Treating Head Lice Infestation

How Can I Treat a Head Lice Infestation?

The most important step in treating a head lice infestation is to treat the person and other family members with head lice with medication to kill the lice. Wash clothing and bedding worn or used by the infested person in the 2-day period just before treatment is started.

Treat the infested person: Requires using an over-the-counter (OTC) or prescription medication. Follow these treatment steps:

1. Before applying treatment, remove all clothing.
2. Apply lice medicine, also called pediculicide, according to label instructions. If your child has extra long hair, you may need to use a second bottle. WARNING: Do not use a creme rinse or combination shampoo/conditioner before using lice medicine. Do not re-wash hair for 1-2 days after treatment.
3. Have the infested person put on clean clothing after treatment.
4. If a few live lice are still found 8-12 hours after treatment, but are moving more slowly than before, do not retreat. Comb dead and remaining live lice out of the hair. The medicine may take longer to kill lice.
5. If, after 8-12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. See your health care provider for a different medication; follow treatment directions.
6. Nit (head lice eggs) combs, often found in lice medicine packages, should be used to comb nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective.
7. After treatment, check hair and comb with a nit comb to remove nits and lice every 2-3 days. Continue to check for 2-3 weeks until you are sure all lice and nits are gone.
8. If using OTC pediculicides, retreat in 7-10 days. If using malathion, retreat in 7-10 days only if crawling bugs are found.

Treat the household: Head lice do not survive long if they fall off a person. You do not need to spend a lot of time or money on house cleaning activities. Follow these steps to help avoid re-infestation by lice that have recently fallen off the hair or crawled onto clothing or furniture.

1. To kill lice and nits, machine wash all washable clothing and bed linens that the infested person touched during the 2 days before treatment. Use the hot water (130^o F) cycle. Dry laundry using high heat for at least 20 minutes
2. Dry clean clothing that is not washable, (coats, hats, scarves, etc.) OR
3. Store all clothing, stuffed animals, comforters, etc., that cannot be washed or dry cleaned into a plastic bag; seal for 2 weeks.
4. Soak combs and brushes for 1 hour in rubbing alcohol, Lysol^*, or wash with soap and hot (130^o F) water.
5. Vacuum the floor and furniture. Do not use fumigant sprays; they can be toxic if inhaled or absorbed through the skin.

Prevent Reinfestation: Lice are most commonly spread directly by head-to-head contact and indirectly though contaminated clothing or belongings. Teach your child to avoid playtime and other activities that are likely to spread lice.

1. Avoid head-to-head contact common during play at school and at home (slumber parties, sports activities, at camp, on a playground).
2. Do not share clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons.
3. Do not share infested combs, brushes, or towels.
4. Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person.

My child has head lice. I don’t. Should I treat myself to prevent being infested? No, although anyone living with an infested person can get head lice. Check household contacts for lice and nits every 2-3 days. Treat only if crawling lice or nits (eggs) within a 1/4 inch of the scalp are found.

Should my pets be treated for head lice? No. Head lice do not live on pets.

My child is under 2 years old and has been diagnosed with head lice. Can I treat him or her with prescription or OTC drugs? For children under 2 years old, remove crawling bugs and nits by hand. If this does not work, ask your childs health care provider for treatment recommendations. The safety of head lice medications has not been tested in children 2 years of age and under.

What OTC Medications are Available to Treat Head Lice?

Many head lice medications are available at your local drug store. Each OTC product contains one of the following active ingredients.

• Pyrethrins (pie-WREATH-rins): often combined with piperonyl butoxide (pie-PER-a-nil beu-TOX-side): Brand name products include A-200*, Pronto*, R&C*, Rid*, Triple X*.
  • Pyrethrins are natural extracts from the chrysanthemum flower. Though safe and effective, pyrethrins only kill crawling lice, not unhatched nits. A second treatment is recommended in 7-10 days to kill any newly hatched lice. Treatment failures are common.
• Permethrin (per-meth-rin): Brand name product: Nix*.
  • Permethrins are similar to natural pyrethrins. Permethrins are safe and effective and may continue to kill newly hatched eggs for several days after treatment. A second treatment may be necessary in 7-10 days to kill any newly hatched lice. Treatment failures are common.

What Are the Prescription Drugs Used to Treat Head Lice?

• Malathion (Ovide*): Malathion has just been reapproved for the treatment of head lice infestations. Malathion treats both lice and head lice eggs. When used as directed, malathion is very effective in treating lice. Few side-effects have been reported. Open sores from scratching may cause malathion to sting the scalp.
• Lindane (Kwell*): Lindane is one of the most common products used to treat head lice. When used as directed, the drug is probably safe. Overuse, misuse, or accidentally swallowing Lindane can be toxic to the brain and other parts of the nervous system. Lindane should not be used if excessive scratching has caused open sores on the head.

If you aren’t sure, ask your pharmacist or health care provider. When using the medicine, always follow the instructions provided.

When Treating Head Lice

1. Do not use extra amounts of the lice medication unless instructed. These drugs are insecticides and can be dangerous when misused or overused.
2. Do not treat the infested person more than 3 times with the same medication if it does not seem to work. See your health care provider for alternative medication.
3. Do not mix head lice drugs.

Should household sprays be used to kill adult lice? No. Spraying the house is NOT recommended. Fumigants and room sprays can be toxic if inhaled or absorbed through the skin.

Should I have a pest control company spray my house? No. Vacuuming floors and furniture is enough to treat the household.

Source: Department of Health and Human Services, Center for Disease Control and Prevention