FDA Says Popular Prescription Lice Treatment Can Be Sold Over-the-Counter

On October 27, the Food and Drug Administration (FDA) announced that it had approved the single-use lotion head lice treatment, Sklice (ivermectin lotion 0.5%), to be sold over-the-counter.

The treatment will no longer require a prescription, which means that consumers will be able quickly and effectively treat a lice infestation without the need to use a nit-comb or a trip to the dermatologist or doctor.

According to the FDA, the goal of the prescription (RX)-to-OTC switch is to foster public health and hygiene by making it easier for consumers to access an effective topical lice treatment, which will help decrease infestation rates and give people a convenient way to treat lice at home.

“This is great news, Sklice is a great product,” Bruce Robinson, MD, a board-certified adult and pediatric dermatologist and clinical professor of dermatology at Lennox Hill Hospital, tells Verywell. “Prescription lice treatment can be hard to get and some OTC treatments aren’t very effective. This will make Sklice more accessible for patient care.”

The switch was permitted because Sklice's manufacturer, Arbor Pharmaceuticals, proved that the drug is safe and effective when used as directed (carefully following the instructions on the product label) and can be used safely without the supervision of a healthcare professional.

How Lice is Transmitted

Head lice do not jump and are most commonly transmitted through head-to-head contact with someone who has live lice (adult lice).

According to the Centers for Disease Control and Prevention (CDC), while it's uncommon, it is possible for lice transmission to occur through sharing common items like hats, scarves, sports equipment and uniforms, hair ribbons, brushes, and combs, or lying on a bed or pillow that was used by someone with an active infestation.

When a child has lice, they might have to stay home from school until the treatment is successful.

However, the AAP discourages "no-nit school policies," which can negatively affect a child's education as well as contribute to the stigma surrounding head lice.

How to Check for Lice

All household members and people who have close contact with someone who has lice will need to be checked for live lice and nits. However, medicines that treat lice (called pediculicide treatments) should only be used on someone with an active infestation.

If you think your child has lice, the AAP recommends taking the following steps to check them for an infestation.

1. Seat your child in a brightly lit room.
2. Carefully part their hair (using a fine-tooth comb can help).
3. Checking one section of hair at a time, look for crawling lice as well as nits on your child's scalp.

How to Treat Lice

There are both OTC and prescription medications available to treat lice. Regardless of the product you choose, always follow the instructions on the label. If you are not sure how to use a lice treatment or if you think it hasn't worked, talk to your doctor.

Sklice: No Nit-Comb Needed

Most lice treatment products rely on the time-consuming post-treatment process of using a nit-comb to carefully remove all remaining nits (eggs) from a person's hair.

Sklice, a topical lotion treatment, can be applied to people 6 months of age and older. To apply the product, start by lathering the entire scalp and dry hair with the lotion and letting it sit for 10 minutes before rinsing with water. Unlike with other treatments, no combing is required.

“It is a great treatment,” Deirdre Hoo per, MD, a board-certified dermatologist and clinical professor of dermatology at both Louisiana State University and Tulane University, tells Verywell. “The biggest problem with lice treatment is that it is time-consuming. Children get it and bring it home and trying to get lice out of your three kids' hair takes a lot of time and moms are busy. No one does a good job of combing.”

A study published in The New England Journal of Medicine in 2012 reported that 74% of patients who received a one-time dose of ivermectin 0.5% with no combing were lice- and nit-free after 15 days. Only 18% of patients that used a vehicle control product were lice and nit-free after 15 days.

Ivermectin's method of action targets nerve and muscle cells of a louse, causing paralysis and death.

In addition to Sklice, there are also other AAP-approved lice treatments that are available OTC and by prescription.

OTC Lice Treatments

• Pyrethrins-shampoo or hair mousse (Brand names: Rid, A-200, Pronto, R&C, Triple X, Licide): Approved for children 2 years and older. Apply the product to dry hair and rinse with water after 10 minutes. These products kill lice, but not eggs. If live lice are found, re-treatment might be necessary after 10 days.
• Permethrin lotion 1%: Approved for children 2 months old and older. Apply to shampooed, towel-dried hair and rinse with water after 10 minutes. This product kills lice, but not eggs. If live lice are found, re-treatment might be necessary after 10 days.

Prescription Treatments

• Malathion lotion 0.5% (Brand: Ovide): Approved for children 6 years or older. Apply to dry hair and rinse with water after 8 to 12 hours. This product kills lice and eggs. If live lice are found, re-treatment might be necessary after 7 days. Warning: This product is flammable and may cause chemical burns.
• Benzyl alcohol lotion 5% (Brand: Ulesfia): Approved for children 6 months and older. Apply to dry hair and rinse with water after 10 minutes. This product kills lice, but not eggs. Re-treatment is needed after 7 days.
• Spinosad topical suspension 0.9% (Brand: Natroba): Approved for children 6 months and older. Apply to dry hair and rinse with water after 10 minutes. This product kills lice and eggs. If live lice are found, re-treatment might be needed after 7 days.

Comb-Out Method

The comb-out method can be used to help find nits and lice as well as to remove nits from the hair. However, it should not be relied on to treat an active lice infestation.

• Step 1. Wet your child's hair.
• Step 2. Use a fine-tooth comb and comb through your child's hair in small sections.
• Step 3. After each comb-through, wipe the comb on a wet paper towel. Examine the scalp, comb, and paper towel carefully.
• Step 4. Repeat steps 2 and 3 until you've combed through all of your child's hair.

You should wash all clothes, bed linens, towels, and hats that have been used within two days before head lice were found. You do not need to throw these items away, but they do need to be treated in hot water and dried on high heat.

Negative Stigma

According to a review published in Frontiers in Cellular and Infection Microbiology in January 2020, head lice have been living off of human blood for thousands of years and have been a common nuisance throughout human evolution.

“There is a stigma that those with lice are unclean or have dirty hair and nothing could be further from the truth,” Robinson says. “Lice feed off of blood from the scalp; it does not matter if the hair is clean or dirty.”

Head lice are found worldwide and do not cause serious illness or carry disease. It doesn’t matter how clean, dirty, rich, or poor a person or place is—everyone is fair game when it comes to getting head lice.