Head lice are consistently considered to be one of the most disgusting parasites which are difficult to notice and hard enough to treat fast. It is tricky but possible if you are cognizant of the most effective and safest treatment methods. Some wisely trust in medicine, others believe in the power of natural remedies. Who is right and what is the best treatment for hair lice?
We have surveyed scientists and physicians as to what is the most effective ways of treatment. Here you will learn how to recognize an infestation at the early stages, which shampoos work and which are absolutely useless, how to comb your hair properly and whether it is possible to kill lice using mayonnaise? We will tell you about to the entire process of treatment, give tips and show you how to protect yourself from relapse.
At the end of the article you’ll find top 4 best shampoos and combs, seven tips for hair treatment shampoo and seven rules of combing out the nits. But let's take first things first: let’s start with the symptoms.
Lice Signs & Symptoms
A head louse infestation can always be identified before it gets to the “head swarming with lice” stage. Common sense, attention to head and house hygiene will help you. What signs should keep you alert?
Eggs (nits). While a couple of small lice can get lost in thick hair, nits are much more noticeable, especially if you are meticulous in regard to hair care. A female louse attachs the eggs ¼ of an inch away from the scalp, and they look like little white specks. The nits attached over ¼ of an inch away from the base of the hair shaft are almost always dead or already hatched. It feels like they are grains of sand in the hair roots, which you can touch when shampooing. But, unlike some debris or dandruff they are nearly impossible to remove with your fingers.
Larvae and adults. Yes, sometimes they are not easy to notice because of their small size (larvae are tinier than adults), but adult lice run around in their hair. They are especially active at night, so you’d better inspect your (or your child's) head at night. Do it as soon as possible once your kid is back a summer camp! Use a fine comb and a magnifying glass to look at the entire head, and don’t forget divide hair into different strands. Pay special attention to the occipital region of the head and behind the ears, as these are favorite spots of parasites.
Feces. Just like any other blood-sucking insects, lice may be invisible, but they have not yet learned to hide their feces. Pay attention to dark spots on the scalp as these are signs of live adults. Also check your clothes in the neck and shoulder area, and the pillowcases for these spots.
Head Lice Symptoms: What Should You Pay Attention To?
As a rule, the symptoms are crystal clear. This is especially true for infected children under 12 years of age, whose scalp is more susceptible to bites than that of adults. The latter, incidentally, completely lack sensitivity to bites in rare cases. Typically, the following symptoms are observed.
Severe irritation and scalp itch
As the Ohio State University Extension scientists explain, when a louse pierces human skin with its jaws, it injects histamine together with saliva. The former causes irritation and itching, and can even provoke allergic reactions in the worst-case scenario. By the way, all the blood-sucking insects are doing the same, so the reaction to any insect bites may be allergic.
Head, neck and ears scratch
This symptom is the result of a previous one. It is especially common among kids who don’t always realize that such severe itching should be reported to adults, they simply keep scratching instead. Secondary infection is possible due to that (scalp bacteria can cause it).
Tingling or motion sensation in your hair
This sensation is felt because the lice crawl fairly quickly - about 1 inch in a few seconds.
Just like the bed bugs, lice are especially active at night and bite at night more.
General irritation amid all the unpleasant symptoms
These horrid symptoms will unlikely go unnoticed, but we hope that you’ll be able to detect them at the earliest stage if you use our tips.
How to treat lice. What is the best way: medications and combing or natural lice treatment?
In this section we’ll describe all known methods of treatment. There are only 2 methods approved the scientists: pediculicide treatment (pharmacologic treatment) and mechanic treatment, i.e. combing.
Which one is more effective and reliable? Actually, it is using pediculicides along with combing because such a combination helps to eliminate all blood-suckers: pediculocides work against larvae and adults while combing will remove the nits. Pediculicide action is proven both by scientists and doctors, in contrast to natural products, which often do not work, or sometimes have a placebo effect. Yes, many believe in natural remedies, but we do not encourage you to experiment with them.
Anyway, we have to tell about all possible treatment methods and it is up to you to choose the most appropriate one.
Lice shampoos’ (pediculicides), gels’ and sprays’ action
The most common pediculicide is a medicated shampoo, which helps kill adults, and eliminate further breeding at this stage. Some of these shampoos have ovicidial effect, i.e. they can kill nits. But basically there is no such effect or it is weak and therefore requires repeat use of shampoo in 7-10 days to get rid of the new ones that have hatched from the eggs.
Why are the nits so difficult to neutralize? Well, the aim of pediculicide shampoos is a louse’s CNS. Once you inflict damage to it, you can kill these parasites. But when a louse is only on the nit stage, the nervous system is not formed completely, so pediculicides have barely any effect on nits. Instead, they do well with larvae and adults. Still, to choose a truly murderous treatment, you need to know what it should contain.
Effective and Not so Much Effective Active Ingredients of Pediculicides
Permethrin and pyrethrin - YES, they are effective
The scientists believe that chemical insecticides that are often used against certain insect species for too long (over ten years) can partially lose their killing action since the insects become resistant to the chemicals and pass such resistance on to next generations. Most products, including shampoos, contain widespread insecticides, namely permethrin or pyrethrins. They are considered to be effective, but as Mike Potter, Extension Entomologist from University of Kentucky College of Agriculture claims, some lice populations may also acquire resistance to the effects of permethrin-based products. He adds: “Resistance to pyrethrin/piperonyl butoxide formulations appears to be less common”.
Mind that both permethrin and pyrethrin act on the adult lice, but do not have ovicidial effect, i.e. they do not kill the eggs. An adult louse should die within 30 minutes (when using pyrethrin) to several hours (when using permethrin) after medicated shampoo treatment. If you find live parasites after the time stated (up to 8 hours), then the lice are resistant to this insecticide. In this case, stop using this product and get another shampoo (if you used a permethrin one, buy pyrethrin and vice versa). Repeatedly wash the head with shampoo after 7-10 days.
CDC (Centers for Disease control & prevention) warns the users of the pyrethrin use restrictions: “Pyrethrins generally should not be used by persons who are allergic to chrysanthemums or ragweed. Pyrethrin is approved for use on children 2 years of age and older”. Permethrin is considered to be milder, as shampoos containing it can be used even on 2 months old babies
Lindane - YES, it is effective, but toxic
In the past the insecticides containing lindane were quite popular. But, as the University of California Statewide IPM Program and CDC experts explain, lindane is extremely toxic and its use is associated with unpleasant side effects for both the patients and the medics. It also strongly pollutes the water and has a lot of use restrictions: it is forbidden to treat pregnant women, the elderly, infants, people with a variety of different diseases and those weighing less than 100 pounds with it. Therefore, although lindane shampoo 1% is approved by the FDA for the treatment of head lice, it is not recommended as a first-line treatment. "While lindane is still available by prescription, pyrethrin and permethrin are safer, more effective, and less polluting than lindane ".
Enzymes (oxidoreductase, transferase, lyase, hydrolase, isomerase, ligase etc) – NO, they are ineffective
Nowadays the so-called enzyme shampoos and gels containing non-toxic enzymes are very popular. They are promised to interrupt the breeding cycle by dissolving the adults’ exoskeletons and the glue that gri[s nits to the hair. Allegedly, after using this shampoo or gel, nits are actually fall off your hair and there is no need to bother with hair combing.
This doesn’t turn out to be true, as according to the same University of California Statewide IPM Program specialists: “Enzymatic treatments, including shampoos that claim to dissolve eggs, the cement that attaches eggs to the hair, or the exoskeleton of the adults, are also available to use against head lice. Although these materials are very appealing because of their relative nontoxicity, in university-conducted research trials none of them has yet proven to work as advertised”.
Enzyme gels can be used after an insecticidal shampoo simply to facilitate hair combing.
Olive, coconut oil, tea tree oil - NO, they are ineffective, but there is certain repelling action
What do you do if you do not want to treat your head with chemicals? Scientists are still arguing about the effectiveness of oils. Some believe that oil absolutely does not work, while others, like the University of California Statewide IPM Program specialists recommend trying soap shampoos containing coconut or olive oil. To observe the effect, you need to wash your hair with this shampoo 3 times with a 4 day interval. However, there may be no killing effect as no one gives a guarantee - so it's best to turn directly to the specialized shampoos. On the other hand, the oils can produce repelling effect, so as a preventive measure, you can use tea tree oil based treatment.
“Homeopathic pediculicides”: Salts containing sodium chloride, i.e. table salt, minerals, plants, animal material - NO, they are ineffective
Homeopathic shampoos or gels are a waste of time and money. Homeopathy does not work: you will only end up having even more lice while you wait for a shampoo to work. Gels will not cope with the task either, although, they are promised, like products with enzymes, to dissolve the nits glue. Still, they can be used simply to facilitate combing the hair.
Conclusion: don’t be driven by ads! You’d better use proven permethrin or pyrethrin shampoos as they are most effective.
Best Lice Shampoos & Cream Rinses
Don’t be astonished that we’ve picked only two products. Surprisingly, among the many louse shampoos found on Amazon.com there are only two worthy and proven options that are approved by both doctors and the FDA and that really work. They are NIX and RID. Therefore, we will tell you about them. Let us warn you that there is one shampoo that is very popular, but is homeopathic. As we have mentioned above, according to the scientists, homeopathy is useless.
NIX Permethrin Lice Treatment Family Pack 2x2 ounce bottles
This Nix set for ~$20.22 for contains a special permetrin 1%-based cream rinse. This pediculicide is also approved by the FDA for the treatment of head louse hence the Nix products are recommended even by the Centers for Disease Control and Prevention. Moreover, permethrin is considered to be gentler than pyrethrin that is why you can use a permethrin cream rinse even for treatment of children from 2 months of age and older. For convenience the set contains not only the 2 pediculicide bottles but also 2 nit combs which are especially important if you want to simultaneously treat two patients. Conveniently, all of this can be bought for only ~$20.22 Check the current price
NB: The manufacturer claims that Nix products will kill both adult lice and eggs. We’ve already explained that nits cannot be killed with pediculicides, they can only be combed – hence the comb supplied. Don’t blindly rely on a single product. The treatment must consist of two parts: shampoo (or cream rinse) head treatment and combing!
RID Complete Lice Elimination 3 Item Kit
One of truly effective shampoos which can be used for kids over 2 years old is the RID for ~$19.21 manufactured by the world famous pharmaceutical giant Bayer. The product is made in the USA. Its active ingredient, Pyrethrins (naturally occurring pyrethroid extracts from the chrysanthemum flower) was approved by the FDA.
This is a kit containing of 4 items. The system is complex: it contains a shampoo, a gel, a comb and a spray.
Step 1 is lice killing shampoo treatment (the active ingredient of the shampoo is Pyrethrum extract);
Step 2 is using lice and egg comb-out gel which is to be applied when combing for facilitating the process;
Step 3 is using the Home Lice Control spray (its active ingredient is 0.5% Permethrin).
The manufacturer, in this way, first suggests that you wash your kid’s hair with a special pediculicidal shampoo; then use the gel for combing the lice and nits out of their hair. Since the parasites attack not only humans but also their accommodation, the kit also contains spray for treating the furniture, mattresses, pillows and other household objects which aren’t supposed to be washed in the washing machine (remember to treat you car salon as well).
Since getting rid of nits is a lengthy process, prepare to spend a few hours combing them out of the kid’s hair. Here is a valuable advice of moms whose kids are infected by lice: “keep using the comb for a month along with oil, just to make sure that all lice and eggs have been totally removed”. Read all of the helpful product reviews on Amazon.com
Price: from ~$19.21 Check the current price
Warning! The next product is the homeopathic product, which is sold on Amazon.com and is a bestselling item in the Lice Treatment Kits category. Licefreee Spray is one of the cheapest sprays (~$8.49) and perhaps that explains its popularity.
The label states that it contains natural ingredients: sodium chloride, benzyl alcohol, and water. What alarmed us is the inscription that this is a homeopathic drug. As we’ve mentioned above, the scientists confirm that homeopathy cannot kill a louse. So please, be careful and remember that only combing helps against nits and pediculicides treat lice.
7 Tips for using pediculicide shampoo
Don’t use a shampoo and a conditioner or a conditioner before using a lice shampoo.
When treating head, wear gloves and push your hair when washing it. It is important that the insecticide does not get in your eyes, mouth, nose, body and mucous membranes; do not use it as a regular shower shampoo!
Use cool or cold water for the treatment. Hot water opens scalp pores and allows for many synthetic chemicals to be absorbed.
Be consistent! Not only you have to wash your head, but you should also make sure that every louse is dead and then carry out repeat treatment within 7-10 days. This is done to get rid of the larvae that used to be nits and thus survived.
If you have asthma, allergies or if you are pregnant, consult your physician before using this or any other medicated shampoo.
If many people undergo treatment, they should use the shampoo simultaneously, within 24 hours in order to prevent repeat infestation.
You can wash your head again or visit a swimming pool only 2 days after using a medicated shampoo, else the treatment effect can be reduced.
NB! Let us remind you that the combination of a shampoo and combing is the most effective type of treatment. After you’ve killed all of the adults and larvae with shampoo, it is a must to comb the nits.
Which Lice Comb Should You Pick and How Do You Use It?
Combs are the only effective remedy for nit removal. The process is long, tedious, but 100% effective. Most importantly, you should be careful and sure to comb out all the eggs, or else the lice will breed and torment you at night again. But do not rush immediately to look for any comb as a mediocre one will not work.
Plastic or Metal Head Lice Comb?
Use only metal one with long teeth. Ordinary plastic combs are not suitable to comb the lice out of your head. They are useless because they bend easily and keep their teeth are separate from each other. Therefore, such a comb simply will not grip larvae and adults. Short-toothed combs, both plastic and metal won’t be suitable either. You might like not only ordinary metal, but also modern electronic combs, which combine the functions of a comb and a vacuum cleaner. With such a device you will not have to remove by hand any nits found as they are stored in a container inside the device.
All metal combs are similar as they have long teeth made of steel and tightly pressed to each other with a comfortable handle. A classic best-selling comb, however, has long been renowned by thousands of customers.
Nit Free Terminator Lice Comb, Professional Stainless Steel Louse and Nit Comb
This is quite a large item here before us; its dimensions are 3x4 inches. It is made of stainless steel and the teeth are micro-corrugated so that the nits which are firmly attached to the hair are hitched up better. There are also corrugations on the comb handle. This is made to prevent the comb from sliding out of your hands when combing very thick hair. Nit Free Terminator is durable enough for the manufacturers to issue a lifetime warranty for it. Its country of origin is the USA.
The buyers of this product note that it is more advantageous than many of its rivals. According to them, the micro-canals which are located on the teeth can really grip on more nits. In addition, the Terminator works fine for thin and fragile hair as well. Not every comb can do that! We weren’t able to find any complaints concerning the breakage of the comb, but we were able to find a few pieces of advice instead. The customers recommend using the comb on wet hair and remind us to combine brushing with using some non-toxic sprays and shampoos. Over 90% of the consumers consider the Terminator useful.
Unlike other classic combs, this one is available in sets of 2, 6, 10, 12, 24 and even 100 units for mass treatment. The reasonable price of ~$7 per unit or lower begins when you buy a set of 6 combs or more.
Price: from ~$7 to $11.10 (depending on the number of combs in a set) Check the current price
Most metal combs are identical in terms of performance and only differ slightly when it comes to design. The combs cost from ~$7 to $11 per unit, and the price often depends on the number of units in set. Pick the best option on Amazon.com.
Best Electronic Lice Comb
Electronic combs are ambiguous gadgets. On the one hand, they facilitate nit removal and safeguard others against as the found eggs are not touched or shaken on the fabric due to the fact that some models of these devices work like vacuum cleaners and thus all eggs are collected in a container inside the device, which is then easily possible to flush down the toilet. But on the other hand to some people they may seem a little upmarket and far more demanding when it comes to maintenance than conventional combs. In any case, the choice is yours, and we will just cover one of the most popular models.
It is a combination of a hair brush and a mini vacuum cleaner. It is the most gentle and soft hackle because its metal teeth ends are rounded. When you comb the hair, vacuum sucking in its handle starts to work and all of the lice and nits gripped are transported into disposable soft bags. The rating of the product is medium, it is 3.8 out of 5 stars on Amazon.com.
Price: ~$59.99 Check the current price
Warning! Not all the electronic combs are equally efficient. The manufacturer of RobiComb for ~$21.63 promises that this battery powered comb will kill all blood-suckers on contact by electrocution. Don’t fall for these empty promises though as the University of Nebraska-Lincoln scientists have tested this comb and revealed that “The manufacturer claims lice trapped in the teeth are electrocuted, but we have not always found this to be true.“ That's why the result is all the same: 42% of the customers don’t consider this product effective and rating is only 3.3 out of 5 stars on Amazon.com. Also they are afraid to have some electric charge on their heads. Are you ready to spend money on such strange experiments?! Don’t do it, electrocuting doesn’t kill nits!
7 Tips on How to Use a Comb
Let’s now get back to the actual technique. Based on the NYC Department of Health & Mental Hygiene and different US universities’ scientists’ opinion, we’ve drawn up the main tips concerning nit combing:
After you have washed your head with louse shampoo, dry your hair a bit before combing so that the water doesn’t drip off them. Dry your hair completely if you use an electronic comb.
Apply some oil (olive or tea tree oil) or hair gel/conditioner on the roots of your hair to facilitate the process. You can use either regular hair gels, conditioners or special ones, such as ones with rosemary extract which not only facilitate comb sliding but also repel lice.
Prepare: make sure the room is well-lit, pour some water into a bowl to clean the comb or prepare a dense transparent bag. Also place bright cloth under your hair (red, for instance) to make white and brown nits as well as white-grayish adults equally visible.
Comb all hairs starting from the temple down to the ends as close to scalp as possible in all directions. You may find it easier if the hair is pre-divided into small strands across the head. Carefully inspect the comb for eggs and live lice, when washing it in the bowl with water or cleaning off in the bag. The procedure can take up an hour or more, especially if the hair is very thick, long and light.
If certain nits cling to the hair tightly, cut these hairs with small nail scissors.
Flush the water from the bowel down the toilet regularly and re-fill the bowl.
After you have combed the entire head, wash your hair with regular shampoo to wash off the oil. Clean the comb (or better, boil it for 15 minutes if it is made of metal). After that you can comb another patient.
5 Tips for People Who Do Nit-Picking
As we don’t recommend self-combing, it’s important to protect the person who is going to comb a contaminated patient from possible infection. We have prepared several tips for these brave warriors.
Make sure that you do not touch your hair while nit-picking as you can catch lice! Secure your hair with hair clips, bobby pins, etc. or tie it back.
Take off any bracelets, rings or other jewelry when combing someone.
In order to protect your clothes, wear a garbage bag over them so that it doesn’t hold down your movements and covers your front. Don’t forget to take it afterwards (over your legs and not over your head, obviously).
Once you’re done, place the gloves and the garbage bag into a plastic bag and dispose of it. Wash your hands well with soap.
More myths & facts about getting rid of nits you'll find in How to Get Rid Of Nits For Sure?
Natural Lice Treatment Is a Waste of Time and Money
As we’ve mentioned before, permethrin and pyrethrin-containing pediculicides are the most effective treatment methods. Natural treatment shows weaker results, if any. Bio-enzyme shampoos, homeopathic treatment and oil-based products (tea tree, olive, coconut, eucalyptus oils etc) are considered to be natural remedies.
Certain scientists believe that the oils are completely useless for killing lice and can only repel them. Others argue that the oils can kill, but this will require as much as 3 washings of the hair with an oil-based shampoo every 4 days, that is, you will have to wait for about 2 weeks until recovery.
Are you ready to watch your kid itching for an entire fortnight? Ifyour child is allergic to it? Is it worth a try? We believe you’d better treat the hair with proven Rid or Nix pediculicides (in accordance with the manuals) which guarantee recovery rather than suffer for 2 or more weeks without any reassurance.
Home remedy for head lice: mayonnaise, vinegar or petroleum jelly. Do they work or are they lethal?
Remember, using home remedies is the worst idea. It is the parents who seek to save on their children’s treatment and thus google treatment, who resort to this. Not only such remedies are ineffective, they are also highly dangerous!
Kerosene, gasoline, vinegar, mayonnaise, petroleum jelly, alcohol, etc are undesirable or even dangerous (gasoline and kerosene) treatments. In some cases such methods may be deadly. The University of Utah Health Care staff reminisces of a terrible case when the parents of a 1 year old baby who got infected with lice decided to use mayonnaise as treatment. They smeared the baby’s head with it, put a plastic shopping bag over it and left for a few hours. The bag slipped onto a baby’s face and the poor being suffocated.
The doctors are against using home remedies: The only safe and effective way to treat head lice is by using an over-the-counter or prescription medication,”says Ellie Brownstein, M.D., a pediatrician at University of Utah’s Greenwood Health Center. “Home remedies to treat lice, including the use of mayonnaise, vinegar or petroleum jelly in the hair and covering with a shower cap for several hours or days, do not work”, according to the Centers for Disease Control.
How to Prevent Lice: Products and Tips
You can make your own lice prevention shampoo by adding a few drops of essential oil in your regular shampoo, or you can buy a ready-to-use one. It depends on your preferences, and on which essential oil smell is most pleasant for you: tea tree, lavender or rosemary oil?
If you prefer 100% organic products and tea tree smell, read our detailed review of Using Tea Tree Oil to Repel Lice.
Below we have listed some ready-to-use shampoos with the rosemary oil which can be used on your or your child’s head.
Fairy Tales Rosemary Repel Creme Shampoo, 12 fl.oz. + Conditioner, 8 fl.oz. - Lice Prevention Shampoo & Conditioner
This is a classic shampoo made by a famous manufacturer. It is positioned a children’s product, but it can be used by adults as well. It contains a whole range of vitamins, minerals, and the main lice repellent: essential oils. This preventive product costs almost ~$19.32 and has a decent rating of 4.4 out of 5 stars on Amazon.com. A free bottle of a brand hair conditioner is supplied with the shampoo.
The manufacturers boast of the fact that their shampoo is officially recommended by the pediatricians. Apparently the clinical tests have shown an effectiveness of 90% of using this shampoo and conditioner along with the brand’s spray. However, we didn’t find anything about some particular licenses or certificates of any medical institutions. The customers praise simultaneous use of the shampoo and the conditioner as they both do their job quite fine.
Please note that you can buy the shampoo separately from the conditioner on Amazon.com Fairy Tales Repel Shampoo, Rosemary, 12 Fluid Ounce will only cost you ~$10.55! Those who are buying large volumes (or the parents of many children) can buy a 32 oz. bottle. Fairy Tales Rosemary Repel Shampoo, 32 Ounce costs only~$23.95.
Lice Shampoos and Combs Comparison Chart
NIX Permethrin Lice Treatment Family Pack 2x2
|Elimination kit (includes 2 pediculicide bottles + 2 combs)||Permethrin|
RID Complete Lice Elimination 3 Item Kit
|Elimination kit (inclides shampoo, comb-out gel, comb & house control spray)||Pyrethrum extract|
| Licefreee Spray, Instant Head Lice Treatment Spray Bottle with Metal Comb
||Elimination kit (includes spray and comb)||Sodium chloride, benzyl alcohol, and water. This homeopathic product is not effective|
Nit Free Terminator Lice Comb
V-Comb - Head Lice Comb
|Electronic metal comb||–|
LiceGuard RobiComb Electronic Lice Comb
|Electronic metal comb||It's not effective|
Fairy Tales Rosemary Repel Creme Shampoo+ Conditioner
|Preventive shampoo & conditioner||Rosemary, citronella, tea tree, mint, and sage and lemongrass oils
10 Prevention Tips
Here are some lice prevention tips as per the U.S. Department of Health and Human Services:
The main principle of prevention is to wash your hair daily.
Try to avoid direct contamination. The most common way to get infected is a “head-to-head” contact. Learn and teach your kids a simple rule: don’t let your hair touch strangers.
Obviously, the kids are not good at controlling themselves. If they don’t listen to you, you’ll have to learn to identify head louse infestation at an early stage. Comb your kids’ hair regularly. The nits will remind you of dandruff which is stuck to the hair and won’t get away. Tiny lice will be given away by their movement: they are barely ever static.
Watch your kids’ behavior on various events or when they play together with the others.
If you’re going somewhere where you are highly likely to get infected with lice, apply a few drops of the tea tree or lavender essential oil on the temples and on the back of a kid’s head. Lice hate such smells.
Don’t wear other people’s hats and outerwear in vain and don’t use their combs, brushes and towels.
Sleeping on someone else’s bed or carpet is also risky.
Washing the infected sheets in hot water (of the temperature up to 130° F) with hot drying is guaranteed to kill parasites.
The parents are to check the kids’ heads most often at the beginning of the school year and after winter holidays.
Disinfect the combs and brushes which the kids have taken to a summer camp, kindergarten or a boarding school.