How to remove lice: which treatment is best? - briefly
The most reliable method pairs a 1 % permethrin or dimethicone preparation with thorough combing of wet hair for at least 10 minutes, followed by a repeat treatment after 7–10 days. Prescription ivermectin is reserved for infestations that do not respond to these first‑line products.
How to remove lice: which treatment is best? - in detail
Effective lice eradication requires a clear understanding of the available options, their mechanisms, and the circumstances that influence success. Treatments fall into three categories: chemical agents, physical methods, and prescription medications. Each approach has specific advantages and limitations that determine suitability for different individuals and infestations.
- Over‑the‑counter insecticidal shampoos and lotions (permethrin 1 %, pyrethrin, carbaryl). Apply to dry hair, leave for the recommended duration, then rinse. These products kill live lice but often fail to eliminate nits, necessitating a second application 7–10 days after the first. Resistance to pyrethroids is documented in many regions, reducing efficacy.
- Prescription‑strength preparations (malathion 0.5 %, benzyl alcohol 5 %, ivermectin 0.5 % lotion). Malathion provides prolonged contact time, useful for resistant infestations. Benzyl alcohol acts as a neurotoxin without insecticidal residues, but requires multiple daily applications for 10 days. Ivermectin offers a single‑dose oral regimen, effective against both lice and nits, but is contraindicated in pregnant women and children under 15 kg.
- Physical removal techniques (wet combing, heated air devices). Wet combing with a fine‑toothed nit comb, performed on damp hair every 2–3 days for two weeks, removes up to 90 % of viable lice and all observable nits. Heated air systems vaporize lice at 50 °C for 10 seconds; they are chemical‑free but demand professional equipment and trained personnel.
- Alternative options (dimethicone, essential‑oil blends). Dimethicone suffocates lice by coating their exoskeleton; studies show comparable success to permethrin without resistance concerns. Essential‑oil products (tea tree, neem) lack robust clinical evidence and should not replace proven treatments.
Choosing the optimal regimen involves assessing resistance patterns, age and health status of the host, and the feasibility of repeated applications. A typical protocol combines a chemical or prescription agent to eliminate active lice, followed by meticulous nit removal using a fine comb for two weeks. For households with known resistance, dimethicone or prescription ivermectin should be prioritized. In cases where chemical exposure is undesirable—e.g., infants, allergy‑prone individuals—wet combing supplemented by a dimethicone rinse offers an effective, non‑toxic alternative. Consistent follow‑up, thorough cleaning of personal items (bedding, hats, brushes) and avoidance of re‑infestation are essential components of any successful eradication strategy.