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Treating Head Lice Infestation
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By treating the person infested with head lice, other infested family members, and by cleaning the house.
Treat the infested person: Requires using an over-the-counter (OTC) or prescription medication. Follow these treatment steps:
Before applying treatment, remove all clothing from the waist up.
Apply lice medicine, also called pediculicide (peh-DICK-you-luh-side), according to label instructions. If your child has extra long hair, you may need to use a second bottle. Pay special attention to how long the medication should be left on and whether rinsing the hair is recommended after treatment.
WARNING: Do not use a cream rinse or combination shampoo/conditioner before using lice medicine. Do not re-wash hair for 1-2 days after treatment.
Have the infested person put on clean clothing after treatment.
If a few live lice are still found 8-12 hours after treatment, but are moving more slowly than before, do not retreat. Comb dead and remaining live lice out of the hair. The medicine may take longer to kill lice.
If, after 8-12 hours of treatment, no dead lice are found and lice seem as active as before, the medicine may not be working. See your health care provider for a different medication; follow treatment directions.
Nit (head lice eggs) combs, often found in lice medicine packages, should be used to comb nits and lice from the hair shaft. Many flea combs made for cats and dogs are also effective.
After treatment, check hair and comb with a nit comb to remove nits and lice every 2-3 days. Continue to check for 2-3 weeks until you are sure all lice and nits are gone.
If using OTC pediculicides, retreat in 7-10 days. If using malathion, retreat in 7-10 days only if crawling bugs are found.
Treat the household: Head lice do not survive long if they fall off a person. You do not need to spend a lot of time or money on house cleaning activities. Follow these steps to help avoid re-infestation by lice that have recently fallen off the hair or crawled onto clothing or furniture.
To kill lice and nits, machine wash all washable clothing and bed linens that the infested person touched during the 2 days before treatment. Use the hot water (130°F) cycle. Dry laundry using high heat for at least 20 minutes
Dry clean clothing that is not washable, (coats, hats, scarves, etc.)
OR
Store all clothing, stuffed animals, comforters, etc., that cannot be washed or dry cleaned into a plastic bag; seal for 2 weeks.
Soak combs and brushes for 1 hour in rubbing alcohol, Lysol*, or wash with soap and hot (130°F) water.
Vacuum the floor and furniture. Do not use fumigant sprays; they can be toxic if inhaled or absorbed through the skin.
Prevent Reinfestation: Lice are most commonly spread directly by head-to-head contact and indirectly though contaminated clothing or belongings. Teach your child to avoid playtime and other activities that are likely to spread lice.
- Avoid head-to-head contact common during play at school and at home (slumber parties, sports activities, at camp, on a playground).
- Do not share clothing, such as hats, scarves, coats, sports uniforms, or hair ribbons.
- Do not share infested combs, brushes, or towels.
- Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infested person.
No, although anyone living with an infested person can get head lice. Check household contacts for lice and nits every 2-3 days. Treat only if crawling lice or nits (eggs) within a 1/4 inch of the scalp are found.
No. Head lice do not live on pets.
For children under 2 years old, remove crawling bugs and nits by hand. If this does not work, ask your child's health care provider for treatment recommendations. The safety of head lice medications has not been tested in children 2 years of age and under.
Many head lice medications are available at your local drug store. Each OTC product contains one of the following active ingredients.
Pyrethrins (pie-WREATH-rins) — often combined with piperonyl butoxide (pie-PER-a-nil beu-TOX-side):
Brand name products include A-200*, Pronto*, R&C*, Rid*, Triple X*.
Pyrethrins are natural extracts from the chrysanthemum flower. Though safe and effective, pyrethrins only kill crawling lice, not unhatched nits. A second treatment is recommended in 7-10 days to kill any newly hatched lice. Treatment failures are common.
Permethrin (per-meth-rin):
Brand name product: Nix*.
Permethrins are similar to natural pyrethrins. Permethrins are safe and effective and may continue to kill newly hatched lice for several days after treatment. A second treatment may be necessary in 7-10 days to kill any newly hatched lice that may have hatched after residual medication from the first treatment was no longer active. Treatment failures are common.
Malathion (Ovide*): When used as directed, malathion is very effective in treating lice. Some medication remains on the hair and can kill newly hatched lice for seven days after treatment. Malathion is intended for use on people 6 years of age and older. Few side-effects have been reported. Open sores from scratching may cause malathion to sting the scalp. Click here for instructions on how to use malathion to treat head lice.
Lindane (Kwell*): When used as directed, the drug is probably safe. Overuse, misuse, or accidentally swallowing Lindane can be toxic to the brain and other parts of the nervous system. For those reasons Lindane is generally used only if other medications have failed. Lindane should not be used if excessive scratching has caused open sores on the head. It should be used with caution in persons who weigh less than 110 pounds.
If you aren't sure, ask your pharmacist or health care provider. When using the medicine, always follow the instructions provided.
When treating head lice
Do not use extra amounts of the lice medication unless instructed. These drugs are insecticides and can be dangerous when misused or overused.
Do not treat the infested person more than 3 times with the same medication if it does not seem to work. See your health care provider for alternative medication.
Do not mix head lice drugs.
No. Spraying the house is NOT recommended. Fumigants and room sprays can be toxic if inhaled or absorbed through the skin.
No. Vacuuming floors and furniture is enough to treat the household.
*Use of trade names is for identification purposes only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.
This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the disease described above or think that you may have a parasitic infection, consult a health care provider.
Revised October 19, 2004
 Head Lice Infestation
Treating Head Lice Infestation with Malathion
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 Head Lice Infestation
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