How to get rid of lice

Lice treatment options

You'll hear lots of conflicting recommendations for dealing with lice. Even official health sources such as government agencies and doctor associations differ. And friends, relatives, and online resources offer all sorts of home remedies and alternative medicines.

Not all treatments are equally effective, either, because head lice can be resistant to the active ingredients in some treatments in some communities. Consult your doctor or another  professional to make sure the method you choose is likely to be safe and effective for your child in your area.  

Here are the options recommended by doctors, lice experts, and parents:

Lice medicine and lice combing combined

Many parents try this approach: Apply over-the-counter or prescription lice medicine to the hair and follow up with frequent comb-outs using a high-quality metal lice comb to remove the dead lice and eggs. Continue to check the hair and comb with the nit comb every couple of days for two to three weeks to make sure you've gotten rid of all lice and nits.

Products differ in their directions (how much to apply, whether to retreat, etc.), so be sure to read the package instructions carefully. To minimize your child's skin exposure to the ingredients, wash the product off in the sink rather than shower, and use warm rather than hot water.

Medicines that kill lice are called pediculicides. Some require one application (they kill both live lice and nits), while others (those that kill only live lice) recommend 2 or even 3 applications if live lice persist after the second treatment.

The active ingredients in pediculites include pyrethrins, benzl alcohol, ivermectin, malathion, or spinosad. For information on each of these ingredients, see The Centers for Disease Control and Prevention's treatment page for head liceOpens a new window. Lindane – while still available and FDA approved for use in adults – is not recommended for use in children. The AAP and the CDC caution against its use in children because of its neurotoxicity.

There are a variety of combs available, from simple fine-tooth combs that come with some lice treatments to battery operated combs with oscillating teeth and combs that claim to zap the live lice and kill them.

For complete directions, read our article on how to use a lice comb.

Some don'ts:

• Do not let your child apply the medicine.
• Do not place a plastic bag on the child's head.
• Do not leave a child alone with the treatment on their hair.
• Do not repeat the treatment beyond the package instructions without talking with your child's doctor. If the treatment didn't work, you may need a new medication.
• Do not use spray pesticides in your home. They're unnecessary and contain dangerous chemicals.
• Don't use lice medicine unless your child has a current infestation (live lice on their scalp).
• Don't forget to check siblings and other household members and treat them, too, if necessary.

Lice removal services

There are salons you can go to for help with head lice. Some provide manual comb-out of lice and nits, and others use warm-air technology to kill them. Most provide services in the office (similar to a hair salon), but some offer in-home services. If you choose to go to a salon, be sure to find out exactly what methods will be used and what the guarantee is for effectiveness. You might also ask your healthcare provider if they're aware of the specific salon you're considering and if they recommend it.

Alternative methods

You'll find all sorts of "natural" lice remedies at drugstores, natural food stores, and online. But keep in mind that natural doesn't mean safe.

These products aren't regulated by the FDA, and there's no scientific proof that they're safe or effective (and some could be toxic). "The safety and efficacy of natural or herbal products are currently not regulated by the FDA, and until more data are available, their use in infants, children, and adolescents should be avoided," warns the AAP.

Note: Talk with your healthcare provider before trying an alternative method for lice removal. Some may be fine to try – even without proven effectiveness, they may be harmless. But others may come with significant risk.

Home remedies include:

Essential oils. Oils that are reportedly used for killing or repelling head lice include: ageratum, aloysia, aniba, Annona, Cananga (ylang ylang), Cinnamomum, cocos, curcuma, elletaria, eucalyptus, eugenia, geranium, helianthus, Juniperus, Lavandula, lippia, litsea, melaleuca, Melia, Mentha, monarda, myrcianthes, Origanum, pimpinella, rosmarinus, salvia, schinus, tagetes, tea tree, zingiberaceae. Essential oils are very potent. Never use one on your child without their doctor's approval.

Barrier products. Petroleum jelly, mayonnaise, melted butter or margarine, and olive oil are applied with the goal of suffocating the lice. One studyOpens a new window of 17 trials published in Pediatric Dermatology compared the use of occlusive agents (products that block water loss, such as petroleum jelly) and pediculicides. The researchers concluded that the occlusive agents may be as good or better than pediculicides at treating head louse infestation.

Cetaphil cleanser. One studyOpens a new window published in Pediatrics reported a 96 percent success rate with the use of Cetaphil cleanser. The product was applied to the hair, dried on with a hair drier, left on overnight, and washed out the next morning. It's recommended to repeat the application once a week for three weeks.

Combing aids. Vinegar and vinegar-based products are used to loosen the sticky substance that attaches nits to the hair shaft, making removal easier. Directions recommend applying to the hair, leaving on for 3 minutes, then combing out with a fine-toothed nit comb.

Dehydrating products. Natrum muriaticum (brand name Vamousse, not FDA approved) is a saline solution (salt) that dehydrates the lice and nits. Another solution that dissolves the exoskeleton of the louse and dehydrates it is isopropyl myristate (brand name Resultz, FDA approved).

Hot air. AirAllé (Lousebuster) is a device that uses hot hair to desiccate lice. One small studyOpens a new window published in the Journal of Medical Entomology claims that treatment results in 95 percent death of lice and eggs. (The study was conducted by the manufacturer.) The device is expensive, though, and requires training to use.

Some people use a regular blow dryer, but the AAP advises against it. "Heat does kill lice," explains Dr. James, "but the temperature in the area where the lice is attached has to be sufficiently high for a sufficient period of time. Many children cannot tolerate the blow dryer heat long enough, and so it's not a method that's recommended." In addition, says the AAP, the blower dryer can cause live lice to become airborne and spread to others.

Note: Never use flammable substances such as gasoline or kerosene on your child. These are very dangerous and haven't been proven effective.