How to Treat Head
Nite (egg) removal is the key step -
Summary: Head lice
and pubic lice infestations can be eliminated by careful
nit removal plus treatment of live lice with
medicated shampoos or rinses. Treatment failures
can often be traced to incomplete nit removal
rather than so called "pesticide resistance".
Jack DeAngelis, PhD
OSU Ext. Entomologist
Treating lice = kill active lice + nit
Every louse infestation, whether
head, body or pubic louse, should be treated in
the same way. First kill active lice then
crush and/or remove nits (eggs). Nits can be
combed out of the hair with the proper type of
comb, or washed from clothing in the case of body
lice. Live head or pubic lice can be killed with
Since lice don't live for very long off
their host it is not necessary to
excessively clean the house and bedding.
Also, since body lice are easily treated
by simply washing clothes the following
information pertains mainly to head lice only (see
What are Body Lice?
for information about body lice infestations)
human body louse (very
similar to head louse); about 2 mm
First, kill live lice
This is the first step but it is not
the most important step. Most live lice (immature
and adult lice) can still be killed with medicated
shampoos or rinses that contain either pyrethrum
or permethrin (see Picking
a Shampoo or Lotion). While there are
reports of insecticide resistance to both
medications lice shampoos/lotions are still more
or less effective. This is still my first choice
for eliminating live lice. Any lice that survive
will be removed in the next step.
Then, crush and remove nits
After treating hair to kill as many live
lice as possible use a good, fine-tooth, metal
lice comb to crush and remove nits and any
remaining live lice. Carefully comb through hair
paying particular attention to the hair on the
back of the head and neck and around the ears.
Comb a small bunch of hair at a time and some
"nit-pickers" will pin back the hair that has been
combed to keep track of their progress.
Nit-combing can take 1 to several hours
so be patient. Don't use the plastic combs
that come with some shampoos and rinses, use a metal
lice comb instead (see How
to Pick the Best Lice Comb). You also might
want to use one of the nit-combing aids that
de-tangles and lubricates hair to make combing
easier . These products can make nit-combing
significantly easier and faster. That's it.
Be sure to follow package instructions carefully.
What is still debated about treating
A few things about head lice are still
debated by parents and teachers. (1) Whether
or not "no-nit" policies in schools are
effective. More people and even the American
Academy of Pediatrics (see recent report
are coming around to the idea that these policies
are not effective and may even be damaging. (2)
Whether or not head lice are resistant to
pyrethrum and permethrin, the medication in
products like Nix (tm) and RID (tm). (3)
Whether or not shampoos and rinses
containing insecticidal medications are safe. And,
(4) whether or not alternative head
lice treatments are useful.
Here's my opinion ...
(1) I do not advocate "no
nit" policies in schools but do sympathize
with schools trying to get parents to properly
treat children that have head lice.
(2) According to scientific
studies from 1999-2002, some head lice
populations in the US show resistance to
permethrin (see What is
Pesticide Resistance?). While some
resistance has been identified not every
population exhibits this characteristic so with a
newly confirmed infestation the first choice
for treatment should still be one of the
over-the-counter (OTC) shampoos/rinses
containing permethrin or pyrethrum.
(3) Insecticide-based shampoos
or rinses are safe and effective if used
according to instruction. However, do not use
products containing lindane as safer
medications are now available. Use products only
as directed by the label.
(4) Don't assume that
"alternative" means non-toxic. There has been
very little formal testing of the many
alternative treatments for head lice. Oil or
hair conditioner-based products probably work
by improving the efficacy of nit combing.
Products containing essential oils probably
help with nit combing as well.
What Do Lice
Nits Look Like?
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