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What to do about head lice

In the UK, you do not have to tell the school if your child has head lice. It makes sense to tell the parents of your child’s ‘best friends’, with whom they might have had head-to-head contact in the last 4–6 weeks. Friends do not necessarily need treatment – they need to be checked for lice, but not treated ‘just in case’. Do not use any treatments unless you are sure there are lice, that is, you have actually found at least one live louse.

Talk to your pharmacist, health visitor, school nurse or doctor if your child has eczema or asthma, and you are thinking of using head lice lotion, or if your child is under 4 years old.

How to get rid of head lice

Washing will not get rid of lice. Head lice batten down their hatches to keep water out, and can survive without breathing air for about 24 hours.
 
Head lice or ‘nit’ lotion
You can buy this from a pharmacy or get it on prescription from your doctor. Your pharmacist, school nurse, health visitor, family doctor or NHS walk-in centre (see Useful contacts) will advise you about the most effective treatments. Lice are resistant to some treatments, and the best treatment may depend on where you live. You should certainly talk to them if your child has any skin problems such as eczema or asthma, because a water-based (rather than alcohol-based) preparation would be advisable. The lotion will not remove the empty egg cases (nits) and you either have to wait for them to grow out, cut the hair they are stuck on, or use a lice comb to remove them. Special shampoos are available that claim to get rid of lice, but in fact they do not work very well.
 
How to use head lice or ‘nit’ lotion
  • Read the label and follow the instructions exactly
  • You will need to treat the head twice, with 7 days between treatments. This way, you will get rid of lice that have hatched from their eggs since the first treatment
  • Do not use the lotion after you have been swimming, because chlorine can interfere with its action
  • Put the lotion on dry hair, parting the hair into sections and combing the lotion through carefully
  • Most head lice lotions are very flammable, and some horrible burns have occurred when people’s hair has caught fire. When you or your child have lotion on your hair, keep well away from fires, candles, gas cookers, pilot lights, matches and cigarette lighters
  • Dry the hair naturally – hot-air hair dryers can deactivate the lotions, and a malfunctioning dryer could set the hair alight
  • Wash it off 12 hours later.
  • Repeat the treatment once more 7–10 days later to get rid of any newly hatched lice (because the first treatment will not kill lice eggs)
Are head lice lotions dangerous? This is a very difficult question to answer. Some of the chemicals in head lice lotions have toxic effects, but only in large doses.
  • Lindane was used as a head lice treatment in the UK for many years, but has now been withdrawn, partly because lice have become resistant to it worldwide, but also because of worries that it might promote cancers or cause nerve damage.
  • Carbaryl (available only on doctor’s prescription in the UK) caused cancers when given to rats in large doses throughout their lives. Therefore it should not be used repeatedly.
  • Malathion is an organophosphate insecticide. There have been concerns that organophosphates might damage nerves. However, the body breaks down and eliminates malathion very quickly. Official UK Government advice is that “malathion does not have the potential to cause a specific polyneuropathy because, unlike some other organophosphates, it cannot bind to the relevant target protein” (Communicable Disease Report, 1997).
  • Permethrin and phenothrin are ‘pyrethroid’ chemicals that occur in chrysanthemum plants. (It has been known for centuries that chrysanthemum flowers can kill insects.) If these chemicals are absorbed by the body, they are eliminated very quickly and they do not appear to be dangerous. However, they may not be as effective as organophosphates (Archives of Disease in Childhood 2006;91:777–8).
In fact, the most likely serious danger from head lice lotions is the risk of fire with alcohol-containing lotions. Also, head lice lotions, especially those containing alcohol, can irritate the scalp, so talk to your doctor if your child has skin problems, such as eczema.
 
On present evidence, it is unlikely that applying a head lice lotion on two occasions, a week apart, would cause any dangerous effects. But it would seem sensible to use them as little as possible. And do not use them unless you are certain live lice are present (that is, you have actually seen a live louse).
 
Dimeticone
Dimeticone is a lotion that kills lice by coating them with an oily substance; it is not a chemical insecticide like the older nit lotions. You can buy it from pharmacies. Apply it to dry hair making sure that all the hair is coated, leave the hair to dry naturally (without using a hairdryer), and wash it off after 8 hours. The treatment is repeated a week later to kill any lice that have hatched since the first treatment. It seems to cure about 70% of cases, which means it is more effective than the insecticide nit lotions (Drug and Therapeutics Bulletin 2009;47:50-2). The usual strength of dimeticone is 4%, but a much stronger version (92%) can be bought from pharmacies. Take care not to get this lotion into the eyes.
 
Isopropyl myristate
Isopropyl myristate is another non-insecticide lotion. It kills lice by blocking their breathing system and also dehydrates them. You apply it for only 10 minutes, then wash it out, and repeat the application a week later. The cure rate with isopropyl myristate seems to be about 80% (Drug and Therapeutics Bulletin 2009;47:50-2)
 
Wet combing
‘Bug busting’ (also called ‘wet combing with conditioner’) is something to try if you are worried about using strong chemicals on the scalp. Wet the hair with ordinary conditioner, and thoroughly comb it all the way from the roots with a plastic (not metal) lice comb. You can wipe the comb on a tissue from time to time to see if you have caught any lice. It removes lice, but not eggs, so you have to repeat the process several times to remove lice that have hatched since the last time that it was done. Do it three times a week for at least 2 weeks. In fact, you should carry on for three further sessions after finding the last louse. In the UK, you can buy a kit containing all the equipment you need (see Useful contacts).
 
There are three problems with this method:
  • Bug-busting is not as effective as lotions. Its cure rate is about 57% (British Medical Journal 2005;331:384–7) compared with 75% for lotion.
  • It takes a long time to do bug busting properly. Each combing session will take about 30 minutes so do not try it unless you are willing to spend several hours a week on it.
  • It is unsuitable for Afro-Caribbean hair – it would be difficult to do it properly and would be too uncomfortable. It is easiest on short, straight hair.
Battery-powered combs

1.5-volt battery-powered combs are available from some pharmacies. The comb kills the head lice by making them lose their grip. It is unsuitable for children under 3 years of age or for anyone with an electrical device, such as a pacemaker. More research is needed to find out how effective this method is. It does not kill the eggs.

Herbal remedies
Herbal remedies are another possibility if you wish to avoid ordinary anti-lice lotions. Rosemary, neem tree, tea tree, bergamot and geranium oils are popular choices. However, some herbal remedies are strong natural chemicals, so you need to watch out for allergies and sensitivities, and stop using them if they seem to be irritating the scalp. Concentrated essential oils are toxic, so they must be diluted. In fact tea tree oil is more toxic than either permethrin or malathion (Prescriber 5 June 2003).

To use these oils, add six drops of a selection of the oils (three or four) to 30 mL (2 tablespoons) of sunflower oil. Massage it well into the scalp and leave for 6 hours. Then shampoo the hair and, when it is wet, go through it with a lice comb. Repeat every 3 days until you think the lice have gone.

It is difficult to know how effective herbal remedies really are, because there have not been any good scientific studies of them.

What to do if treatment is ineffective

No treatments are 100% effective. The cure rate for lotions is probably about 75%. There are several reasons a treatment might seem not to work.
  • Maybe it has actually worked. Nits (the empty white eggshells) can remain after the lice are dead. Lotions do not get rid of the eggshells, and even special lice combs may not remove all of them, because the mother louse has fixed them very firmly to the hair. Itching can persist for weeks after the lice have gone, because it is caused by an allergy to louse spit. Remember that if itching is the only symptom, there may be another reason, and repeated use of head lice lotions could further irritate the scalp.
  • The most obvious reason is that the treatment has not been carried out properly. For long hair, did you use enough lotion? Did you make sure the lotion saturated the scalp (where the lice live), not just the hair? Did you leave the lotion on for the correct time? Did you repeat the treatment 7–10 days later to get rid of newly-hatched lice? If you were bug-busting, did you do it thoroughly, or were you fed up and half-hearted?
  • It is possible that your child has simply caught lice again.
  • Some head lice are resistant to one or other of the head lice lotions. So talk to your pharmacist, school nurse, health visitor or family doctor, and try one that contains a different chemical. Because the new dimeticone and isopropyl myristate treatments work by smothering the lice, resistance is unlikely to develop.
  • Bug-busting is not 100% effective. If some lice remain, after a few weeks they will multiply. But using this method will certainly keep the numbers down, even if it does not eliminate them entirely.
     

Ways of preventing re-infection

  • Tell the parents of ‘best friends’ that your child has head lice, so they can be checked.
  • Check everyone in your family, but treat them only if you find live lice.
  • Think about your choice of treatment. Malathion is absorbed into the keratin of the hair and skin surface, and gives protection even after you have washed it off. This effect dwindles away over about 6 weeks. Permethrin and phenothrin (but not carbaryl) also have a protective effect lasting several weeks.
  • Get into the habit of brushing and combing your hair thoroughly twice a day. This might kill some lice.
  • Wash the hair three times a week, apply conditioner and, while it is wet, comb through carefully with a plastic lice comb. This will kill some lice and help prevent re-infection.

 For more information, see our sections on how head lice are caught and how to tell if you have head lice, or read Dr Phil Hammond's light-hearted poem on head lice

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Monday, March 7th 2011

 


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Comments on this article

Posted by Optional on 25/05/2013 at 03:16

Listerine does the job. Soak the hair for 1 hour in straight Listerine, with head wrapped in saran wrap. Wash out with coconut shampoo. Live lice will die and eggs are easy to comb out. Comb through hair with fine-toothed lice comb in 1inch sections at a time. Repeat process 7 days later to get rid of any newly hatched eggs missed from the previous treatment. This is the only method I have found that actually kills the lice.

Posted by Angel on 04/09/2012 at 09:19

The best way I got lice off my head the first time I felt a lice on my head.. I used vinegar I washed my hair with vinegar and took the lice comb and took it trough my hair it really do work.. Otherwise mayonaise and vinegar also work put it on your hair for 30minutes with a plastic over your head to smother the lice and then wash your hair very neatly

Posted by Optional on 21/12/2011 at 10:27

can some one help me was looking trough my hair and then i saw i lice bug and picked it out of my hair but 6 years ago i had the same problom so what is the fastest way to get rid of them

Posted by Optional on 09/08/2011 at 03:23

When my children were younger and came home with lice I used almost every lice shampoo i could find and they never seemed to die. One day I was out of shampoo and cash so I grabbed a jar of mayonnaise, slopped it in their hair and on their scalps, put a shower cap on them and sent them to bed. The next morning I put them in the shower washed it out and used a lice comb. I was happily surprised to find that 99% of the live lice were dead and the nits came out fairly easily. I repeated the treatment 8 or 9 days later just in case I had missed some eggs and the lice that had hatched were all dead. The added oils from the mayo also softened their hair so that was a plus.

Posted by Liz on 28/03/2011 at 09:44

Has anyone found anything that lice don't live in after 10 hours in a substance? I'm giving up!! Also its easier to get my daughter to put lotion on for less than an hour rather than all night

Posted by leemer on 04/09/2010 at 06:03

Years of struggling with the little critters and a distinct lack of information (even from pharmacists). Have tried "bug-busting" but mine and my son's hair is long, thick and very curly! I spend on average around 2 hours running a bug-comb through his hair every few days for several weeks, but still find them (probably from re-infestation). Fed up with this time-consuming often painful (back-ache and pulled hair) method, even with copious amounts of conditioner. I put his hair into sections and use clips to try to keep the sections separated, but every time I put the comb through his hair I have to rinse it to rid the comb or risk putting the tiny ones back into his hair! It is now time to resort to silicone-based products and to try some of the "preventative" treatments - no proof that prevention works but worth a try I think. BTW, I have found a live louse after about a day, on a hair-towel so, IMO washing of bed-linen is a must.

Posted by brisbane head lice centre on 04/08/2010 at 06:33

Hi to DJH from us in Oz. The lice cannot live for long without a host. They need to feed every 4 hours and will die if they cannot. Lice cannot jump or fly.Every country in the world has head lice and keeping hair tied up is a good start. Treat the hair initially with a natural lotion product and comb it out. Then repeat 5 to 7 days later. Any white eggs left are empty shells and hang on by old glue.Pull them out with tweezers if they wont comb out. All the best from Shayne.

Posted by DJH on 09/05/2010 at 09:58

I got head lice from my sister's children in Australia. A week later, I am still combing the nasty insects out of my hair. Does anyone know if the lice can live away from someone's head. Can they live on the tissues I am using to get them off? Will they hop from the floor back onto my head? Please help.

Posted by HK on 22/04/2010 at 12:17

I am a teacher and often listen to frustrated parents who are fed up with their children getting head lice. However, I always reply with "please tie their hair up" as it's the best prevention available! I NEVER have my hair down at school.

Posted by Anonymous on 05/02/2010 at 05:55

I am a stay at home mother and was told by my hair stylist I may have head lice. I treated my hair immediately with RID! The only way I think I may have gotten it was the WIC office. So to those mothers who visit WIC, be aware when you sit down. Just goes to show children are not the only ones getting this stressful & embarrassing issue!

Posted by Mrs K on 01/01/2010 at 03:05

Bring back the nit nurse and send the kids home, I am fed up with costly remidies and politicle correctness its the working parents that are suffering as usual a we dont get freebies

Posted by Anonymous on 12/07/2009 at 08:44

Head lice is extremely annoying. My 12 year old daughter got it at school. We didn't know how she got it, but suspect the borrowing of a simple hair bobble. We washed her hair everyday, and combed for about half an hour, and we also used some head lice shampoo. There was no sign after about four days. I did this (just to be sure) for a whole week. I remember she was very self concious at school about people realising, as at the age of 12, you are very self-conconius on your image. I plaitted her hair and put it up for everyday apart from one where i let it down on the friday, but gave her a bobble incase. The faster you react, the quicker it can be solved.

Posted by Anonymous on 08/05/2009 at 10:16

as both a parent and an individual who worked in a large women's refuge i found the best 'cure' is toothcomb the hair using hair conditioner at least every othery day when there is a live infestation. Thereafter using the same method as a prevention weekly for as long as there is a risk of reinfestation

Posted by Anonymous on 16/03/2009 at 09:21

After trying LOTS of different methods I finally managed to get rid of head lice by covering hair with conditioner (Pantene Smooth & Sleek was the best) & combing hair with a nit comb every other day. The other essential step was to wash pillow & pillow cases every couple of days. It did the job!

Posted by anoymous on 28/02/2009 at 12:41

It helps to prevent nits if you plat/braid your hair, nits like hair that isnt tied up so its easyier for them to jump in i think

Posted by Anonymous on 19/02/2009 at 11:18

Why can't there just be a national Nit day where EVERYONE regaurdless of whether they do or don't have them treat there hair. Then the pests will be wiped out forever and never bother anyone again! They are becoming mutants building up resistance and no longer being affected by these chemicles! We need a MASS killing spree.It's the only way otherwise they'll just keep going from person to person.

Posted by Jules on 11/01/2009 at 08:56

Well I am very fed up of treating my 3 girls at

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Fascinating facts

In the UK, each month 20% of hairdressing salons see head lice in a client's hair

An estimated 5% of the UK population has head lice

Each year in the UK, the NHS and the general public together spend £29 million on head lice treatments

'Lousy', 'nitwit', 'nit-picking', 'nitty-gritty', 'go through something with a fine-tooth comb' - all these phrases come from lice

The average person with head lice has about 20 lice. During their 30-day life, 20 lice will lay 2652 eggs (Lancet 2003;361:99-100)

After mating, a female head louse keeps spare sperm in a special container in her body (spermatotheca), so that she does not have to bother with mating again, but can use the sperm she has kept (Lancet 2003;361:99-100)

Head lice are fairly speedy. They can move at 23 cm per minute (Lancet 2003;361:99-100)

Head lice have probably been annoying humans for at least 72 000 years (New Scientist 2003;23 Aug)

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