If lice cannot be removed, what should be done? - briefly
Consult a healthcare professional for prescription‐strength pediculicide or specialist‑performed removal, and implement rigorous cleaning of personal items and environment. Evaluate treatment resistance and consider alternative therapies if standard options fail.
If lice cannot be removed, what should be done? - in detail
When standard combing and over‑the‑counter shampoos fail to eradicate head‑lice infestations, a systematic approach is required. First, confirm the presence of live insects by examining hair under a bright light and using a fine‑toothed lice comb. If live nymphs or adults are observed after at least two treatment cycles, proceed with the following steps.
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Prescription medication – Obtain a topical insecticide such as permethrin 1 % (Nix) or a higher‑strength formulation like malathion 0.5 % (Ovide) prescribed by a clinician. Apply according to the package directions, typically after washing hair with a neutral shampoo, leaving the product on for the specified duration, then rinsing thoroughly.
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Repeat treatment – A second application is essential 7–10 days after the first, targeting newly hatched lice that survived the initial dose. Failure to repeat is a common cause of persistent infestations.
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Environmental decontamination – Wash all bedding, clothing, and personal items used within the previous 48 hours in hot water (≥ 130 °F/54 °C) and tumble‑dry on high heat for at least 20 minutes. Items that cannot be laundered should be sealed in plastic bags for two weeks, preventing reinfestation from dormant eggs.
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Household cleaning – Vacuum carpets, upholstered furniture, and car seats to remove detached nits and lice. Discard vacuum bags or empty canisters immediately after use.
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Alternative therapies – If resistance to conventional insecticides is suspected, consider oral ivermectin (single dose of 200 µg/kg) prescribed by a physician, or a combination of dimethicone lotion applied to dry hair for 10 minutes before rinsing. These agents act by suffocating lice rather than neurotoxic mechanisms, reducing the likelihood of resistance.
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Follow‑up inspection – Conduct thorough combing sessions every two days for two weeks after the final treatment. Document any remaining live insects; persistent findings warrant a referral to a dermatologist for specialized management.
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Preventive education – Advise all household members to avoid sharing combs, hats, or hair accessories. Encourage regular head checks, especially in school settings where transmission rates are high.
By integrating prescription‑level treatment, rigorous environmental control, and diligent post‑treatment monitoring, the probability of complete eradication increases markedly, even when initial methods prove ineffective.