Lice

First-Line Treatments (Over-the-Counter)

1. Permethrin 1% lotion (Nix)

   • Safe for children ≥2 months old.

   • Apply to washed, towel-dried hair and rinse after 10 minutes.

   • Repeat in 7–10 days if live lice are still present.

   • Resistance in some areas, but still widely used.

2. Pyrethrins with piperonyl butoxide (Rid, others)

   • Plant-derived; safe for children ≥2 years old.

   • Apply to dry hair and rinse after 10 minutes.

   • Repeat in 7–10 days.

   • Not effective if child is allergic to ragweed or chrysanthemums.

Prescription Treatments (if OTC fails or resistance suspected)

• Malathion 0.5% lotion (Ovide)

  • Approved for children ≥6 years.

  • Kills lice and some eggs.

  • Apply to dry hair, leave on 8–12 hours, then rinse.

  • Flammable—keep away from heat sources.

• Benzyl alcohol 5% lotion (Ulesfia)

  • Approved for children ≥6 months.

  • Kills lice but not eggs; must retreat in 7 days.

  • Can cause scalp irritation.

• Ivermectin 0.5% lotion (Sklice)

  • Approved for children ≥6 months.

  • Single 10-minute application to dry hair, no nit combing required.

  • Usually no retreatment needed.

• Spinosad 0.9% topical suspension (Natroba)

  • Approved for children ≥6 months.

  • Kills lice and unhatched eggs.

  • Apply to dry hair, rinse after 10 minutes; may repeat in 7 days if needed.

Additional Measures

• Nit combing: Even with effective treatment, combing out nits (eggs) with a fine-toothed comb helps reduce reinfestation.

• Environment: Wash bedding, clothing, and towels in hot water (≥130°F). Seal non-washable items in a plastic bag for 2 weeks. Vacuum furniture and car seats.

• School & daycare: The AAP and CDC state children do not need to be excluded from school after starting treatment.

Not Recommended

• Gasoline, kerosene, essential oils, or home remedies (like mayonnaise or vinegar) — not proven effective and may be dangerous.

• Head shaving is unnecessary.

Bottom line for parents:
Start with OTC permethrin (≥2 months) or pyrethrins (≥2 years). If that fails, see your pediatrician for prescription options like ivermectin, spinosad, or malathion. Always retreat in 7–10 days unless using a single-application product.