Before I lay out the various head lice treatments available, I'd like to share with you all a recent discussion I had with a parent in my office.  During the course of a typical ill visit, the conversation ultimately made its way to the topic of head lice.  Not quite sure how we ended up there, but nevertheless, we did.  Anyway, she had mentioned to me how one of the local agencies that will come to the home of a lice-infested child and guarantee full eradication charged a friend of hers nearly $1,000 as multiple visits were required.  Now I realize these businesses have been quite successful but I still stood there flabbergasted as I have a difficult time understanding why it costs so much when we're dealing with something with minimal health consequences.  But I suppose since there is such a preoccupation with head lice, for some it doesn't matter what the price is as long as resolution occurs. 

But why don't we take a step back and get a better understanding of what head lice treatment actually entails.  In essence, treatment involves three simple steps:

1. Killing the lice.


2. Combing or manually removing the lice.


3. Keeping lice from spreading.

So how best to kill lice?  Well, a variety of treatment types exist...gel, shampoo, cream rinse and mousse...and nearly always, a second course of treatment is required.  Two of the over-the-counter (OTC) medications include:

1. Pyrethrins (brand names include Rid and Pronto among others): As they only kill live lice and not the nits (AKA the eggs), a second treatment occurs 7-10 later. As they are usually in shampoo form, application time is usually for just 10 minutes before rinsing out. Unfortunately, resistance is common these days in particular geographic locations. Also, if your child is sensitive to ragweed, treatment with pyrethrins is not recommended secondary to the concern of an allergic reaction...although there is some debate surrounding this.


2. Permethrin 1% (brand name Nix): Approved for children above 2 years of age, this cream rinse is applied after shampooing with a non-conditioning shampoo. It is left on for about 10 minutes and because it, too, kills only the live lice and not the nits, reapplication occurs 7-10 days later as well. But bear in mind, the residue from this cream is designed to kill the newly hatched lice (unlike the pyrethrins). But following the theme of pyrethrins, resistance is now being reported.

As far as some of the prescription medications, I offer you three of the more commonly used ones:

1. Permethrin 5% (brand name Elimite): Now some of you may recognize this is as the cream used for scabies treatment. Although there is some debate on whether it is more effective then permethrin 1%, there has been definite anecdotal reported success. With this cream, it is left on overnight and then washed off in the AM.


2. Malathion 5% (brand name Ovide): This lotion had been off the U.S. market for a period of time then reintroduced earlier this decade. It, too, is left on overnight and then washed off in the AM. Repeat use in 7-10 days is typically recommended. The concerns surrounding this produce are that it has a high alcohol content...making it quite flammable...and the risk of respiratory compromise if ingested. Personally, I certainly like its effectiveness, but I become a bit queasy with the concerns surrounding its use.


3. Lindane 1% (brand name Kwell): I begin my description by saying it has central nervous system side effects if used improperly and seizures have been reported with its use. Application time is only 10 minutes with reuse 7-10 days later. Because resistance has been reported for quite some time and the above-mentioned health concerns, I certainly try to avoid its use in general and will certainly avoid prescribing it in young children.

But remember with whatever medication that is used, please follow the directions as outlined on the box or on the prescription label.  And just a couple of words on the home remedies many of you are probably already aware of...mayonnaise, olive oil, petroleum jelly, herbal oils...although certainly ok to try, they have yet to be scientifically proven to work.  But for those hoping for a natural treatment resolution, go ahead and give it a go...just lather it in and leave it on the hair overnight with a shower cap on top. 

Now as far as combing out the nits, a few important points to keep in mind:  Go ahead and use the special comb as it can make it more effective in removing the lice.  Be patient...both you and your child...as this process can take quite some time.  Spend the same amount of time daily for about 2 weeks before feeling comfortable you have resolution.  And please note, this is how the come-to-your-home lice agencies make the big bucks. 

Lastly, I share with you all some of the tips in preventing lice from spreading:

• Check everyone else in the house for lice...don't overlook anyone.


• Wash all clothes, towels, hats, bed sheets in hot water and dry on high heat.


• Vacuum things that cannot be washed...furniture, carpets, fabrics...anything your child may have been in contact 1-2 days before starting treatment.


• For items that cannot be washed...toys, stuffed animals...put in a plastic bag for two weeks (more than enough time to kill off the lice).


• Soak combs/brushes in boiling water for at least 5 minutes.


• Avoid head-to-head contact as this is the most common way for lice to spread.


• And even though it is much less common for lice to spread in this fashion, still avoid sharing combs/brushes, hats/coats/scarves.

And by the way, for those who read part I and are wondering what my neighbor ultimately did with her son...let's just say his hair is growing back in nicely.

Dr. Jeremy