How to Get Rid of Lice

As many as 12 million cases of head lice will be contracted this year. If you or one of your family members has contracted head lice, then it is important that you know how to treat it quickly and prevent other infestations.

1. Head lice are spread through direct contact.
2. Head lice are not a symptom of poor hygiene.
3. Over the counter medications for lice is usually the first method of treatment.
4. Head lice cannot live longer than 48 hours without feeding.
5. Head lice are not the same as body lice.

The content in this page is not a substitute for professional medical advice. Please contact your doctor before using the information presented here.

• Head lice are small (2.1 to 3.3 millimeters) insects that infest the head and neck and feed on blood.Centers for Disease Control and Prevention: Lice: Head Lice They are the second most communicable disease affecting school children (just after the common cold).MayoClinic.com: Head Lice: Definition It is estimated that up to 12 million children between the ages of three and eleven are infested with head lice each year in the United States.Centers for Disease Control and Prevention: Lice: Head Lice: Epidemiology & Risk Factors A few things that you should know about lice:

1. Lice cannot hop or fly, but move by crawling.Centers for Disease Control and Prevention: Lice: Head Lice
2. Head lice are not a sign of poor personal hygiene or an unclean living environment.MayoClinic.com: Head Lice: Definition
3. Head lice do not transmit disease.Centers for Disease Control and Prevention: Lice: Head Lice: Epidemiology & Risk Factors
4. Head lice are not the same as pubic lice (which may infest hair on the face but not the head).Centers for Disease Control and Prevention: Lice: Pubic "Crab" Lice: Factsheet For information on pubic lice, check out Mahalo's how to get rid of crabs.

• According to the Mayo Clinic and CDC, symptoms of head lice include:

1. Tickling feeling as if something is moving in your hair.Centers for Disease Control and Prevention: Lice: Head Lice: Factsheet
2. Intense itchingMayoClinic.com: Head Lice: Symptoms
3. Small red bumps on your scalp, neck and shoulders (caused by an allergic reaction to the saliva).MayoClinic.com: Head Lice: Symptoms
4. Sores on the head caused by scratching.Centers for Disease Control and Prevention: Lice: Head Lice: Factsheet Excessive scratching may lead to a bacterial infection which causes the skin to become red and may have crusting and oozing.KidsHealth: Head Lice
5. Irritability and difficulty sleeping (since lice are more active in the dark).

• However, even with a large infestation, the Mayo Clinic cautions that many people do not have any symptoms. Therefore, anyone suspected of having head lice should have their scalp area inspected. Lice are fast moving, small (about the size of a strawberry or sesame seed) and avoid light, so they can be tricky to find. Using a fine-toothed louse comb can be helpful.Centers for Disease Control and Prevention: Lice: Head Lice: Diagnosis Lice eggs (nits) may be visible on hair shafts, but can be mistaken for dandruff. Eggs, however, can not be easily brushed away.

• YouTube Video: Lice Moving Through Hair (Time: 2:01)

• Typically, head lice are spread through direct head-to-head contact with someone infected. However, head lice may also be transmitted through:
  1. Clothing such as hats, scarves, coats, sports uniforms and hair ribbons.
  2. Combs, brushes or towels.
  3. Other items such as a bed, couch, pillow, carpet or stuffed animal.Centers for Disease Control and Prevention: Lice: Head Lice: Factsheet
• Contact with these items must be made within a day or two because, as WebMD notes, head lice cannot live much longer without feeding.WebMD: Head Lice: What They Are and How to Get Rid of Them The CDC states that dogs, cats, and other pets cannot get or transmit head lice.Centers for Disease Control and Prevention: Lice: Head Lice: Factsheet

• According to the American Academy of Pediatrics, the first line of treatment for lice should be either permethrin or pyrethrin because they are nontoxic to humans.AHealthyMe.com: Lice These are the chemicals that are found in over the counter remedies. Both are safe and effective when used when directed. Antihistamines (both prescription and nonprescription) can be used to relieve itching that often occurs with lice.WebMD: Lice Medications

1. Pyrethrins are found in products such as A-200, Pronto, R&C, Rid, and Triple X and usually combined with piperonyl butoxide. According to the CDC, pyrethrins should not be used by anyone who is allergic to chrysanthemums or ragweed.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment
2. Permethrin is found in Nix. According to the CDC, permethrin is not approved for use in children less than 2 years old.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment
3. Pyrethrins and Permethrin will only kill live lice. So, a second treatment is required nine to ten days later to kill any newly hatched eggs.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment
4. Some strains of lice have become resistant to pyrethrins and permethrin.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment

• Expert Village: How to Treat Head Lice (Time: 1:10)

• Here are a few tips on how to effectively an over-the-counter or prescription medication

1. Shampoo your hair to remove any oil or styling products on it. Do not apply conditioner, cream rinse or use a shampoo/conditioner combo.AHealthyMe.com: Lice
2. Once your hair is dry, apply the lice shampoo. Follow the instructions on the label, especially regarding how long the medication should be left on and how to wash it off.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment
3. Put on clean clothing and do not re-wash your hair for one to two days afterwards.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment
4. Allow hair to air dry. KidsHealth warns you should not use a dryer because some medications contain flammable ingredients.KidsHealth: Head Lice
5. Check your hair eight to 12 hours later.AHealthyMe.com: Lice
   1. If a few live lice are found, but are moving more slowly than before, do not retreat. Instead, use a fine-tooth nit comb to remove any remaining live lice.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment
   2. If the lice appear as active as before, consult with your doctor about other treatments.AHealthyMe.com: Lice
6. Check your hair and use a nit comb to remove any nits every two to three days to decrease the chance of reinfestation.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment
7. According to the CDC, retreatment is recommended (unless using the prescription drug malathion) nine to ten days later.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment
8. If lice are present after two applications, consult with your doctor.eMedicineHealth.com: Head Lice, Body Lice and Public Lice (Crabs)
9. Continue to check for lice for two to three weeks to ensure lice are gone.Centers for Disease Control and Prevention: Lice: Head Lice: Treatment

• Use a fine-toothed (flea) or nit comb (found in many lice medicine packages) every two to four days to physically remove lice from your hair. According to the Mayo Clinic, this is the first-line treatment for children under two years old.MayoClinic.com: Head Lice: Lifestyle and Home Remedies
  1. To help remove nits from the hair shafts, rinse your hair with vinegar.MayoClinic.com: Head Lice: Lifestyle and Home Remedies
  2. Grasp a lock of hair with a cloth saturated in vinegar and strip the lock downward to remove nits.MayoClinic.com: Head Lice: Lifestyle and Home Remedies
  3. You may want to hold your head over a newspaper.New York City Department of Health and Mental Hygiene: How to Get Rid of Lice and Nits in the Hair and Scalp
  4. You can also soak your hair with vinegar for several minutes and then comb it.MayoClinic.com: Head Lice: Lifestyle and Home Remedies
  5. Clean comb frequently with a tissue or paper towel.New York City Department of Health and Mental Hygiene: How to Get Rid of Lice and Nits in the Hair and Scalp

• If over the counter remedies are not effective, your doctor may prescribe medication. Doctors may also prescribe antibiotics to treat any skin infections.WebMD: Lice Medications Examples of medications that are commonly prescribed to treat lice include:

1. Malathion (Ovide) is a lotion that is left on the hair for up to 12 hours before rinsing.WebMD: Lice Medications It is flammable and should be used carefully.MayoClinic.com: Head Lice: Treatments and Drugs
2. Lindane (Kwell, G-Well) comes as either a cream, lotion or a shampoo.MayoClinic.com: Head Lice: Treatments and Drugs It is used when other products fail.WebMD: Lice Medications
3. Permethrin cream (Elimite) is applied to the scalp and left for eight to 14 hours before rinsing.WebMD: Lice Medications
4. Ivermectin is a pill that may be prescribed when someone does not respond to other topical treatments.WebMD: Lice Medications
5. Precipitated sulfur is not as effective as other medications but may be used to treat young children and women who are pregnant or nursing.WebMD: Lice Medications

• No matter what medication you use to get rid of lice, you will need to take some other measure to ensure that you are not reinfested. This includes:

1. Checking all members of the household. Anyone who shows evidence of lice or nits should be treated.New York City Department of Health and Mental Hygiene: How to Get Rid of Lice and Nits in the Hair and Scalp
2. Wash bedding, clothing, hats and similar items in hot (at least 130 degrees F) soapy water and dry at high heat for at least 20 minutes.MayoClinic.com: Head Lice: Head Lice: Lifestyle and Home Remedies Note: Most water heaters are set at 120 degrees F for child safety.eMedicineHealth.com: Head Lice, Body Lice and Public Lice (Crabs)
3. Seal any unwashable items (such as stuffed toys) in an airtight plastic bag for seven to ten days.
4. Vacuum floor and furniture. Discard the vacuum bag immediately.eMedicineHealth.com: Head Lice, Body Lice and Public Lice (Crabs)
5. Cover furniture with a plastic dropcloth for two weeks. Do not do this if you have toddlers (because they may become entangled in the plastic).
6. Wash combs, brushes, ribbons, and similar items in hot (at least 130 degrees F) soapy water or soak them in rubbing alcohol for one hour.MayoClinic.com: Head Lice: Head Lice: Lifestyle and Home Remedies

• Body lice are slightly larger 2.3 to 3.6 mm in length but similar in appearance to head lice.Centers for Disease Control and Prevention: Lice: Body Lice eMedicineHealth.com: Head Lice, Body Lice and Public Lice (Crabs) The CDC notes that unlike head and pubic lice, body lice live in clothing and only transfers to human hosts to feed.Centers for Disease Control and Prevention: Lice: Body Lice They can survive for up to 30 days away from their host.eMedicineHealth.com: [http://www.emedicinehealth.com/lice/article_em.htm Head

Lice, Body Lice and Public Lice (Crabs)] Unlike head and pubic lice, body lice can transmit disease such as typhus and louse-borne relapsing fever.Centers for Disease Control and Prevention: Lice: Body Lice: Epidemiology & Risk Factors

• Symptoms of body lice include:
  1. Intense itching, especially in areas where seams of clothing are tight such as waistband lines or bra strap regions.eMedicineHealth.com: Head Lice, Body Lice and Public Lice (Crabs)
  2. Red itchy bite marks on the body.MayoClinic.com: Body Lice: Symptoms Crusts, abrasions or scabbing caused by scratching may also be present.eMedicineHealth.com: Head Lice, Body Lice and Public Lice (Crabs)
  3. Rash, if you are allergic to the bites.MayoClinic.com: Body Lice: Symptoms
  4. Lice may be visible on your body or in your clothing.MayoClinic.com: Body Lice: Symptoms

• Body lice are typically found in areas where crowding and poor hygiene is a problem.eMedicineHealth.com: Head Lice, Body Lice and Public Lice (Crabs) People who do not have access to regular bathing and changes of clean clothes are also at risk. Infestations spread through direct contact with clothing, bed linen, towels and similar items or through contact someone infested with body lice.Centers for Disease Control and Prevention: Lice: Body Lice: Epidemiology & Risk Factors

• Treatment is not usually required for body lice. They are usually controlled by improving hygiene and providing the person infested with regular changes of clean clothes.Centers for Disease Control and Prevention: Lice: Body Lice

• As stated earlier, head lice is a common problem for elementary children and are not a symptom of poor hygiene. The stigma attached to head lice can be almost as difficult to overcome as the head lice themselves. However, vigilant care for two weeks is usually enough to get rid of the pests once and for all.