How to treat head lice effectively with combs and medication
You can get rid of lice with combs, shampoos, creams, or medication. Eric Audras/Getty Images
Eric Audras/Getty Images
To treat head lice, you can physically remove the lice with a special comb for lice treatment.
While combing is effective, it can also be time-consuming, and other medications may also help you get rid of lice fast.
For example, there are specific shampoos, topical creams, and oral medications that can also help you treat head lice.
This article was medically reviewed by Sharleen St. Surin-Lord, MD, a board-certified dermatologist at Visage Dermatology and assistant professor of dermatology at Howard University.
This story is part of Insider’s complete guide to Bug Bites.
Head lice can quickly spread through a school, family, or group of friends. Though irritating, lice isn’t harmful to your health, and fortunately, it’s treatable with the right combs, topical treatments, and medications.
Here’s what you need to know to treat lice effectively.
Treatment for lice
There are two main ways to get rid of lice:
Remove the lice. You can use a specialized comb with closely-packed teeth that finely parses the hair to catch and remove lice at all their life stages.
Use medication. These typically include insecticidal shampoos, topical creams, or oral medicines that can kill lice.
How to use a lice comb
Lice combs are available at drug stores without a prescription, for a relatively low price. You can also buy one online — our colleagues at Insider Reviews recommend the Nit Free Terminator.
Here’s how to use one:
1. Start at the scalp and work your way through the hair until you’ve combed over the whole head. Your hair can be wet or dry. Do this at least twice, for about 15 to 30 minutes in total.
2. Wipe the comb on a clean paper towel or tissue and check for lice or their eggs. You can use a magnifying glass to help make the inspection process easier.
3. You should repeat this process every day until you find no lice for three days in a row. Then you can stop combing.
4. However, you should still check the head every two to three days over the next two weeks to see if the lice returns — as well as the head of others in your household who may have been exposed to the lice.
This combing method is an effective way to get rid of lice, but it can be time-consuming and difficult to do so properly. If lice are still present after two weeks, your doctor may suggest using lice-killing medication.
OTC medications are usually effective at treating lice, says Richard Chung, MD, a pediatrician at Duke University School of Medicine.
Children will typically only need prescription medication if comb treatments and OTC options don’t work first, according to the Seattle Children’s Hospital.
Here’s what you should know about the main types of medication for lice:
Lice shampoos can help kill and wash away lice, and are usually used in combination with combing.
Typically, you’ll want to thoroughly massage the shampoo into hair after combing, and let it sit for about 15 minutes before rinsing it out.
Common examples include RID lice-killing shampoo, Lice Shield, and LiceLogic, which are all available over-the-counter.
Some over-the-counter topical medications, like 1% permethrin (brand name Nix), effectively kill lice, but not their unhatched eggs. Prescription topical creams like spinosad 0.9% topical suspension (brand name Natroba) can kill adult lice and their eggs.
For both of these creams, you’ll want to apply them to your scalp and let it sit for 10 minutes before rinsing it out of your hair. Make sure you’re careful not to get these creams near your face, eyes, or other parts of your body, as they can cause side effects like eye and skin irritation.
OTC medications that don’t kill lice eggs will need reapplication in about nine days once the eggs hatch into nymphs and adults. Stronger prescription medications — especially those that kill lice in all life stages — typically need only one application.
However, a major difference between OTC and prescription lice medications is the price; for example, permethrin costs about $20, while spinosad is around $270 without insurance, according to a study published in The Journal of Family Practice in 2012.
Some research has found that prescription oral medication may help quickly kill lice.
For example, a scientific review published in the American Journal of Health-System Pharmacy in 2018 indicated that oral ivermectin can be at least as effective at treating head lice as other topical options.
However, oral medication for lice is typically used only after combing and other topical treatment methods have failed to work. Ask your doctor about oral medication if these first-line treatments are not effective.
The bottom line
While effective, combing can be annoying and time-consuming, and medication typically works faster as a treatment method. Talk with your doctor if you believe your child has lice to figure out which treatment will be most appropriate.
Sometimes, lice can reappear after treatment, and many parents are worried about reinfestation, especially in schools. Overall, Chung says kids with lice can be around other children as long as kids avoid the typical behavior that spreads lice: head-to-head contact and sharing items that touch hair, such as hats, clothing, brushes, or combs.
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