Here’s a look at the pros and cons of the various treatment options:
• OTC Lice Shampoos
Pesticide shampoos are sold OTC in the drugstore. Copious amounts of the shampoo are applied to dry hair. These treatments require repeat shampooing in a week to 10 days. Pyrethrins combined with piperonyl butoxide include: A–200*, Pronto*, R&C*, Rid*, Triple X*, Licide*. Permethrin lotion, 1% is called Nix*.
Pros: The shampoos are easy to buy at any major store and relatively cheap.
Cons: Contain neurotoxins that can be absorbed via the scalp, only 35% effective since lice have become resistant to the pesticides. Shampoos do not kill nits.
• Professional Removal Service – Organic Lice Solutions
Sometimes parents need to call in for backup, as they may have tried treating their kids but have no one to check them for lice. Entirely organic, pesticide-free treatments consist of trained professionals performing meticulous inspection and combing with industry specific lice combs, using entirely organic products to kill and remove all adult lice, nits and remove all eggs to prevent future outbreaks.
Pros: The infestation is reliably cured in one treatment. No need for parents to do anything. No harmful chemicals. Backed by a lice-free guarantee.
Cons: Requires outside assistance. Can be costly depending on the size of the infestation.
• Electric Lice Comb
These battery-operated combs have the added feature of an electric charge that zaps adult lice on contact. Though it kills adult lice instantly, an electric comb does not kill nits.
Pros: Kills lice, doesn’t require shampoos
Cons: Expensive, the electric humming sound can be scary for little ones, only does part of the job.
• Oil, Essential Oil, Mayonnaise, Listerine, etc.
Many oils are natural louse repellents, which make them good for prevention. But once the person already has a bug or an egg in the hair, they will need more than just oil. Various oils, mayonnaise, listerine, cetaphil, and other products may make a dent in the infestation but will not get rid of it efficiently or reliably.
Pros: Natural, safe, preventative
Cons: They don’t kill lice or their eggs. Lice treatment is only effective when all the nits are removed.
• Prescription Chemical Treatments
Various prescription drugs are described below:
Pros: Sometimes covered by insurance
Cons: Expensive if out-of-pocket, contain pesticides, do nothing about nit removal so a visual inspection still shows nits. Can cause irritation to the skin.
- Benzyl alcohol lotion, 5%; Brand name product: Ulesfia lotion*
Benzyl alcohol lotion, 5% has been approved by the FDA for the treatment of head lice. It sometimes kills lice but it is not ovicidal(i.e., does not kill lice eggs). A second treatment is needed 9 days after the first treatment to kill any newly hatched lice before they can produce new eggs. Benzyl alcohol lotion is intended for use on persons who are 6 months of age and older and its safety in persons aged more 60 years has not been established. It can be irritating to the skin.
- Ivermectin lotion, 0.5%; Brand name product: Sklice*
Ivermectin lotion, 0.5% was approved by the FDA in 2012 for treatment of head lice in persons 6 months of age and older. It is not ovicidal, but appears to prevent nymphs (newly hatched lice) from surviving. It is effective in most patients when given as a single application on dry hair without nit combing. It should not be used for retreatment without talking to a healthcare provider.
- Spinosad 0.9% topical suspension; Brand name product: Natroba* Malathion lotion, 0.5%; Brand name product: Ovide*
Spinosad was approved by the FDA in 2011. Nit combing is not required. Spinosad topical suspension is approved for the treatment of children 6 months of age and older. Repeat treatment should be given only if live (crawling) lice are seen 7 days after the first treatment.
- Malathion lotion, 0.5%; Brand name product: Ovide*l
Malathion is an organophosphate. A second treatment is recommended if live lice still are present 7–9 days after treatment. Malathion is intended for use on persons 6 years of age and older. Malathion can be irritating to the skin. Malathion lotion is flammable therefore do not use electrical heat sources, including hair dryers or smoke when applying malathion lotion and while the hair is wet.