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Treatment
GeneralGuidelines
Treatmentforheadliceisrecommendedforpersonsdiagnosedwithanactiveinfestation.All
householdmembersandotherclosecontactsshouldbecheckedthosepersonswithevidenceof
anactiveinfestationshouldbetreated.Someexpertsbelieveprophylactictreatmentisprudent
forpersonswhosharethesamebedwithactivelyinfestedindividuals.Allinfestedpersons
(householdmembersandclosecontacts)andtheirbedmatesshouldbetreatedatthesametime.
Somepediculicides(medicinesthatkilllice)haveanovicidaleffect(killeggs).Forpediculicides
thatareonlyweaklyovicidalornotovicidal,routineretreatmentisrecommended.Forthosethat
aremorestronglyovicidal,retreatmentisrecommendedonlyiflive(crawling)licearestill
presentseveraldaysaftertreatment(seerecommendationforeachmedication).Tobemost
effective,retreatmentshouldoccurafteralleggshavehatchedbutbeforeneweggsareproduced.
Whentreatingheadlice,supplementalmeasurescanbecombinedwithrecommendedmedicine
(pharmacologictreatment)however,suchadditional(nonpharmacologic)measuresgenerally
arenotrequiredtoeliminateaheadliceinfestation.Forexample,hats,scarves,pillowcases,
bedding,clothing,andtowelswornorusedbytheinfestedpersoninthe2dayperiodjustbefore
treatmentisstartedcanbemachinewashedanddriedusingthehotwaterandhotaircycles
becauseliceandeggsarekilledbyexposurefor5minutestotemperaturesgreaterthan53.5C
(128.3F).Itemsthatcannotbelaunderedmaybedrycleanedorsealedinaplasticbagfortwo
weeks.Itemssuchashats,groomingaids,andtowelsthatcomeincontactwiththehairofan
infestedpersonshouldnotbeshared.Vacuumingfurnitureandfloorscanremoveaninfested
person'shairsthatmighthaveviablenitsattached.
Treattheinfestedperson(s):RequiresusinganOverthecounter(OTC)orprescription
medication.Followthesetreatmentsteps:
1. Beforeapplyingtreatment,itmaybehelpfultoremoveclothingthatcanbecomewetor
stainedduringtreatment.
2. Applylicemedicine,alsocalledpediculicide,accordingtotheinstructionscontainedinthe
boxorprintedonthelabel.Iftheinfestedpersonhasverylonghair(longerthanshoulder
length),itmaybenecessarytouseasecondbottle.Payspecialattentiontoinstructionson
thelabelorintheboxregardinghowlongthemedicationshouldbeleftonthehairand
howitshouldbewashedout.
WARNING:
Donotuseacombinationshampoo/conditioner,orconditionerbeforeusinglicemedicine.
Donotrewashthehairfor12daysafterthelicemedicineisremoved.
3. Havetheinfestedpersonputoncleanclothingaftertreatment.
4. Ifafewlivelicearestillfound812hoursaftertreatment,butaremovingmoreslowly
thanbefore,donotretreat.Themedicinemaytakelongertokillallthelice.Combdead
andanyremainingliveliceoutofthehairusingafinetoothednitcomb.
5. If,after812hoursoftreatment,nodeadlicearefoundandliceseemasactiveasbefore,
themedicinemaynotbeworking.Donotretreatuntilspeakingwithyourhealthcare
provideradifferentpediculicidemaybenecessary.Ifyourhealthcareprovider
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recommendsadifferentpediculicide,carefullyfollowthetreatmentinstructionscontained
intheboxorprintedonthelabel.
6. Nit(headliceegg)combs,oftenfoundinlicemedicinepackages,shouldbeusedtocomb
nitsandlicefromthehairshaft.Manyfleacombsmadeforcatsanddogsarealsoeffective.
7. Aftereachtreatment,checkingthehairandcombingwithanitcombtoremovenitsand
liceevery23daysmaydecreasethechanceofselfreinfestation.Continuetocheckfor2
3weekstobesureallliceandnitsaregone.Nitremovalisnotneededwhentreatingwith
spinosadtopicalsuspension.
8. Retreatmentismeanttokillanysurvivinghatchedlicebeforetheyproduceneweggs.For
somedrugs,retreatmentisrecommendedroutinelyaboutaweekafterthefirsttreatment
(79days,dependingonthedrug)andforothersonlyifcrawlingliceareseenduringthis
period.Retreatmentwithlindaneshampooisnotrecommended.
SupplementalMeasures:Headlicedonotsurvivelongiftheyfalloffapersonandcannot
feed.Youdon'tneedtospendalotoftimeormoneyonhousecleaningactivities.Followthese
stepstohelpavoidreinfestationbylicethathaverecentlyfallenoffthehairorcrawledonto
clothingorfurniture.
1. Machinewashanddryclothing,bedlinens,andotheritemsthattheinfestedpersonwore
orusedduringthe2daysbeforetreatmentusingthehotwater(130F)laundrycycleand
thehighheatdryingcycle.Clothinganditemsthatarenotwashablecanbedrycleaned
OR
sealedinaplasticbagandstoredfor2weeks.
2. Soakcombsandbrushesinhotwater(atleast130F)for510minutes.
3. Vacuumthefloorandfurniture,particularlywheretheinfestedpersonsatorlay.However,
theriskofgettinginfestedbyalousethathasfallenontoarugorcarpetorfurnitureisvery
small.Headlicesurvivelessthan12daysiftheyfalloffapersonandcannotfeednits
cannothatchandusuallydiewithinaweekiftheyarenotkeptatthesametemperatureas
thatfoundclosetothehumanscalp.Spendingmuchtimeandmoneyonhousecleaning
activitiesisnotnecessarytoavoidreinfestationbyliceornitsthatmayhavefallenoffthe
headorcrawledontofurnitureorclothing.
4. Donotusefumigantspraystheycanbetoxicifinhaledorabsorbedthroughtheskin.
PreventReinfestation:
Moreon:Prevention&Control(/parasites/lice/head/prevent.html)

OverthecounterMedications
Manyheadlicemedicationsareavailable"Overthecounter"withoutaprescriptionatalocal
drugstoreorpharmacy.EachOverthecounterproductapprovedbytheFDAforthetreatment
ofheadlicecontainsoneofthefollowingactiveingredients.Ifcrawlinglicearestillseenaftera
fullcourseoftreatmentcontactyourhealthcareprovider.
1. Pyrethrinscombinedwithpiperonylbutoxide
Brandnameproducts:A200*,Pronto*,R&C*,Rid*,TripleX*.
Pyrethrinsarenaturallyoccurringpyrethroidextractsfromthechrysanthemumflower.
Pyrethrinsaresafeandeffectivewhenusedasdirected.Pyrethrinscanonlykilllivelice,
notunhatchedeggs(nits).Asecondtreatmentisrecommended9to10daysafterthefirst
treatmenttokillanynewlyhatchedlicebeforetheycanproduceneweggs.Pyrethrins
generallyshouldnotbeusedbypersonswhoareallergictochrysanthemumsorragweed.
Pyrethrinisapprovedforuseonchildren2yearsofageandolder.
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2. Permethrinlotion,1%
Brandnameproduct:Nix*.
Permethrinisasyntheticpyrethroidsimilartonaturallyoccurringpyrethrins.Permethrin
lotion1%isapprovedbytheFDAforthetreatmentofheadlice.Permethrinissafeand
effectivewhenusedasdirected.Permethrinkillslivelicebutnotunhatchedeggs.
Permethrinmaycontinuetokillnewlyhatchedliceforseveraldaysaftertreatment.A
secondtreatmentoftenisnecessaryonday9tokillanynewlyhatchedlicebeforetheycan
produceneweggs.Permethrinisapprovedforuseonchildren2monthsofageandolder.

PrescriptionMedications
Thefollowingmedications,inalphabeticalorder,approvedbytheU.S.FoodandDrug
Administration(FDA)forthetreatmentofheadliceareavailableonlybyprescription.If
crawlinglicearestillseenafterafullcourseoftreatment,contactyourhealthcareprovider.
Benzylalcohollotion,5%
Brandnameproduct:Ulesfialotion*
Benzylalcoholisanaromaticalcohol.Benzylalcohollotion,5%hasbeenapprovedbythe
FDAforthetreatmentofheadliceandisconsideredsafeandeffectivewhenusedas
directed.Itkillslicebutitisnotovicidal.Asecondtreatmentisneeded7daysafterthefirst
treatmenttokillanynewlyhatchedlicebeforetheycanproduceneweggs.Benzylalcohol
lotionisintendedforuseonpersonswhoare6monthsofageandolderanditssafetyin
personsagedmore60yearshasnotbeenestablished.Itcanbeirritatingtotheskin.
Ivermectinlotion,0.5%
Brandnameproduct:Sklice*
Givenasatabletinmassdrugadministrations,ivermectinhasbeenusedextensivelyand
safelyforovertwodecadesinmanycountriestotreatfilarialworminfections.Ivermectin
lotion,0.5%wasapprovedbytheFDAin2012fortreatmentofheadliceinpersons6
monthsofageandolder.Itisnotovicidal,butappearstopreventnymphs(newlyhatched
lice)fromsurviving.Itiseffectiveinmostpatientswhengivenasasingleapplicationondry
hairwithoutnitcombing.Itshouldnotbeusedforretreatmentwithouttalkingtoa
healthcareprovider.
Malathionlotion,0.5%
Brandnameproduct:Ovide*
Malathionisanorganophosphate.TheformulationofmalathionapprovedintheUnited
Statesforthetreatmentofheadliceisalotionthatissafeandeffectivewhenusedas
directed.Malathionispediculicidal(killslivelice)andpartiallyovicidal(killssomelice
eggs).Asecondtreatmentisrecommendediflivelicestillarepresent79daysafter
treatment.Malathionisintendedforuseonpersons6yearsofageandolder.Malathioncan
beirritatingtotheskin.Malathionlotionisflammabledonotsmokeoruseelectricalheat
sources,includinghairdryers,curlers,andcurlingorflatirons,whenapplyingmalathion
lotionandwhilethehairiswet.
Moreon:Malathion(/parasites/lice/head/gen_info/faqs_malathion.html)
Spinosad0.9%topicalsuspension
Brandnameproduct:Natroba*
Spinosadisderivedfromsoilbacteria.Spinosadtopicalsuspension,0.9%,wasapprovedby
theFDAin2011.Sinceitkillsliveliceaswellasunhatchedeggs,retreatmentisusuallynot
needed.Nitcombingisnotrequired.Spinosadtopicalsuspensionisapprovedforthe
treatmentofchildren4yearsofageandolder.Itissafeandeffectivewhenusedasdirected.
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Repeattreatmentshouldbegivenonlyiflive(crawling)liceareseen7daysafterthefirst
treatment.
Forsecondlinetreatmentonly:
Lindaneshampoo1%
Brandnameproducts:Noneavailable
Lindaneisanorganochloride.TheAmericanAcademyofPediatrics(AAP)nolonger
recommendsitasapediculocide.Althoughlindaneshampoo1%isapprovedbytheFDAfor
thetreatmentofheadlice,itisnotrecommendedasafirstlinetreatment.Overuse,misuse,
oraccidentallyswallowinglindanecanbetoxictothebrainandotherpartsofthenervous
systemitsuseshouldberestrictedtopatientsforwhompriortreatmentshavefailedor
whocannottolerateothermedicationsthatposelessrisk.Lindaneshouldnotbeusedto
treatprematureinfants,personswithHIV,aseizuredisorder,womenwhoarepregnantor
breastfeeding,personswhohaveveryirritatedskinorsoreswherethelindanewillbe
applied,infants,children,theelderly,andpersonswhoweighlessthan110pounds.
Retreatmentshouldbeavoided.
Whentreatingheadlice
1. Donotuseextraamountsofanylicemedicationunlessinstructedtodosobyyour
physicianandpharmacist.Thedrugsusedtotreatliceareinsecticidesandcanbe
dangerousiftheyaremisusedoroverused.
2. Allthemedicationslistedaboveshouldbekeptoutoftheeyes.Iftheygetontotheeyes,
theyshouldbeimmediatelyflushedaway.
3. Donottreataninfestedpersonmorethan23timeswiththesamemedicationifitdoes
notseemtobeworking.Thismaybecausedbyusingthemedicineincorrectlyorby
resistancetothemedicine.Alwaysseektheadviceofyourhealthcareproviderifthis
shouldhappen.He/shemayrecommendanalternativemedication.
4. Donotusedifferentheadlicedrugsatthesametimeunlessinstructedtodosobyyour
physicianandpharmacist.
*Useoftradenamesisforidentificationpurposesonlyanddoesnotimplyendorsementbythe
PublicHealthServiceorbytheU.S.DepartmentofHealthandHumanServices.
Pagelastreviewed:September24,2013
Pagelastupdated:September24,2013
Contentsource:GlobalHealthDivisionofParasiticDiseasesandMalaria
Notice:LinkingtoanonfederalsitedoesnotconstituteanendorsementbyHHS,CDCoranyofitsemployeesofthesponsorsorthe
informationandproductspresentedonthesite.

CentersforDiseaseControlandPrevention1600CliftonRd.Atlanta,GA30329
4027,USA
800CDCINFO(8002324636)TTY:(888)2326348ContactCDCINFO

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