Treatment of Head Lice
Effective treatment of head lice aims to eradicate live lice and their eggs while minimising reinfestation. The process involves both chemical and mechanical methods, and a comprehensive treatment of head lice plan includes education, environmental control, and follow-up screening. The key to success lies in using safe, evidence-based treatments while maintaining good hygiene practices.
Topical insecticides are the most common first-line treatment. Permethrin 1% lotion is widely used and available over-the-counter in many countries. It is applied to damp hair and left on for ten minutes before rinsing. Pyrethrin-based products, often combined with piperonyl butoxide, are another option. Both types work by paralysing and killing live lice, though resistance is increasingly common in some areas. Re-treatment is usually necessary 7–10 days after the initial application to kill newly hatched lice.
Prescription treatments may be required when over-the-counter options fail. These include malathion lotion, benzyl alcohol lotion, spinosad topical suspension, and ivermectin lotion. Malathion is highly effective but flammable and should be used with caution. Ivermectin and spinosad not only kill live lice but also reduce the need for nit removal due to their ovicidal effects.
Treatment of Head Lice
Manual removal is an essential part of treatment. Wet combing with a fine-toothed lice comb helps physically remove lice and nits from the hair. Conditioner applied to wet hair immobilises the lice, making them easier to capture. Combing should be done in sections under bright light and repeated every few days for two weeks to ensure all lice are removed.
Home remedies such as tea tree oil, coconut oil, vinegar, and mayonnaise are popular but lack consistent scientific support. These substances may suffocate lice but are not reliably ovicidal and often require repeated use. They should not be considered primary treatment and may cause allergic reactions in sensitive individuals.
Environmental cleaning supports the eradication of lice. Although lice survive only 1–2 days off the scalp, items in close contact with the hair should be cleaned. Wash bedding, hats, scarves, and clothing in hot water and dry on a high heat cycle. Items that cannot be washed can be sealed in plastic bags for 48–72 hours. Vacuuming furniture, carpets, and car seats can remove shed hairs with attached nits, though extensive cleaning is not necessary.
Treatment of Head Lice
Schools and childcare centres should follow local public health guidelines. Exclusion from school is no longer routinely recommended in many countries, as lice are not considered a public health hazard. However, discretion and communication with caregivers remain vital in managing outbreaks and reducing transmission.
Family members should be screened, and only those with active infestations should be treated. Prophylactic treatment of uninfested individuals is discouraged due to potential resistance and unnecessary exposure to chemicals.
Re-treatment and follow-up are essential. A second application of treatment and continued combing are often necessary to break the lice life cycle. If live lice persist after two treatments, resistance should be suspected, and alternative therapies or professional advice sought.
Treatment of Head Lice
The psychological burden of treatment—especially for children—can be significant. Reassurance, education, and consistent routines help reduce stress and stigma. Supporting families through the process improves compliance and outcomes.
In conclusion, the treatment of head lice requires an integrated approach using effective topical products, manual removal, environmental hygiene, and education. When applied consistently and correctly, these strategies lead to complete resolution and help prevent recurrence.
