Six to 12 million kids in the U.S. get head lice each year, and just as many tears are shed by kids—and adults—trying to get rid of them. Prescription insecticides can be toxic, and over-the-counter treatments may not work. The result? Frustration.
"The biggest problem today is that lice have become resistant to the over-the-counter stuff," said Anna Albano-Krosche, owner of the head lice removal salon, The Lice Lady of Westchester in Elmsford, N.Y.
Natural remedies can get rid of lice, they're just not as well studied as commercial treatments. Here are a variety of home remedies, over-the-counter, and prescription treatments used to treat head lice.
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First things first: Take a deep breath and don't freak out if your child has head lice. Sure, they're gross (just talking about them can make your head itch), but they're not actually harmful to health.
It's best to approach lice as a war on many fronts: You need to use a variety of techniques to kill not only adult lice, but also their tiny eggs (called nits), which are glued to the hair shaft. The nits can survive treatments that kill the adults and vice versa (These bugs have evolved over a millennium to live in hair, so they're tricky).
It's best to steel yourself for weeks or months of vigilance since lice can reappear due to repeated exposure or a missed nit. What doesn't help is panic.
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Nitpicking and combing
The gold standard for head lice removal, you'll need to do this in conjunction with almost all other treatments. First you comb hair section by section with a special comb like the Nit Free Terminator Comb ($10; ) to remove lice and nits.
Years ago Albano-Krosche spent hours extracting nits by hand from her kids' hair. These days, she wields a fined-toothed metal comb. "It's so much quicker and cleaner and neater," she said. After a comb-through, she uses a magnification light to find and pick out any strays.
"No matter what kind of (lice-killing) product you use, the combing it the key," she said. You cannot get rid of lice until you've picked every last egg, she noted.
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Pyrethrum, the active ingredient in Rid shampoo ($13; ) and similar over-the-counter products (A-200 and Pronto, for example) comes from chrysanthemum flowers that harbor natural insecticides called pyrethrins. Pyrethrins attack the nervous systems of live lice but don't always work because some lice have become resistant to the toxin.
Apply product to dry hair, wait 10 minutes, add water to form a lather and rinse. Comb for nits. A second application is recommended 7 to 10 days later to kill any live bugs that remain. Watch for allergic reactions.
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This kitchen staple is thought to be an excellent smothering agent. Lice supposedly suffocate and die when the ooze plugs their breathing holes, but it needs to be applied overnight under a shower cap because lice can survive without breathing for hours. You'll also have to comb to remove nits, but the olive oil should help loosen them from the hair shafts.
Albano-Krosche has had success with an olive oil-and-combing regimen. Joan Sawyer, co-author of the book Head Lice to Dead Lice, promotes a "5-Step Battle Plan" that involves applying olive oil on specific days over the course of a 21-day period.
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Permethrin lotion 1%
Permethrin, the active ingredient in over-the-counter products like Nix ($15; ) is a synthetic version of pyrethrins. Permethrin works in much the same way as pyrethrins to attack live lice, although there are reports of lice becoming resistant to this medicine. Allergic reactions are possible.
On damp, shampooed (but not conditioned) hair, saturate head with the lotion. Leave for 10 minutes, rinse and comb out nits. Repeat if live lice appear 7 or more days after the initial treatment.
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In a study, hot-air methods proved highly effective in killing nits, but less so in eradicating live lice. An old-fashioned bonnet dryer killed nearly 89% of nits but just 10% of lice, while a blow dryer using direct heat got rid of nearly 98% of nits and 55% of lice. So use a hair dryer on freshly washed hair to increase your chance of eradicating the little buggers. But never use hot air after applying a chemical lice treatment. Some may contain flammable ingredients.
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This prescription lotion (brand name Natroba) contains , a natural insecticide derived from bacteria found in soil. It was approved in January 2011 for patients 4 years of age and older. In two clinical trials, 84.6% and 86.7% of patients were lice-free 14 days after treatment, versus 44.9% and 42.9% with permethrin.
Coat the scalp and work the liquid through dry hair from roots to ends. Leave on for 10 minutes, rinse and comb for nits. The common side effects are eye and skin irritation.
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You could try drowning lice by immersing hair under water in the bathtub. But chances are it won't work all that well. Various reports suggest lice can survive total submersion for many hours at a time. Not even chlorinated pool water can kill off head lice, says the U.S. Centers for Disease Control and Prevention.
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Approved in February 2012, ivermectin lotion 0.5% (brand name Sklice) comes from bacteria found in soil. It paralyzes and kills lice and their eggs and can be used with kids over 6 months of age. In clinical trials, roughly three-quarters of patients were lice-free after a single application (without nit combing) two weeks after treatment. Fewer than 1% experienced side effects, such as eye and skin irritation.
Apply the lotion to dry hair and scalp. Rinse after 10 minutes.
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Hair styling gel/petroleum jelly
There's not a lot of research that proves that applying thick, hair-stiffening styling gel ($5; ) or petroleum jelly () kills head lice, although like olive oil, many moms swear by it. The goo supposedly suffocates the bugs by clogging their breathing holes.
One study found petroleum jelly worked better than other home remedies. However, the cautions that Vaseline may not work and is difficult to remove. (Styling gel should be easier to wash out.)
Here's one approach: Coat the hair and scalp, cover it overnight with a shower cap, and wash out the next morning. Comb for nits. Repeat the treatment one week later.
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Benzyl alcohol lotion 5%
This prescription lotion () hit the market in 2009. It works by stunning a louse's breathing apparatus, causing asphyxiation (it doesn't kill nits).
At least two applications are needed. In two clinical trials, 75% and 76.2% of participants were lice-free 14 days after the second treatment. Ulesfia can be prescribed for patients 6 months of age and older. It can cause eye and skin irritation.
Saturate dry hair and scalp with the lotion, wait 10 minutes and rinse out in a sink. It's okay to shampoo afterward, and using a nit comb will help remove nits and dead lice.
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It's a great binder for macaroni salad, but does mayonnaise cut it as a head lice treatment? Lice can open and close their breathing holes to avoid suffocation, so there's no guarantee that it will work. The has received conflicting reports on the success of this home remedy.
People who've tried it recommend using real, full-fat mayonnaise. Slather it on liberally and pop on a shower cap. Let the mayo do its thing overnight. Shampoo and comb for nits in the morning. Repeat one week later to kill any lice that hatch from nits that survive the treatment.
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Despite its name, this technique doesn't involve plastic wrap of any kind. What it does involve is the application of a non-toxic product to dry hair (Cetaphil-brand gentle skin cleanser), combing out as much as possible, and blowing the hair dry. This is repeated 3 times at one-week intervals.
A 2004 study in Pediatrics described the and some doctors recommend it.
In two trials, an average of 96% of patients were cured at the end of treatment, and 94% were lice-free at a 6-month follow-up.
For how-to instructions, visit .
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Dish soap doesn't kill lice. But it does help remove the bug-suffocating glop—salad oil, mayonnaise, hair styling gel, or Vaseline—that moms slather into kids' hair.
Dawn dishwashing liquid is said to be good for cutting through the greasy mess left behind. Some dish soaps supposedly help break down the glue-like substance attaching nits to the hair shaft.
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Some people believe vinegar will dissolve the sticky glue that the female louse uses to attach her eggs to hair shafts. The acetic acid in vinegar is considered helpful in prepping hair for nit combing after using a bug-killing treatment. Like many lice home remedies, there's no proven evidence of a clinical benefit. Often, is recommended—either straight up or diluted with water.
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Years ago, when Albano-Krosche's children had lice, she thought her house was infested and went as far as taking the curtains down. "As I learned now, it's very little to do with the environment; it's more about cleaning the head." That's because head lice can only live a day or two off the scalp, and they can't hop or fly. Plus, their eggs get cemented to the hair. So you don't need to sterilize the entire house.
To prevent re-infection, clean items that have been in recent with the infected family members' heads. Wash bedding, caps, scarves and towels in hot water, and dry on a hot setting. Soak combs and brushes in very hot, soapy hot water. Vacuum floors, pillows, upholstered furniture and car seats. Stow non-washables—a treasured stuffed animal, for example—in a sealed bag for 2 weeks.
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Need a nit-picking hand? Hire a de-lousing service to handle the job. The need for effective, non-toxic treatment options has sprouted a whole industry of people who specialize in removing head lice. The National Association of Lice Treatment Professionals was launched in 2012 to bring some standards to the industry (and in response to complaints from consumers about some of these businesses.) It's probably best to ask friends, neighbors, or the school nurse for recommendations for a reliable service.
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Lice are just as happy to invade a squeaky clean head as a dirty one, so frequent washing is no guarantee of preventing an infestation.
The best advice is to avoid head-to-head . And don't make it easy for them to crawl from one head to the next. Keep long hair in a tight ponytail or braid. Other tips: Don't share combs, brushes, barrettes, hats, scarves or pillows. Albano-Krosche suggests adding a couple drops of an essential oil, such as tea tree oil, to your own grooming products to ward off the bugs.
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This device looks like a vacuum cleaner with a brush-like nozzle. It blasts heated air toward the hair roots and scalp to dry out lice and their eggs. In a 2006 study, , killed 98% of nits and 80% of live lice.
LouseBuster treatments are only available through certified operators. It's relatively safe and quick. The typical treatment takes only 30 minutes.
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Malathion lotion 0.5%
This prescription insecticide (brand name Ovide) kills live lice and some eggs. But it's flammable and can cause stinging and second-degree burns. It's , according to the CDC.
Apply to dry hair, leave on for 8 to 12 hours and air dry. Never blow dry or expose hair or lotion to heat sources. Shampoo and rinse hair in a sink, not the shower or tub, before combing. Treat again after seven to nine days if live bugs remain.
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Lindane shampoo 1%
This neurotoxin kills lice and their eggs. But it's a suspected human carcinogen. Overuse or misuse of Lindane (brand names Kwell and Thionex) can causes serious side effects, including seizures and death. And even when used as directed, it can cause seizures in some people, according to the .
It's no longer recommended by the American Academy of Pediatrics to kill lice, and is not recommended for children, the elderly, or anyone who weighs less than 110 pounds. It is only prescribed to people who have failed or cannot tolerate other treatments. Use only as directed by your doctor.