Table of ContentsView AllTable of ContentsOTC TherapiesRid (pyrethrins plus piperonyl butoxide)Home RemediesPrescriptionsComplementary MedicineFrequently Asked QuestionsNext in Head Lice GuideCoping With Head Lice
Table of ContentsView All
View All
Table of Contents
OTC Therapies
Rid (pyrethrins plus piperonyl butoxide)
Home Remedies
Prescriptions
Complementary Medicine
Frequently Asked Questions
Next in Head Lice Guide
It can be distressing to discoverhead lice. However, you can follow some simple steps to effectively treat the lice at home. For particularly stubborn cases, you can check with your healthcare provider to see if you need a prescription.
This article discusses head lice treatments, including over-the-counter and prescription medication. It also looks at-home remedies and complementary medicine.
Verywell / Jessica Olah
Over-the-Counter (OTC) Therapies
The first-linetreatment of head liceis using an anti-lice shampoo, such as Nix or Rid. You can buy these at the drugstore or online. Known aspediculicides, they will kill the adult lice outright, but they don’t kill nits (lice eggs).
Nits hatch in seven to 10 days and develop into egg-laying adults in another seven to 10 days. You usually have to re-treat with an anti-lice shampoo seven to 10 days after an initial application. This kills any newly hatched head lice and breaks thislice life cycle. Many experts recommend doing the second head lice treatment on the ninth day.
The most popular OTC options are:
Nix (permethrin)
This 1% permethrin lotion is the first choice for treatment.It is the least toxic to humans and is less allergenic than Rid.It leaves a residue on the hair that should kill the nymphs that hatch from any viable eggs. However, since your regular shampoo and conditioner can keep Nix from adhering to the hair shaft, a second application on the ninth day is needed.Permethrin is toxic to the lice’s neurological system. Some lice have developed resistance to permethrin.
Rid (pyrethrins plus piperonyl butoxide)
Rid is a shampoo made from chrysanthemum extract that is toxic to lice but only has a low toxicity in humans and other mammals.However, there are rareallergic reactionsin people who are sensitive to the flower.Unlike Nix, it doesn’t remain on the hair, so a second application is needed. The effectiveness of this product has been decreasing as resistance grows.
LiceMD (dimethicone)
The nits are tenacious and the closely-spaced tines of the comb, which are usually made of steel, can scrape them off individual hairs. (More on combing below.)
You shouldn’t use dog shampoo to treat lice on humans. It’s true that it may contain some of the same active ingredients as some anti-lice shampoos. However, dog shampoo is not made for and has not been tested on humans. There is no way to know that it’s safe or that it works.
While combing is a recommended part of an anti-lice shampoo treatment, it’s also a useful home remedy in and of itself.
Cleaning is another important step not to overlook. Other home remedies have not been proven to be as effective.
Combing and Nit-Picking
You may remove the nits and live lice with a lice comb and tweezers. This is a recommended part of an OTC treatment course but is also useful as an alternative for those interested in a natural approach. The National Pediculosis Association recommends using its LiceMeister comb to regularly screen for, detect, and remove lice and nits.
For combing after treatment with an anti-lice shampoo, follow the directions. Do not wash the hair for the recommended length of time (one or two days). You will do the combing eight to 12 hours after product application.
For non-treated hair or after the no-wash period has expired, it is easiest to do the combing after you have washed the hair and used hair conditioner.
How to Remove Lice
You should repeat the procedure daily for several days to make sure that you get all of the lice and nits. If you don’t, the eggs will hatch and lice will be present again. Do the lice combing again two weeks after treatment to ensure the lice are gone.
No home remedies or products that claim to loosen the nits from the hair have been proven to be effective, so it’s wise not to use them. Some, such as vinegar, can interfere with the residual activity of permethrin. Others, such as WD-40, bleach, oracetonecan damage the hair and pose a toxic risk or risk of fire when used.
Another option is to hire a lice removal specialist who can do all the dirty work at your home or at their place of business.
It’s even possible that your health insurance will cover head lice removal or that you can get reimbursed through your health savings account. If so, it may be worth it, especially if it’syouwho has the lice.
Effective self-treatment is nearly impossible. Lice removal specialists really are pros at making sure every single nit gets picked.
Cleaning
The American Academy of Pediatrics (AAP) recommends cleaning any clothing or other items that have been in contact with the head of the person who has lice in the past 24 to 48 hours.
Some tips include:
Coarse Hair Causes and Fixes
Smothering (Occlusive) Agents
Most other natural home remedies involve putting something on the scalp and hair to “smother” the head lice, much like LiceMD. Popular choices include mayonnaise, olive oil, and Vaseline (petroleum jelly).
These are usually left on overnight, often under a shower cap, and then washed out the next day. They can be very messy, though, and have not been proven to work.
Some experts believe that any benefit this method may have come from nits and lice being removed as you try to wash the agent out of your hair.
See your pediatrician or family healthcare provider if you can’t get rid of lice.Lice can be stubborn, able to live through an entire course of lice shampoo treatment.A healthcare provider can confirm whether live lice are still present and teach you how to better identify and remove nits.
Your pediatrician will likely know the patterns of resistance to the usual anti-lice shampoos in your area, if applicable. They can help determine what the best next treatment for you might be.
Your healthcare provider may prescribe a prescription-strength anti-lice medication, such as:
Malathion
Malathion kills live lice as well as some lice eggs.The lotion is applied to dry hair and left to air dry, then washed off after eight to 12 hours. Only one application is usually needed.
It is highly flammable because it contains alcohol. You must not use a hairdryer or smoke while it is being applied or drying.
It is not used for children younger than age 2, and the safety hasn’t been assessed for children under age 6.
Natroba (spinosad 0.9% suspension)
It works much like permethrin and lingers to have effects on any eggs that hatch. However, it does need a second application after seven days.
Sklice (ivermectin 0.5%)
Ulesfia (benzyl alcohol lotion 5%)
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Off-Label Medications
In addition to topical medications, there are two oral prescriptions that healthcare providers may use off-label. This means they aren’t specifically FDA-approved for treating lice, but they’re often used anyway.
Stromectol (ivermectin)
This is an antiparasitic drug that has shown effectiveness in treating resistant head lice infestations. It is given in two doses, seven to 10 days apart. Because this drug will also cross into the human brain and may affect neural activity, it shouldn’t be given to children who weigh less than 33 pounds.
Septra or Bactrim (trimethoprim-sulfamethoxazole)
You may be familiar with this antibiotic for other types of infections.You take a 10-day course. It has been shown to be effective at treating resistant infestations of head lice and may be used in combination with Nix.
While these are being researched, the FDA has not approved oral drugs for the treatment of head lice.
Complementary and Alternative Medicine (CAM)
Complementary and alternative medicine uses therapies outside of conventional medicine. These practices and products may sometimes be used along with traditional treatments.
In treating head lice, essential oils are sometimes touted for treating infestations. To test these claims, some researchers have looked at the effects of different essential oils on lice.
A 2012 study looked at the effect oftea tree oiland nerolidol, a component of essential oils, on head lice. It found that tea tree oil at 1% concentration was able to kill 100% of head lice in 30 minutes. Nerolidol at 1% concentration was able to keep 50% of eggs from hatching after four days.
Products containing neem seed extract have shown potential for killing head lice with a single treatment in some small studies.
However, most of the few studies on this are performed in a test tube, so the effectiveness of these treatments in humans is questionable.
If you do try essential oils, it is important to note that they shouldn’t be applied at full strength to the skin, as they can be irritating and have adverse effects when absorbed. It should be diluted with a carrier oil or skin lotion.
As there isn’t much research, it isn’t known whether the products containing essentials oils or neem extract are safe. This is especially true for vulnerable populations such as children, pregnant women, and nursing mothers.
The American Academy of Pediatrics cautions against using herbal anti-lice products on infants and children.
Summary
Head lice can often be treated at home with over-the-counter medications. Home remedies like combing and nit-picking can also remove nits and live lice. If you are having trouble getting rid of lice, your healthcare provider may suggest a prescription-strength medication.
Essential oils like tea tree oil have been studied for their effects on lice. However, research is mostly limited to test-tube studies. More studies are needed to determine the effects on people.
A Word From Verywell
Getting effective treatment is necessary to wipe out a lice infestation and stop it from spreading. Choosing conventional treatments that are known to work offers your best chance at putting this behind you.
If you’re having trouble getting rid of lice, check with your healthcare provider. They can give you tips for treating it and help find the medication that will work best for you.
No. But you may be able to clear someone’s scalp of adult lice and nits in eight to 12 hours with medication and thorough and careful removal of nits. Once lice no longer have human contact, they die quickly, so you should not have to worry about re-infestation.
According to the Centers for Disease Control and Prevention, people who are pregnant should not use Sklice (ivermectin) or lindane shampoo (which people who are breastfeeding also should avoid).
Coping With Head Lice
17 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Treatment of head lice.Cummings C, Finlay JC, MacDonald NE.Head lice infestations: A clinical update.Paediatr Child Health. 2018;23(1):e18‐e24. doi:10.1093/pch/pxx165Verma P, Namdeo C.Treatment of pediculosis capitis.Indian J Dermatol. 2015;60(3):238‐247. doi:10.4103/0019-5154.156339Ihde ES, Boscamp JR, Loh JM, Rosen L.Safety and efficacy of a 100 % dimethicone pediculocide in school-age children.BMC Pediatr. 2015;15(1):70. doi:10.1186/s12887-015-0381-0National Pediculosis Association.Head lice removal.American Academy of Pediatrics.Head lice: What parents need to know.National Pediculosis Association.Alternative treatments.Brown D, Rowland K.PURLs: Combatting lice in a single treatment.J Fam Pract; 2012;61(1):41-42.Aditya S, Rattan A.Spinosad: An effective and safe pediculicide.Indian Dermatol Online J. 2012;3(3):213‐214. doi:10.4103/2229-5178.101825Deeks LS, Naunton M, Currie MJ, Bowden FJ.Topical ivermectin 0.5% lotion for treatment of head lice.Ann Pharmacother. 2013;47(9):1161‐1167. doi:10.1177/1060028013500645Nolt D, Moore S, Yan AC, Melnick L; COMMITTEE ON INFECTIOUS DISEASES, COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, SECTION ON DERMATOLOGY.Head lice.Pediatrics. 2022;150(4):e2022059282. doi:10.1542/peds.2022-059282Michigan Department of Health and Human Services.Head lice management and treatment.Chandler RE.Serious neurological adverse events after ivermectin-do they occur beyond the indication of onchocerciasis?Am J Trop Med Hyg. 2018;98(2):382‐388. doi:10.4269/ajtmh.17-0042Kemnic TR, Coleman M.Trimethoprim sulfamethoxazole. In:StatPearls. StatPearls Publishing; 2024.Di Campli E, Di Bartolomeo S, Delli Pizzi P, et al.Activity of tea tree oil and nerolidol alone or in combination against pediculus capitis (head lice) and its eggs.Parasitology Research. 2012;111(5):1985-1992. doi:10.1007/s00436-012-3045-0Abdel-Ghaffar F, Al-Quraishy S, Al-Rasheid KA, Mehlhorn H.Efficacy of a single treatment of head lice with a neem seed extract: An in vivo and in vitro study on nits and motile stages.Parasitol Res. 2012;110(1):277‐280. doi:10.1007/s00436-011-2484-3Smith CH, Goldman RD.An incurable itch: Head lice.Can Fam Physician.2012;58(8):839-841.Additional ReadingCenters for Disease Control and Prevention.About head lice.Devore CD, Schutze GE.Head lice.Pediatrics. 2015;135(5). doi:10.1542/peds.2015-0746.Meister L, Ochsendorf F.Head lice: Epidemiology, biology, diagnosis, and treatment.Deutsches Ärzteblatt International. 2016;113(45):763-772. doi:10.3238/arztebl.2016.0763.
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Centers for Disease Control and Prevention.Treatment of head lice.Cummings C, Finlay JC, MacDonald NE.Head lice infestations: A clinical update.Paediatr Child Health. 2018;23(1):e18‐e24. doi:10.1093/pch/pxx165Verma P, Namdeo C.Treatment of pediculosis capitis.Indian J Dermatol. 2015;60(3):238‐247. doi:10.4103/0019-5154.156339Ihde ES, Boscamp JR, Loh JM, Rosen L.Safety and efficacy of a 100 % dimethicone pediculocide in school-age children.BMC Pediatr. 2015;15(1):70. doi:10.1186/s12887-015-0381-0National Pediculosis Association.Head lice removal.American Academy of Pediatrics.Head lice: What parents need to know.National Pediculosis Association.Alternative treatments.Brown D, Rowland K.PURLs: Combatting lice in a single treatment.J Fam Pract; 2012;61(1):41-42.Aditya S, Rattan A.Spinosad: An effective and safe pediculicide.Indian Dermatol Online J. 2012;3(3):213‐214. doi:10.4103/2229-5178.101825Deeks LS, Naunton M, Currie MJ, Bowden FJ.Topical ivermectin 0.5% lotion for treatment of head lice.Ann Pharmacother. 2013;47(9):1161‐1167. doi:10.1177/1060028013500645Nolt D, Moore S, Yan AC, Melnick L; COMMITTEE ON INFECTIOUS DISEASES, COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, SECTION ON DERMATOLOGY.Head lice.Pediatrics. 2022;150(4):e2022059282. doi:10.1542/peds.2022-059282Michigan Department of Health and Human Services.Head lice management and treatment.Chandler RE.Serious neurological adverse events after ivermectin-do they occur beyond the indication of onchocerciasis?Am J Trop Med Hyg. 2018;98(2):382‐388. doi:10.4269/ajtmh.17-0042Kemnic TR, Coleman M.Trimethoprim sulfamethoxazole. In:StatPearls. StatPearls Publishing; 2024.Di Campli E, Di Bartolomeo S, Delli Pizzi P, et al.Activity of tea tree oil and nerolidol alone or in combination against pediculus capitis (head lice) and its eggs.Parasitology Research. 2012;111(5):1985-1992. doi:10.1007/s00436-012-3045-0Abdel-Ghaffar F, Al-Quraishy S, Al-Rasheid KA, Mehlhorn H.Efficacy of a single treatment of head lice with a neem seed extract: An in vivo and in vitro study on nits and motile stages.Parasitol Res. 2012;110(1):277‐280. doi:10.1007/s00436-011-2484-3Smith CH, Goldman RD.An incurable itch: Head lice.Can Fam Physician.2012;58(8):839-841.Additional ReadingCenters for Disease Control and Prevention.About head lice.Devore CD, Schutze GE.Head lice.Pediatrics. 2015;135(5). doi:10.1542/peds.2015-0746.Meister L, Ochsendorf F.Head lice: Epidemiology, biology, diagnosis, and treatment.Deutsches Ärzteblatt International. 2016;113(45):763-772. doi:10.3238/arztebl.2016.0763.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Disease Control and Prevention.Treatment of head lice.Cummings C, Finlay JC, MacDonald NE.Head lice infestations: A clinical update.Paediatr Child Health. 2018;23(1):e18‐e24. doi:10.1093/pch/pxx165Verma P, Namdeo C.Treatment of pediculosis capitis.Indian J Dermatol. 2015;60(3):238‐247. doi:10.4103/0019-5154.156339Ihde ES, Boscamp JR, Loh JM, Rosen L.Safety and efficacy of a 100 % dimethicone pediculocide in school-age children.BMC Pediatr. 2015;15(1):70. doi:10.1186/s12887-015-0381-0National Pediculosis Association.Head lice removal.American Academy of Pediatrics.Head lice: What parents need to know.National Pediculosis Association.Alternative treatments.Brown D, Rowland K.PURLs: Combatting lice in a single treatment.J Fam Pract; 2012;61(1):41-42.Aditya S, Rattan A.Spinosad: An effective and safe pediculicide.Indian Dermatol Online J. 2012;3(3):213‐214. doi:10.4103/2229-5178.101825Deeks LS, Naunton M, Currie MJ, Bowden FJ.Topical ivermectin 0.5% lotion for treatment of head lice.Ann Pharmacother. 2013;47(9):1161‐1167. doi:10.1177/1060028013500645Nolt D, Moore S, Yan AC, Melnick L; COMMITTEE ON INFECTIOUS DISEASES, COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, SECTION ON DERMATOLOGY.Head lice.Pediatrics. 2022;150(4):e2022059282. doi:10.1542/peds.2022-059282Michigan Department of Health and Human Services.Head lice management and treatment.Chandler RE.Serious neurological adverse events after ivermectin-do they occur beyond the indication of onchocerciasis?Am J Trop Med Hyg. 2018;98(2):382‐388. doi:10.4269/ajtmh.17-0042Kemnic TR, Coleman M.Trimethoprim sulfamethoxazole. In:StatPearls. StatPearls Publishing; 2024.Di Campli E, Di Bartolomeo S, Delli Pizzi P, et al.Activity of tea tree oil and nerolidol alone or in combination against pediculus capitis (head lice) and its eggs.Parasitology Research. 2012;111(5):1985-1992. doi:10.1007/s00436-012-3045-0Abdel-Ghaffar F, Al-Quraishy S, Al-Rasheid KA, Mehlhorn H.Efficacy of a single treatment of head lice with a neem seed extract: An in vivo and in vitro study on nits and motile stages.Parasitol Res. 2012;110(1):277‐280. doi:10.1007/s00436-011-2484-3Smith CH, Goldman RD.An incurable itch: Head lice.Can Fam Physician.2012;58(8):839-841.
Centers for Disease Control and Prevention.Treatment of head lice.
Cummings C, Finlay JC, MacDonald NE.Head lice infestations: A clinical update.Paediatr Child Health. 2018;23(1):e18‐e24. doi:10.1093/pch/pxx165
Verma P, Namdeo C.Treatment of pediculosis capitis.Indian J Dermatol. 2015;60(3):238‐247. doi:10.4103/0019-5154.156339
Ihde ES, Boscamp JR, Loh JM, Rosen L.Safety and efficacy of a 100 % dimethicone pediculocide in school-age children.BMC Pediatr. 2015;15(1):70. doi:10.1186/s12887-015-0381-0
National Pediculosis Association.Head lice removal.
American Academy of Pediatrics.Head lice: What parents need to know.
National Pediculosis Association.Alternative treatments.
Brown D, Rowland K.PURLs: Combatting lice in a single treatment.J Fam Pract; 2012;61(1):41-42.
Aditya S, Rattan A.Spinosad: An effective and safe pediculicide.Indian Dermatol Online J. 2012;3(3):213‐214. doi:10.4103/2229-5178.101825
Deeks LS, Naunton M, Currie MJ, Bowden FJ.Topical ivermectin 0.5% lotion for treatment of head lice.Ann Pharmacother. 2013;47(9):1161‐1167. doi:10.1177/1060028013500645
Nolt D, Moore S, Yan AC, Melnick L; COMMITTEE ON INFECTIOUS DISEASES, COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, SECTION ON DERMATOLOGY.Head lice.Pediatrics. 2022;150(4):e2022059282. doi:10.1542/peds.2022-059282
Michigan Department of Health and Human Services.Head lice management and treatment.
Chandler RE.Serious neurological adverse events after ivermectin-do they occur beyond the indication of onchocerciasis?Am J Trop Med Hyg. 2018;98(2):382‐388. doi:10.4269/ajtmh.17-0042
Kemnic TR, Coleman M.Trimethoprim sulfamethoxazole. In:StatPearls. StatPearls Publishing; 2024.
Di Campli E, Di Bartolomeo S, Delli Pizzi P, et al.Activity of tea tree oil and nerolidol alone or in combination against pediculus capitis (head lice) and its eggs.Parasitology Research. 2012;111(5):1985-1992. doi:10.1007/s00436-012-3045-0
Abdel-Ghaffar F, Al-Quraishy S, Al-Rasheid KA, Mehlhorn H.Efficacy of a single treatment of head lice with a neem seed extract: An in vivo and in vitro study on nits and motile stages.Parasitol Res. 2012;110(1):277‐280. doi:10.1007/s00436-011-2484-3
Smith CH, Goldman RD.An incurable itch: Head lice.Can Fam Physician.2012;58(8):839-841.
Centers for Disease Control and Prevention.About head lice.Devore CD, Schutze GE.Head lice.Pediatrics. 2015;135(5). doi:10.1542/peds.2015-0746.Meister L, Ochsendorf F.Head lice: Epidemiology, biology, diagnosis, and treatment.Deutsches Ärzteblatt International. 2016;113(45):763-772. doi:10.3238/arztebl.2016.0763.
Centers for Disease Control and Prevention.About head lice.
Devore CD, Schutze GE.Head lice.Pediatrics. 2015;135(5). doi:10.1542/peds.2015-0746.
Meister L, Ochsendorf F.Head lice: Epidemiology, biology, diagnosis, and treatment.Deutsches Ärzteblatt International. 2016;113(45):763-772. doi:10.3238/arztebl.2016.0763.
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