Head Lice

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Head lice, or pediculus humanus capitus, are wingless insects that live on the human scalp. The parasites feed almost exclusively on the human blood. Thankfully, these parasites are not vectors for any human diseases.

Lice move by crawling. The lice do not fly, jump, or hop. The lice are mainly spread by head to head contact. However, the lice may also be spread by objects that have come in contact with an infected scalp such as a hat, comb, brush, or towel.

Head lice infestations affect millions of people every year, from all socioeconomic backgrounds. Head lice is most common in school aged children 


The most common symptom of head lice is itching. There may be sores on the scalp caused by scratching. In addition, some people will experience a crawling sensation. Lice can also cause pink eye or swollen lymph nodes. Head lice can be asymptomatic.


Head lice is diagnosed by finding the lice or their eggs. The insects are large enough to be seen without any magnification. They eggs are light brown and the size of a seed. The eggs (nits) may be yellow, brown, tan, or white and are the size of a pin head. They are strongly attached to hair at a 45 degree angle, and are difficult to peel off hair.

There are many things in the scalp that look like lice eggs but are not, including dandruff, lint, and sand. These other things comb out easily, whereas nits are stuck to the hair and do not comb out easily.

OTC Treatment Options



NIX Lice Treatment 2 Pack

(Permethrin 1%)

RID Complete Lice Elimination Kit (Piperonyl butoxide 4%, pyrethrum extract).

Nit Free Terminator Lice Comb

Nix Ultra Lice Removal Comb

RID Ridvantage Comb


​Make sure to carefully read and follow the detailed instructions on the package. Do not use conditioner or shampoo/conditioner before using lice medicine.

Do not use RID if you are allergic to chrysanthemum or ragweed. Rid is approved for ages 2 years and older. When using Rid, you will need to retreat 7-10 days after initial treatment. See package insert for detailed instructions

OTC Tips

When used correctly, the OTC medicines should successfully treat head lice. To increase efficacy and decrease the chance of reinfestation, most treatment regimens also include physically removing the lice and eggs. If purchased separately, buy a lice comb that has teeth that are close together. Carefully comb out all of the lice and eggs. Combing out lice and eggs is extremely critical! Inspect family and close contacts and treat all infected persons. When treating with Nix, you will need to retreat 7-10 days later if there is still evidence of lice or eggs. Continue to check for lice and eggs for 2-3 weeks. Nix is recommended for persons 2 months old and older.

Nix Lice Treatment Detailed Instructions (Package Instructions)

  • All household members should be checked by another person for lice and/or nits (eggs)
  • Use a magnifying glass in bright light to help you see the lice and nits (eggs)
  • Use a tool, such as a comb or two unsharpened pencils to lift and part the hair
  • Look for tiny nits near the scalp, beginning at the back of the neck and behind the ears
  • Small sections of hair (1-2 inches wide) should be examined at a time
  • Unlike dandruff, nits stick to the hair. Dandruff should move when lightly touched
  • If either lice or nits (egg) are found, treat with Nix Creme rinse


  • Wash hair with a shampoo without conditioner. Do not use a shampoo that contains a conditioner or a conditioner alone since this may decrease the activity of Nix. Rinse with water
  • Towel dry hair so it is damp but not wet
  • Shake the bottle of Nix well
  • Completely saturate the hair and scalp with Nix. Begin to apply Nix behind the ears and at the back of the neck
  • Keep Nix out of the eyes. Protect the eyes with a washcloth or towel
  • Leave Nix on the hair for 10 minutes, but no longer
  • Rinse with warm water
  • Towel dry hair and comb out tangles
  • If live lice are seen seven days or more after the first treatment, a second treatment should be given

Remove lice/nits

  • Remove nits by combing the hair with the special small tooth comb provided. Remaining nits may be removed by hand (using a throw-away glove), or cutting the nits out
  • Use the nit comb provided and make sure the hair remains slightly damp while removing nits
  • If the hair dries during combing, dampen it slightly with water
    Part the hair into 4 sections. Work on one section at a time. Longer hair may take more time (1-2 hours)
  • Start at the top of the head on the section you have picked
  • With one hand, lift a 1-2 inch wide strand of hair. Get the teeth of the comb as close to the scalp as possible and comb with a firm, even motion away from the scalp to the end of the hair
  • Use clips to pin back each strand of hair after you have combed out the nits
  • Clean the comb completely as you go. Wipe the nits from the comb with a tissue and throw away the tissue in a sealed plastic bag to prevent the lice from coming back
  • After combing, recheck the entire head for nits and repeat combing if necessary
  • Check the affected head daily to remove any nits that you might have missed

Alternative/Complementary Treatments

This treatment works by coating the lice and suffocating them. Apply the Cetaphil cleanser throughout the scalp to dry hair. After all the hair is wet, wait 2 minutes for Cetaphil to soak in. Comb out as much excess cleanser as possible. Blow dry hair very thoroughly. Dry down to the scalp to suffocate the lice. Expect this to take 3 times longer than normal drying. The dried Cetaphil will suffocate the lice and destroy the nits. Leave it on your hair for at least 8 hours. In the morning, wash off the Cetaphil with a regular shampoo. Repeat this process again in 1 and 2 weeks. Reported cure rates with this method are around 96%.

Treating the Home

  • Soak combs/brushes that have been in contact with the infested person. Soak in hot water (130 F or hotter) for 10 minutes
  • All items that have had contact with the infested person in the past 2 days should be washed in the washing machine with hot water and in the dryer with hot setting for at least 10 minutes. This includes clothes, stuffed animals, sheets, blankets, and towels.
  • Anything that can not be washed should be sealed in plastic bags in the freezer overnight or at room temperature for 2 weeks
  • Vacuum the floors and furniture
  • Do not use fumigant sprays, these can be toxic
  • All household members and close contacts should be checked
  • All persons with evidence of infestation should be treated

If after trying the over the counter treatments your condition does not improve, it may be helpful to see your dermatologist for further evaluation and treatment. If necessary, prescription strength medications may be recommended.

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