Head Lice

Head Lice (Pediculosis) – Symptoms and Treatment Options

One of the most frustrating problems I see parents deal with is head lice. Many parents react with shame – believing that being infected with head lice means their children are “dirty”. Head Lice infect up to 12 million U.S. school aged children every year1. Head lice are spread by kids when they share personal articles, such as combs, brushes, barrettes, and pillows. They are common among school aged children, childcare kids, and others who come in close contact with lots of other children.

Head lice are tiny, gray bugs, the size of a sesame seed, that move fast and are often hard to see in your child’s hair. They live in the hair and bite the scalp to suck blood. These bites cause the scalp to itch, which is usually the first symptom. These bites can become infected and cause the scalp to turn red or crusty.

When you are checking for head lice in your child, look for small grey or reddish brown live lice scurrying around their scalp. Don’t worry, lice can not hop or fly off of your child’s head, but they are very fast, so spend some time looking all around the scalp. If the lice have had time to lay eggs, you may want to look for “nits.” Nits hold the lice eggs, and are small, oval-shaped, white sacks attached to the side of hair shafts. They are often found on the hairs at the base of the neck.

Treatment of Head Lice

Drug-Free Head Lice Treatments– This is a good option if you have caught the infestation early and are very diligent about removing all the lice and any nits that have formed. There are specialized combs, like the LiceMeister ® Comb, which have very small teeth to break up the nits. This comb is endorsed by the National Pediculosis Association, which promotes safe, pesticide-free treatments2. For more information on these options and head lice, see their website www.HeadLice.org

(OTC) Over-the-Counter Head Lice Treatments- This is a good option if there are lots of lice and this is the first time your child has ever had head lice. Common OTC head lice shampoos include Nix® (permethrin), Rid® (pyrethrin), and Lice MD® (dimethicone). These treatments are effective if you follow the directions on the box. These OTC shampoos and conditioners only kill the live head lice, parents still need to be diligent about combing through the nits. A lice comb is usually included with your shampoo kit. Even if you do everything right, there may still be some lice that remain. This does not mean that the treatment did not work. Nits hatch in 7-10 days, develop into adults in another 7-10 days, and lay more eggs. This is why it is so important to remove all the nits before they hatch into more live head lice.

Things to remember when treating with OTC head lice shampoos:
►Follow the directions exactly for the product you are using. Do not leave product on longer than recommended and don’t use shower caps.
►Wait long enough after treatment for it to kill the nits (3-8 hours) before removing them.
►Do NOT use on babies. Rid® is approved for children 2 years old and up, and Nix® is approved for 2 months of age and up (Caution-You should still consult with your pediatrician before treating with OTC head lice shampoos on children younger than 12 months.)
►Do NOT use near eyes, nose, or mouth
►Only treat the members of the family that have been infected with head lice, don’t use these treatments for prevention. You can avoid spreading head lice by not allowing children to share hair tools and products and by diligently cleaning your house and car.


When disinfecting your house and car to prevent spreading head lice, there is no need to spend all day cleaning and spraying your whole house. Simply wash all sheets, pillowcases, and blankets in hot water (this will kill any lice that have made contact with these items). Lice cannot live for more than 24 hours off the human body. Vacuum the house and car. Soak brushes and combs for 1 hour in your lice shampoo. You can quickly place other items in boiling water if safe to do so.


Prescription Head Lice Treatments- There are an increasing amount of resistance being seen with head lice (head lice still remain after treatment)3. If you suspect this might be happening with your child, contact your doctor. There is a new prescription product available for head lice –
Ulesfia™. Ulsefia™’s active ingredient is benzyl alcohol 5% lotion, and it is approved for children as young as 6 months. When using it, you must supervise your child at all times, and avoid getting it in their eyes. You will need to repeat the treatment in 7 days. Depending on length of your child’s hair, more than 1 bottle might be needed. Ulsefia™ can be expensive. It retails for about $60, and may or may not be covered under your pharmacy insurance.
Less expensive prescription alternatives include Lindane (Kwell®) or Malathion (Ovide®)-talk to your doctor to see if these products are right for your child.

As you can see, there are many choices for the treatment of head lice. Just remember if your child comes home with head lice, relax, know the facts, and know that you have treatment options. Choose the option that you and your child feels comfortable with and ask for help when you need it. This is one of the most asked questions of pharmacist. Mom’s Medicine Chest wants you to be informed about head lice, so you can make the best choice for your family.

Head Lice Information Sources:

1. Centers for Disease Control and Prevention, (CDC) – Division of Parasitic Disease, May 2008
2. National Pediculosis Association www.HeadLice.org
3. Head Lice: New Approaches May Help Overcome Pediculicide Resistance
W. Steven Pray, PhD, DPh, US Pharm. 2010;35(3):10-15.


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