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How to Treat Lice
Nit removal is the key -
Summary: Head lice and pubic lice
infestations can be eliminated by careful nit
removal and treatment of live lice with
medicated shampoos or rinses. Treatment failures can
often be traced to incomplete nit removal rather
than "pesticide resistance".
Jack DeAngelis, PhD
OSU Ext. Entomologist (ret.)
Treating lice = nit
infestation (head, body or pubic louse) should
be treated in the same way. First kill live lice
then crush and/or remove nits, or louse
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 medicated shampoos/rinses.
Since lice don't live
for very long off their host it is not
necessary to excessively clean the house, bedding
and clothing. Also, since body lice
are easily treated by simply washing clothes the
following information pertains mainly to head lice
only (see What are Body
louse (very similar to head louse);
about 2 mm (1/16") long
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 most
lice populations are still more or less susceptible.
This is still my first choice for eliminating live
lice. Any lice that survive will be removed in the
Then, crush and remove
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 shamoos 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 detangles and lubricates hair
to make combing easier . These products can make
nit-combing significantly easier and faster. See
recommendations for combs, shampoos, lotions and
combing aids. That's it. You don't
need to repeat this (whew!) until lice again become
a problem, and hopefully never!
What is still debated
about treating lice?
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 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 our opinion ...
(1) We 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, our reasons are detailed here.
(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.
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.
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.
Best Lice Comb to Use?
the Best Lice Shampoos and Lotions?
What Do Lice
Nits Look Like?
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