How to Get Rid of Lice: The Bug Stops Here

Estimates suggest that between 6 and 11 million infestations of lice occur each year in the United States, mostly in children between the ages of 3 and 11. It's a common, childhood problem that has nothing to do with hygiene and eventually plagues most schools and day care centers.

Lice are the worst kind of guests—the uninvited kind—that simply don't know when to leave. Though inconvenient, lice cause no medical harm but unfortunately don't hit the road on their own. Thankfully, there are effective treatments.

Basically, there are two ways to eliminate lice. One is by using a medicated shampoo called a pediculicide. Anti-lice shampoos come in over-the-counter and prescription varieties. Some believe non-toxic methods are effective. Nit picking is a time-consuming process involving a comb through of lice and nits (lice eggs) using a tool specifically designed for this purpose. Though extensive testing has not been conducted, some advocate suffocating lice with natural substances like olive oil, petroleum jelly, butter, margarine, or mayonnaise. The Nuvo approach involves Cetaphil®, a skin cleanser.

The Pros and Cons of Chemical Treatment
The American Academy of Pediatrics reports that over-the-counter medicated shampoos like Nix® (active ingredient permetrin) or Rid® (which contains pyrethrin) are effective and have been well tested for toxicity. "If applied exactly as recommended on the label-with a second treatment 7 to 10 days following the first-a high rate of elimination should result," says Joseph Bocchini, MD, chair of the pediatrics department at the Louisiana State University Health Science Center. "These products are safe, cost effective, and have an 80 percent or higher response rate."

For stubborn cases, consult your pediatrician who can prescribe medicated shampoos that contain other chemicals such as Malathion which is also used to control mosquitoes and Dimethicone. But Bocchini and other experts say to avoid Lindane which has been banned in most countries as well as in. "Lindane is no longer recommended because of its significant toxicity," says the pediatrician. If misused, Lindane can be absorbed by the skin and cause seizures.

A five percent benzyl-alcohol lotion sold under the brand name Ulesfia is a non-pesticide option. Approved by the FDA in 2009, Ulesfia works by suffocation so resistance should not become an issue and experts say it is more effective than home treatments. However, it's pricey (one bottle is $63 on and usually not covered by insurance. Side effects can include headache and stomach upset. Manufacturers recommend using a nit comb after treatment.

Non-Chemical Options
Apart from drug-resistance issues, many parents are concerned about the pesticide component in anti-lice shampoos. Nit picking with a fine-toothed comb is one of the standards in the past, according to Bocchini who is also former chair of the AAP's committee on infectious disease. "But it's extremely time consuming and has a high failure rate."

To remove lice and nits with this method, your child must be seated in good light either outside or under a lamp, since lice are tiny (no bigger than a sesame seed) and translucent, making them difficult to see. Dampen the hair with water and comb through with a regular comb or brush. Then divide the hair into sections using clips. Working with the nit comb-one area at a time-begin at the scalp and slowly move the comb to the ends of hair. Loosen lice and nits by dipping the comb into a bowl of water with a few drops of vinegar added to it. Continue working in this manner throughout the entire scalp. This process must be repeated daily for two to three weeks to be sure no louse or nit is overlooked. (Note: The life cycle of lice is three weeks but they survive less than 48 hours away from the human host.)

Death by Suffocation
The Centers for Disease Control and Prevention (CDC) does not have clear scientific evidence to determine if suffocation of head lice with mayonnaise, olive oil, margarine, butter, or similar substances is an effective form of treatment. Advocates recommend working the substance of choice into your child's scalp, then covering with a shower cap overnight.

"There really is not good evidence of how effective these options are," says Bocchini. "These substances won't hurt a child but are messy and most will find they fail."

Some doctors support the Nuvo method which uses a bottle of Cetaphil, an inexpensive and widely-sold cleanser for sensitive skin. In one study published in the Journal of Pediatrics (2004), this method produced a 95 percent success rate when it was repeated once a week for three weeks. Coat the hair with Cetaphil, comb it through, then blow dry it until it hardens into a helmet. Shampoo eight hours later.

The trouble with following a non-medicated approach, according to Bocchini, is treatment takes longer and schools with no-nit policies will not allow remittance until a child's head is deemed to be nit-free. The APA would like to see no-nit policies abandoned. "Children should be allowed back to school (or daycare) after one treatment of anti-lice shampoo since that will kill most lice and nits are not contagious (the second treatment of a pediculicide will rid the scalp of the eggs)," says the pediatrician. "Children should not miss school because of head lice."

Perhaps the best way to deal with lice is to prevent infestation to begin with. Bocchini attests that girls get lice more often than boys but says the reason is most likely behavioral. Still there are parents of girls with long hair that arrange it in a tight bun before sending their daughters off to school. One lice-busting mom says in a blog that a heavy dose of hairspray gives extra protection.  One tip everyone supports is to teach your children to avoid head-to-head contact since that is the most common way lice are transferred.


Interview with Joseph Bocchini, MD
Louisiana State University Health Science Center, Chair of Pediatrics Department
AAP Chair of Infectious Diseases

The American Academy of Pediatrics

The Centers for Disease Control and Prevention

The National Pediculosis Association