Treatments and Medications

No one likes the thought of head lice. But rest assured, there are many methods and products designed to deal with outbreaks. Here are some of the most commonly used and prescribed lice abetment products.

Over-the-Counter (OTC) Head Lice Products

The first step many parents take is to use a shampoo such as Rid or Nix. Both of these contain chemicals called pyrethrins, which interfere with the lice biochemistry and poison the lice. Product instructions direct users to apply the Rid shampoo to dry hair and leave on for 10 minutes, while they should apply Nix to freshly shampooed hair. Some products also include gels and cream rinses that help comb the lice out of the hair after treatment.

  • Rid contains piperonyl butoxide (4%) and pyrethrum extract. Piperonyl butoxide acts as a carrier for the pyrethrum extract, which is an insecticide. You should know that the Environmental Protection Agency (EPA) classifies piperonyl butoxide as a possible human cancer-causing agent, but pyrethrum appears to be safe for occasional human use.
  • Nix contains permethrin, which is in the same chemical class as pyrethrum extract. The EPA currently does not consider permethrin to be a concern at the levels used in Nix. Nix is recommended by the American Academy of Pediatrics.
  • The active ingredients in Rid and Nix are also used in a wide variety of other head lice treatments under numerous brand names.

A 2014 study found that most head lice in North America have a gene mutation that renders them resistant to over-the-counter medications containing pyrethrins. Prescription medications, such as those described in the following section, may be required for getting rid of head lice. 

Prescription Medicines for Head Lice

When other products don’t work or when lice infestations come back repeatedly, you might turn to your physician for prescription medications that can help. These include:

  • Malathion (Ovide): This medicine should be used only by people over the age of 6. Malathion is flammable, so make sure you don’t use a hair dryer or any source of heat while the product is on your hair. Pregnant or breastfeeding mothers should NOT use this product unless under medical care.
  • Lindane (Kwell) can be prescribed as a lotion, cream, or shampoo. People who weigh less than 110 pounds should not use it; neither should pregnant or breastfeeding mothers or people who are HIV-positive. There are a number of possible side effects including skin rashes and seizures.
  • Ulesfia is a new product that has recently come on the market. This prescription product contains benzyl alcohol to kill lice. The benzyl alcohol basically suffocates the lice instead of poisoning them. It can be used in children over 6 months of age, but serious side effects, including seizures, coma, and death have occurred in premature and small babies.
  • Another recently approved prescription medication is Sklice lotion. It contains ivermectin,1 a substance that kills lice and is derived from bacteria. This one-time lotion is applied to dry hair, left in for 10 minutes, and then washed out with water only. It can be used on children 6 months and older but is not recommended for pregnant or breastfeeding women except while under the care of a qualified professional. Common side effects include:
    • eye redness or soreness
    • eye irritation
    • dandruff
    • dry skin
    • burning sensation of the skin

Besides the worries that some of these chemicals may cause cancer in humans, another concern with both OTC and prescription products is that lice show a growing resistance to the insecticides in these products.2,3 Researchers have been studying other natural products as treatments for head lice.

  • Chick-Chack (also known as Hair-Clean-1-2-3®) contains coconut oil, anise oil, and ylang ylang oil, and has been shown in one study to be just as effective as products like Rid and Nix.4
  • Products containing tea tree oil and lavender oil have been found to be just as effective in killing head lice as the pyrethrin-containing products—with no exposure to potentially cancer-causing chemicals.5,6
  • Other products with a bit less research backing them contain the essential oils of neem, eucalyptus, cloves, and/or peppermint.7-9 Results from studies so far seem to indicate that all of these are as effective as Rid and Nix, with better safety profiles. In some studies, the oils were left on overnight, while others treated for only 10 to 15 minutes.