Lice Lessons

Those little buggers can be tough to beat, but this guide to safe and effective treatments will help you ditch the itch.
girls braided hair

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At age 3, my daughter, Molly, had long, thick hair with soft, loose curls. I absolutely loved it -- until lice struck when my son, Frankie, was only 3 weeks old. What's worse than a colicky newborn and a newly potty-trained preschooler? Try that plus a lice infestation lasting three months (yes, I said months). Before the diagnosis, I worried about how I'd keep the house clean, take care of a newborn, and still have quality time with Molly. I never suspected that QT would be spent wrestling a nit comb through her hair while she screamed and the baby cried.

Lice are tiny insects that attach to human hair and feed on the host's blood, usually causing intense itching. Since they move fast and avoid light, the tip-off to their presence is often their eggs -- called nits -- which are small gray or light-brown specks that seem glued to the hair shaft.

Back when we were kids, getting rid of the pests was a simple if unpleasant process: Your mom would douse your hair in Kwell, a chemical lice-killing shampoo, and then make you sit still while she combed out the nits.

It's more complicated today. Lindane, the active ingredient in Kwell, was found to cause seizures and even death in rare cases, prompting the FDA to issue a public-health advisory against products containing lindane in 2003. While it's still on the market, the American Academy of Pediatrics (AAP) doesn't recommend it. Moreover, lice have developed resistance to lindane and other chemical treatments.

Thankfully, head lice don't transmit disease and they may be less common than we think. Although there are an estimated 6 to 12 million reported cases of head lice annually, Richard J. Pollack, Ph.D., an entomologist at the Harvard School of Public Health, says that dandruff, dirt, and tiny clumps of scalp cells called DEC plugs are all often mistaken for nits.

But if head lice strike your household, take comfort in knowing there are now a host (sorry!) of treatment options. So many, in fact, that you'll need this handy guide to figure out which is best for your family.

How to Identify and Treat Lice
How to Identify and Treat Lice


The Standbys

Are you most comfortable with a removal method that's been around a while? Choose one of these.

Louse- and nit-combing
This is the oldest approach. If you use it with another treatment, follow package directions for that product. If it's your sole method, slow down lice before you comb by moistening hair with any thick white conditioner (which makes it easier to get the comb through), or a dimethicone-based product such as LiceMD PesticideFree, or a mix of conditioner and baking soda (for extra grip). This way you can remove live lice and nits. For two weeks, comb the entire head every day or so, targeting a small section at a time and starting as close to the scalp as possible. Most experts recommend using a metal nit comb (found at drugstores) and wiping off the nits and lice frequently. The process can take more than an hour and works only if you get every louse and viable egg. (Put on a movie for your kid!)

Over-the-counter chemical treatments
These include the brands Nix (for kids 2 months and up) and Rid (2 years and up). They get their power from the chrysanthemum flower, either through its extracts (pyrethrin) or a synthetic version (permethrin). Treatments that have these ingredients are the only OTC products that are FDA-approved to treat head lice. They come in a rinse or a shampoo you leave on the hair for ten minutes, but they can't completely kill the eggs, so you'll need to nit-comb and re-treat nine days later to kill any newly hatched lice. These products have been used for years, but lice are becoming increasingly resistant to them. However, the AAP still recommends this type of treatment as the first line of defense. "It has the longest safety track record, it's available without a prescription at a fair price, and it will work in the majority of cases if used correctly," says Barbara Frankowski, M.D., professor of pediatrics at The University of Vermont College of Medicine and coauthor of the AAP's most recent report on head lice.

Malathion
This lotion (brand name: Ovide, for ages 6 and up) is an insecticide commonly used to fight agricultural pests. It's about 90 percent effective, but is also flammable and needs to be left on a child's head for eight to 12 hours. It's supposed to kill lice and eggs in one treatment, though you can re-treat in seven to nine days if needed. It's available only by prescription and is the only Rx treatment that comes in generic form (which costs less).

New Rx Treatments

Little boy hiding under a towel

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Your kid's doc may want you to try an OTC chemical treatment first. If you do but you still find live lice in the next day or two, she may recommend one of these new Rx options, all of which are lotions you leave on the hair for ten minutes.

Ulesfia (benzyl alcohol)
Approved for kids 6 months and up, this works by asphyxiating lice; it's not a chemical pesticide. It doesn't kill the eggs, so you need two rounds of the lotion and combing is recommended, but one study reported a 100 percent "cure" rate.

Natroba (spinosad)
Derived from the fermentation of a soil bacterium, Natroba (for ages 4 and up) paralyzes the lice, but is safe because it can't get into the human nervous system. Its cure rate is about 85 percent. Unlike Ulesfia, Natroba kills the eggs, which means your child probably needs only one treatment. It should also mean no nit-combing, but this med (and others that don't require nit-picking) only kills the eggs; it doesn't make them disappear. So if you don't want your kid to have a head full of dead lice eggs or her school has a no-nit policy, you have to comb them out.

Sklice (Ivermectin)
This also works by paralysis and should need only one application, but its cure rate is about 75 percent. It's for ages 6 months and up.

New Nondrug Options

Some parents choose to skip calling the doctor and try one of these.

AirAllé
This device, which was formerly called LouseBuster and is cleared by the FDA, uses controlled, heated air to kill lice and eggs in a single treatment. Research results have been impressive: In one study, 95 percent of lice and eggs were killed. A drawback is availability, because the device can be used only by a certified operator (find one at laradasciences.com). Another consideration is cost: Expect to pay between $150 and $250, depending on where you live, though the fee is commonly reimbursed through flexible-spending accounts.

Lice-removal services and salons
These businesses do the nit-picking for you, usually for a hefty price. Staffers also may use (and sell) their own shampoo and other products. Going this route may work -- or not. The companies aren't regulated, so there's no set standard for training, knowledge, or success.

Can essential oils prevent lice?

It's a question many parents ask, feeling that sending their child to a lice-prone classroom is akin to marching her into battle without armor. Studies have shown that some essential oils do, indeed, possess anti-lice properties. But, like other natural products, lice treatments based on these scented oils aren't required to be tested and FDA-approved. Heather Jeney, M.D., an integrative pediatrician in Montclair, New Jersey, has found certain formulas -- including Fairy Tales' Rosemary Repel line -- to be effective, while Stuart Ditchek, M.D., a pediatrician in Brooklyn, New York, and an author of Healthy Child, Whole Child, stands behind Licenders' peppermint oil-containing products. Both companies' products are designed to be applied regularly to repel lice and to eliminate an active infestation, when used in combination with proper nit and lice removal.

A word of caution: Never use an undiluted essential oil on your child without consulting her doctor -- it can be irritating and potentially toxic.

Home Remedies

You can see the appeal: These common substances are cheap, readily available, and nontoxic. Some people swear by them. Others say that controlled studies are lacking and you're better off with a proven method.

Olive oil, butter, petroleum jelly, Crisco, mayonnaise
There are many methods for using these, but they generally involve, in various orders, nit-combing, dousing the hair and scalp with the substance, leaving it on overnight under a shower cap to suffocate lice, and repeating the process at least twice. These greasy substances can be difficult to remove, so serious shampooing afterward is necessary.

Cetaphil
Dermatologist Dale Pearlman, M.D., of Menlo Park, California, published a study in Pediatrics about a lotion found to be 96 percent effective in curing head lice. He later explained that the lotion was the gentle facial cleanser Cetaphil. While some have criticized his study and Cetaphil hasn't been evaluated by the FDA for head lice, Dr. Frankowski has found that it works in most cases "if the family follows all the directions properly."

Do's and Don'ts

head lice

DO rinse chemical treatments in the sink (rather than the tub) to minimize skin exposure; nit-comb over a disposable drop cloth.

DO pay special attention to the nape of your child's neck and behind the ears -- a louse's favorite places to hang out.

DON'T think continued itching means that a treatment has failed. A kid can keep itching for days after lice are gone.

DON'T wash your child's hair obsessively during an outbreak. Head lice aren't a sign of poor hygiene.

DON'T use any household insecticides, such as those for roaches or ants. They are not intended for human use and shouldn't be applied to hair or skin.

Epilogue

Why did it take my family three months to be lice-free? Not because of anything complex like pesticide resistance, but rather good old reinfestation. Turned out I had the critters too. While I was dogged about checking Molly's hair -- I got lax about checking my own after I didn't find anything the first few times. (Plus, it's really hard to check your own hair well.) Once we got on the same treatment schedule, the lice disappeared and our house returned to normal -- or as normal as a house can be with a colicky baby and a newly potty-trained preschooler.

Originally published in the September 2013 issue of Parents magazine.

All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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