How Head Lice Is Treated

It can be distressing to discover head lice. However, you can follow some simple steps to effectively treat the lice at home. For particularly stubborn cases, you can check with your healthcare provider to see if you need a prescription.

This article discusses head lice treatments, including over-the-counter and prescription medication. It also looks at-home remedies, complementary medicine, and off-label medications.

Home Remedies for Lice
Verywell / Jessica Olah

Over-the-Counter (OTC) Therapies

The first-line treatment of head lice is using an anti-lice shampoo, such as Nix or Rid. You can buy these at the drugstore or online. Known as pediculicides, they will kill the adult lice outright, but they don't kill nits (lice eggs). 

Nits hatch in seven to 10 days and develop into egg-laying adults in another seven to 10 days. You usually have to re-treat with an anti-lice shampoo seven to 10 days after an initial application. This kills any newly hatched head lice and breaks this lice life cycle.

Many experts recommend doing the second head lice treatment on the ninth day.

The most popular OTC options are:

Nix (permethrin) 

This 1% permethrin lotion is the first choice for treatment. It is the least toxic to humans and is less allergenic than Rid.

It leaves a residue on the hair that should kill the nymphs that hatch from any viable eggs. However, since your regular shampoo and conditioner can keep Nix from adhering to the hair shaft, a second application on the ninth day is needed.

Permethrin is toxic to the lice's neuro system. Some lice have developed resistance to permethrin.

Rid (pyrethrins plus piperonyl butoxide)

Rid is a shampoo made from chrysanthemum extract that is toxic to lice but only has a low toxicity in humans and other mammals. However, there are rare allergic reactions in people who are sensitive to the flower.

Unlike Nix, it doesn't remain on the hair, so a second application is needed. The effectiveness of this product has been decreasing as resistance grows.

LiceMD (dimethicone)

LiceMD Pesticide Free is another type of OTC anti-lice shampoo. Known as an occlusive agent, it uses dimethicone. This is a non-toxic form of synthetic silicone oil. It works by closing off the lice's breathing spiracles and smothering them.

A benefit of this treatment is that it makes the hair slippery, so it's easier to use the lice comb on long or curly hair. 

A fine-toothed lice comb is included with all of these products, which you will use to remove the nits. You will continue to remove nits after application of the treatment. You may have to check each night for a week or more until you get them all.

The nits are tenacious and the closely-spaced tines of the comb, which are usually made of steel, can scrape them off individual hairs. (More on combing below.)

You shouldn't use dog shampoo to treat lice on humans. It's true that it may contain some of the same active ingredients as some anti-lice shampoos. However, dog shampoo is not made for, nor has it been tested on humans. There is no way to know that it's safe or that it works.

Home Remedies

While combing is a recommended part of an anti-lice shampoo treatment, it's also a useful home remedy in and of itself.

Cleaning is another important step not to overlook. Other home remedies have not been proven to be as effective.

Combing and Nit-Picking

You may remove the nits and live lice with a lice comb and tweezers. This is a recommended part of an OTC treatment course but is also useful as an alternative for those interested in a natural approach. The National Pediculosis Association recommends using its LiceMeister comb to regularly screen for, detect and remove lice and nits.

For combing after treatment with an anti-lice shampoo, follow the directions. Do not wash the hair for the recommended length of time (one or two days). You will do the combing eight to 12 hours after product application.

For non-treated hair or after the no-wash period has expired, it is easiest to do the combing after you have washed the hair and used hair conditioner.

How to Remove Lice

Note that it can take an hour or two to properly perform the lice combing. It can take longer for long or curly hair. Follow these steps:

  1. Assemble your supplies: a regular comb, fine-toothed lice comb, spray bottle of water, tweezers, magnifying lens, tissues, a bowl of hot water, clips and rubber bands (to use to secure the hair as you comb), and a towel.
  2. Settle the person being treated into a comfortable position with entertainment such as a video, book, or game. Place a towel around the person's shoulders to protect the clothing.
  3. Comb out damp hair with the regular comb so any tangles are eliminated. Wet hair is best for combing. Use the spray bottle to wet hair as needed.
  4. Start at the top of the head. Place the teeth of the lice comb as close to the scalp as possible (where any newly-laid eggs and adult lice will be).
  5. Lift a small section of hair. Scoop the comb into the hair section at the scalp. Then comb upward along the hair shaft with a firm, even motion to the end of the hair.
  6. Return the lice comb to the scalp and rotate it 45 degrees from the original position. Again comb from the scalp to the end of the hair shaft. Do this two more times so you have combed the lock from each of four directions. 
  7. If you observe any nits or adult lice that aren't removed with the comb, remove them with tweezers. You may want to use a magnifying glass to see them.
  8. Clip the section of hair you just finished with a hair clip. Wipe the lice comb frequently with the tissue and observe to see if there are any lice or nits being removed. Lift another section and comb it in the same way.
  9. Continue until you have combed all sections. Pay special attention to the areas around the ears and the hairline at the back of the neck, which are preferred by lice.
  10. Ensure the hair is wet and do a final pass with the lice comb, this time without parting the hair. This can make it easier to capture light-sensitive live lice.
  11. After you are finished, wash the hair.
  12. Clean the lice comb and hair products in hot water. Launder the towel and your clothes.

You should repeat the procedure daily for several days to make sure that you get all of the lice and nits. If you don't, the eggs will hatch and lice will be present again. Do the lice combing again two weeks after treatment to ensure the lice are gone.

No home remedies or products that claim to loosen the nits from the hair have been proven to be effective, so it's wise not to use them.

Some, such as vinegar, can interfere with the residual activity of permethrin. Others, such as WD-40, bleach, or acetone can damage the hair and pose a toxic risk or risk of fire when used.

There is one other way to go. Lice removal specialists will do all the dirty work at your home or at their place of business.

It's even possible that your health insurance will cover head lice removal or that you can get reimbursed through your health savings account. If so, it may be worth it, especially if it's you who has the lice.

Effective self-treatment is nearly impossible. Lice removal specialists really are pros at making sure every single nit gets picked.

Cleaning

The American Academy of Pediatrics (AAP) recommends cleaning any clothing or other items that have been in contact with the head of the person who has lice in the past 24 to 48 hours.

Some tips include:

  • Wash clothing and bedding in hot water and dry in a hot dryer.
  • Use a vacuum to remove lice and nits from furniture, carpets, stuffed animals, car seats, and other objects.
  • Put items you can't easily clean into a large plastic bag and close it up tight for two weeks. If any lice hatch, they will starve without having access to blood.

Smothering (Occlusive) Agents

Most other natural home remedies involve putting something on the scalp and hair to "smother" the head lice, much like LiceMD. Popular choices include mayonnaise, olive oil, and Vaseline (petroleum jelly).

These are usually left on overnight, often under a shower cap, and then washed out the next day. They can be very messy, though, and have not been proven to work.

Some experts believe that any benefit this method may have comes from nits and lice being removed as you try to wash the agent out of your hair.

Prescriptions

See your pediatrician or family healthcare provider if you can't get rid of lice. Lice can be stubborn, able to live through an entire course of lice shampoo treatment. A healthcare provider can confirm whether live lice are still present and teach you how to better identify and remove nits.

Your pediatrician will likely know the patterns of resistance to the usual anti-lice shampoos in your area, if applicable. They can help determine what the best next treatment for you might be.

Your healthcare provider may prescribe a prescription-strength anti-lice medication, such as:

Ovide (malathion)

Malathion kills live lice as well as some lice eggs. The lotion is applied to dry hair and left to air dry, then washed off after eight to 12 hours. Only one application is usually needed.

It is highly flammable because it contains alcohol. You must not use a hairdryer or smoke while it is being applied or drying.

It is not used for children younger than age 2, and the safety hasn't been assessed for children under age 6.

Ulesfia (benzyl alcohol lotion 5%)

Ulesfia is a non-pesticide prescription treatment for head lice.

Ulesfia can be applied to the hair of children over 6 months of age until it is saturated. It's washed off after 10 minutes and then reapplied seven days later.

Unlike Nix, Rid, and other head lice shampoos, Ulesfia is thought to work by blocking the louse's respiratory spiracles, thereby suffocating it.

Natroba (spinosad 0.9% suspension)

Natroba is a suspension of benzyl alcohol and compounds formed by a soil bacteria during fermentation. It's approved for topical use in children 6 months of age and older.

It works much like permethrin and lingers to have effects on any eggs that hatch. However, it does need a second application after seven days.

Sklice (ivermectin 0.5%)

This topical lotion was approved by the U.S. Food & Drug Administration (FDA) in 2012 for children 6 months or older. It causes muscle paralysis in the lice. Only one application is needed.

Xeglyze (abametapir)

Xeglyze was approved by the FDA in 2020 to treat head lice in patients 6 months or older. It's applied once to dry hair.

Head Lice Doctor Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Child

Complementary and Alternative Medicine (CAM)

Complementary and alternative medicine uses therapies outside of conventional medicine. These practices and products may sometimes be used along with traditional treatments.

In treating head lice, essential oils are sometimes touted for treating infestations. To test these claims, some researchers have looked at the effects of different essential oils on lice.

A 2012 study looked at the effect of tea tree oil and nerolidol, a component of essential oils, on head lice. It found that tea tree oil was able to kill 100% of head lice in 30 minutes at 1% concentration. Nerolidol at 1% concentration was able to keep 50% of eggs from hatching after four days.

Products containing neem seed extract have shown potential for killing head lice with a single treatment in some small studies.

However, most of the few studies on this are performed in a test tube, so the effectiveness of these treatments in humans is questionable.

If you do try essential oils, it is important to note that they shouldn't be applied at full strength to the skin, as they can be irritating and have adverse effects when absorbed. It should be diluted with a carrier oil or skin lotion.

As there isn't much research, it isn't known whether the products containing essentials oils or neem extract are safe. This is especially true for vulnerable populations such as children, pregnant women, and nursing mothers. 

The American Academy of Pediatrics cautions against using herbal anti-lice products on infants and children.

Summary

Head lice can often be treated at home with over-the-counter medications. Home remedies like combing and nit-picking can also remove nits and live lice. If you are having trouble getting rid of lice, your healthcare provider may suggest a prescription-strength medication.

Essential oils like tea tree oil have been studied for their effects on lice. However, research is mostly limited to test-tube studies. More studies are needed to determine the effects on people.

Off-Label Medications

In addition to topical medications, there are two oral prescriptions that healthcare providers may use off-label:

Stromectol (ivermectin)

This is an antiparasitic drug that has shown effectiveness in treating resistant head lice infestations. It is given in two doses, seven to 10 days apart. Because this drug will also cross into the human brain and may affect neural activity, it shouldn't be given to children who weigh less than 33 pounds. 

Septra or Bactrim (trimethoprim-sulfamethoxazole)

You may be familiar with this antibiotic for other types of infections. You take a 10-day course. It has been shown to be effective at treating resistant infestations of head lice and may be used in combination with Nix.

While these are being researched, the FDA has not approved oral drugs for the treatment of head lice.

A Word From Verywell

Getting effective treatment is necessary to wipe out a lice infestation and stop it from spreading. Choosing conventional treatments that are known to work offers your best chance at putting this behind you.

If you're having trouble getting rid of lice, check with your healthcare provider. They can give you tips for treating it and help find the medication that will work best for you.

Frequently Asked Questions

  • Is it possible to get rid of head lice instantly?

    No. But you may be able to clear someone's scalp of adult lice and nits in eight to 12 hours with medication and thorough and careful removal of nits. Once lice no longer have human contact, they die quickly, so you should not have to worry about re-infestation.

  • Are there any lice medications that are safe to use during pregnancy?

    According to the Centers for Disease Control and Prevention, people who are pregnant should not use Sklice (ivermectin) or lindane shampoo (which people who are breastfeeding also should avoid).

  • Why does my head still itch after treatment for lice?

    Post-treatment scalp itch can last for weeks after head lice are gone. Sometimes this is because of irritation to the scalp caused by scratching. It also can be a reaction to the ingredients in lice medication, as can happen when someone who's allergic to ragweed or chrysanthemums uses pyrethrins.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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