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Home treatment with nonprescription medicines can usually get rid of lice. These medicines include:

• Nix (permethrin 1% creme rinse).
• Rid, Pronto, A-200, R&C, or Triple X (shampoos and gels with pyrethrins and piperonyl butoxide).

If nonprescription methods are not working, a stronger medicine may be needed. Your health professional may prescribe a more concentrated (5% instead of 1% nonprescription) form of permethrin (Elimite), malathion lotion, or a shampoo containing pyrethrins and piperonyl butoxide.

Health professionals in the United States recommend using a lotion or shampoo to kill the eggs and lice. In Britain, where lice have become resistant to medicated lotions and shampoos, one study found that using special fine-toothed combs with a conditioner helped get rid of head lice.³ You may choose to remove the eggs through combing to improve your or your child's appearance. Cleaning combs, brushes, clothing, and other objects can help prevent lice from spreading to other members of your household.

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There are both nonprescription medicines and prescription products to treat head and pubic lice. Most products come as a shampoo, creme rinse, or lotion (topical treatment) that is applied to the affected areas, left on for a period of time, and then rinsed off. Doctors sometimes prescribe the pill ivermectin to treat lice when two or more approved topical medicines have not been effective.

Permethrin 1% creme rinse (such as Nix) is also a common first method of treating lice because it is safe and effective and continues to kill lice and their eggs (nits) even after the cream has been rinsed off. This product is available without a prescription.

When treating lice with medicine, keep in mind:

• A second treatment 7 to 10 days after the first treatment is usually recommended to ensure that any newly hatched lice are also killed.
• Itching may persist even after successful treatment. Do not reapply medicated products unless you are advised to do so by a doctor. Excess use of these products may increase the risk of negative side effects such as nausea, headaches, or more serious side effects.

If lice infest the eyelashes, applying petroleum jelly (such as Vaseline) to the eyelashes several times a day for a week can kill the lice.

Generally, drugs are not needed to treat body lice-since the lice live in clothing, not on the body-unless the person is severely infested. The most common way to treat body lice is to wash clothing and bedding in hot water [130 F or higher] in an automatic washing machine in order to kill the lice and eggs.

Medication Choices

Nonprescription products for head and pubic lice

• Permethrin creme rinse 1% (Nix) is a common first choice for treating head lice. It kills lice and their eggs for 2 weeks or more after it has been rinsed off.
• Shampoos containing pyrethrins and piperonyl butoxide (Pronto, Rid, A-200) are left on the hair for 10 minutes and then rinsed out. A second treatment is needed 1 week after the first to kill newly hatched lice.

Prescription products for head and pubic lice

• Permethrin cream 5% (Elimite) is a cream that is applied to the skin or scalp, left on for 8 to 14 hours, and then rinsed.
• Malathion lotion (Ovide) is applied to hair and left on for 8 to 12 hours before rinsing off. A second treatment must be done 7 to 9 days later if lice are still present.
• Lindane (Kwell, G-Well) is a lotion or a shampoo that should only be used when other products fail to get rid of lice or when a person cannot use any of the other products. Lindane contains potentially harmful toxins that can cause negative side effects when it is not used properly.⁴
• Carbaryl, which comes in lotion or shampoo form, is used only in Europe. It currently is not available for human use in the United States or Canada.

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What are lice?

Lice are tiny insects that live on humans and feed on blood. When a large number of lice live and multiply on a person, it is called an infestation.

Three different kinds of lice live on humans:

• Head lice are usually found in hair, most often on the back of the neck and behind the ears. Head lice are common in preschool and elementary school-age children. Adults can get them too, especially adults who live with children.
• Pubic lice , also called crabs, are usually found in the pubic area. But they may also be found on facial hair, on eyelashes, on eyebrows, in the armpits, on chest hair, and, rarely, on the scalp.
• Body lice live and lay eggs (nits) in the seams of clothing. The lice are on the body only when they feed.

What causes a lice infestation?

Lice spread easily from one person to another through close contact or through shared clothing or personal items (such as hats or hairbrushes). A louse cannot jump or fly.

What are the symptoms?

The most common symptom of lice is itching. There are different symptoms, depending on which type of lice you have.

• Head lice may not cause any symptoms at first. Itching on the scalp may start weeks or even months after lice have started to spread. Scratching can make the skin raw. The raw skin may ooze clear fluid or crust over, and it may get infected.
• Pubic lice cause severe itching. Their bites may cause small marks that look like bruises on the torso, thighs, or upper arms. If pubic lice get on the eyelashes, the edges of the eyelids may be crusted. You may see lice and their eggs at the base of the eyelashes.
• Body lice cause very bad itching, especially at night. Itchy sores appear in the armpits and on the waist, torso, and other areas where the seams of clothes press against the skin. The lice and eggs may be found in the seams of the person's clothing but are generally not seen on the skin.

Frequent scratching can cause a skin infection. In the most severe cases of head lice, hair may fall out, and the skin may get darker in the areas infested with lice.

How is a lice infestation diagnosed?

A doctor can usually tell if you have lice by looking closely for live lice or eggs in your hair. He or she may look at the lice or eggs under a microscope to be sure.

Your doctor can also find pubic lice and body lice by looking closely at your body or your clothing.

How is it treated?

The most common treatment is an over-the-counter or prescription cream, lotion, or shampoo. You put it on the skin or scalp to kill the lice and eggs. In some cases, you may need treatment a second time to make sure that all the eggs are dead. If two or more treatments don't work, your doctor may prescribe a pill called ivermectin.

It’s also important to wash clothing and bedding in hot water to help get rid of lice.

Some people have an allergic reaction to lice bites that causes itching for 7 to 10 days after the lice and eggs have been killed. Steroid creams or calamine lotion can relieve the itching. If you have severe itching, you can try antihistamine pills.

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Lice will not go away without proper treatment. Treatment should begin as soon as symptoms of lice are noticed or when live lice and eggs (nits) are seen on the person's body or in clothing. Specific treatment depends on the type of lice infestation.

• Head lice and pubic lice are destroyed with nonprescription or prescription medicines applied to the skin or scalp, and sometimes with the prescription pill ivermectin. The most common way to treat lice is to use medicated creams, lotions, or shampoos that kill lice.
• Body lice , which live and lay eggs in the seams of clothing, are destroyed by washing clothing in hot water [130 F or higher] for 5 minutes or more. This will usually kill adult lice and prevent eggs from hatching. Body lice are only present on the skin when they feed and will usually go away on their own if you bathe daily and wear clean clothes. Medicines to kill body lice are usually not needed.

Usually, children with head lice return to school or day care after their first treatment. However, some schools have a "no nits" policy. In this case, the child can only return to school or day care after eggs have been removed. "No nits" policies are discouraged by both the American Academy of Pediatrics and the National Association of School Nurses.² Most health professionals agree that a child should be allowed to return to class after proper treatment and should be urged to avoid close head-to-head contact with other students. Confidentiality should be maintained so as not to embarrass a child who has head lice.

Itching may continue even after all lice are destroyed because of a lingering allergic reaction to their bites. Corticosteroid creams or calamine lotion can help. For severe itching, antihistamine medicines (such as Benadryl) or stronger, prescription-strength corticosteroid creams may be needed.

What To Think About

Who should be treated?

• Household members and anyone who has been in close contact with a lice-infested person should be examined for signs of lice. If they have itching and skin sores that are commonly seen with lice infestations or if lice or eggs are found on their bodies, treatment is recommended.
• Anyone who has shared a bed with a person who has lice should be treated, whether they have symptoms or not.
• If lice recur after treatment, everyone in the household should be treated again with medicine.
• People who have pubic lice are encouraged to tell their sex partners so that they can also be treated. It is also a good idea to see a health professional to be tested for other sexually transmitted diseases. Up to one-third of people who have pubic lice also have some other sexually transmitted disease.¹

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