needed, I prefer benzyl alcohol or spinosad. Malathion is also a commonly prescribed medication, but it smells bad and may be flammable. It is also important to follow the directions for the specific product because they are applied for differing amounts of time, and some are applied on wet hair while others are applied on dry hair.

“When rinsing the hair, we recommend using cool water to limit the risk of absorption. When blood vessels get warm, they get bigger and increase absorption through the skin. Rinsing over a sink rather than a shower or bath also lessens contact with other skin. Many products are irritating to the eyes, so care should be used not to rinse it into the eyes.” — Adam Keating, MD, a pediatrician at Cleveland Clinic Children’s.

Manual vs. Chemical

“For the most part, lice treatment is the same for all age groups. It is important to read the contraindications for any product to check for age restrictions or other vulnerable populations (like pregnant women) and for allergies. Most over-the-counter and prescription lice treatments are safe if the directions are followed appropriately. However, many people do not follow directions. For example, when the product label says to leave it in the hair for one hour, some people rinse it out after 10 minutes.

“As with many things, there are many options for lice treatment, and some are better than others. However, it’s just as important to have good lice comb as it is to use a good lice treatment product. Most combs that are supplied with a treatment kit are not effective. We use and recommend the Nit Free Terminator Comb. It is a “must-have” for successful treatment. For any person that is concerned about any ingredient in a product, it is possible to have a successful treatment using an inert product, such as a conditioner, olive oil, or coconut oil combined with the Nit Free Terminator Comb. Combing (manual or mechanical removal) is also a treatment method on its own.” — Anna Warren, the owner of The Asheville Lice Treatment Center in North Carolina

Ingredients

“Key features of lice treatment include topical neurotoxic agents, oral agents, combination therapy, and mechanical removal therapy. Washing all bedding, sheets, and towels in hot water for at least 30 minutes is also important in the treatment and prevention of reinfestation. Items that cannot be washed can be placed in a Ziploc bag for more than one week as lice cannot survive without blood from a human for longer than 48 hrs. Wash all surfaces. Any other siblings and adults should be treated also if live lice are visualized in the scalp. Also important to note, the removal of nits must be done on a daily basis manually after topical treatments. It is very important to make sure patients are aware of side effects and age recommendations of certain treatment methods. Always be sure to check with your healthcare provider and/or pediatrician for the best advice for your child. All treatment options work similarly but can have more side effects in younger-age children.

“I usually recommend Nix or RID over-the-counter treatments, up to two applications one week apart, as the first line of defense. It is very important to comb wet hair with a fine-toothed comb, removing all nits. If one nit survives, reinfestation can occur. Treatment of all family members in the home, and washing all sheets, towels, and bedding at the same time of treatment is important. If the first treatment fails, I recommend Skliceor Ovide therapy (prescription options). It is important to discuss with your primary medical provider all concerns relating to the safety and efficacy of different treatments of lice.” — Sara Siddiqui, MD, a pediatrician at NYU Langone Health

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As a seasoned health writer, Alena Hall understands how important it is to know exactly what you’re getting in a wellness product. Over the years, she has reviewed dozens of products, from athletic recovery aids to homeopathic essential oils to ever-trendy CBD topicals, to help readers like you discover products that can help you live your best life.