It can be unsettling to find out your child has lice, but fortunately, there are plenty of treatment options, both prescription and non-prescription, to tackle the pesky bugs and banish them from your life and home. Below, pediatricians from the Forbes Health Advisory Board share their advice on the best active ingredients and products to get rid of lice—and tips to make those treatments as effective as possible. Note: Read product instructions carefully before application.
Permethrin is an insecticide, derived from synthetic chemicals that “act like natural extracts from the chrysanthemum flower,” according to the National Pesticide Information Center (NPIC). Permethrin affects the nervous system of insects, and is a common ingredient in products like bug protectant spray for clothing and gear. Permethrin lotion 1% is approved by the U.S. Food and Drug Administration (FDA) for treating head lice in children 2 months and older.
Permethrin is the active ingredient in Nix, a non-prescription product recommended by Ruth Kanthula, M.D., a board-certified pediatric infectious diseases specialist for MedStar Health—practicing at MedStar Georgetown University Hospital—and Forbes Health Advisory Board member. The product, “kills live lice and young lice, hatching from eggs,” explains Dr. Kanthula. It leaves residue on the hair “so the product can continue to kill the lice that will hatch from the eggs (nits) remaining on the hair after the first application.”
Products containing permethrin are also recommended by Robert Dracker, M.D., founder and director of Summerwood Pediatrics and Infusacare Medical Services and a Forbes Health Advisory Board member, though he does note that products with permethrin as an active ingredient usually need to be repeated.
Dr. Kanthula agrees, advising a second treatment be administered nine to 10 days after the first treatment.
Another non-prescription product recommended by Dr. Kanthula is Rid. This product is formulated with pyrethrin, which is similar to permethrin, but instead of being synthetic, is naturally derived from the chrysanthemum flower. Rid kills living lice and is “safe and effective when used as directed,” according to Dr. Kanthula. She says there’s no residual lice-killing activity after the product is rinsed off, so it also requires a second treatment.
Since pyrethrin is a naturally occurring extract from the chrysanthemum flower, it should be avoided by people who are allergic to chrysanthemums and ragweed, and is only approved for those ages 2 years and older.
Malathion (the generic name for brand-name, prescription head lice treatment lotion Ovide) kills live lice and some lice eggs. Dr. Dracker says this medication is “very effective” but cautions to keep it away from mucous membranes—like the mouth and eyes—during application, a warning echoed by the Centers for Disease Control and Prevention (CDC). The CDC also notes that malathion is flammable and to keep the medication and wet hair away from heat sources such as hair dryers, electric curlers, cigarettes or open flames.
Malathion should only be used in children over the age of 2, according to the CDC. Dr. Dracker adds that you can re-apply this treatment if live lice are still noticeable one week later.
LiceMD Pesticide Free Lice and Eggs Removal Kit
For parents who would prefer not to use pyrethroid-based containing agents to kill lice, Dr. Kanthula recommends LiceMD. “This product contains dimethicone; a silicone-based polymer that lubricates the hair to help with removal of nits and lice,” she explains. The product is non-toxic and odorless, with Dr. Kanthula noting that you may only need one application for it to be effective.
Ivermectin Lotion (Sklice)
Sklice is recommended by Dr. Dracker. The American Academy of Family Physicians (AAFP) recommends the product for people over 6 months old, and notes that its active ingredient, ivermectin, does not have the neurotoxicity concerns or flammability concerns of other active ingredients.
The AAFP calls the non-prescription medication safe, effective and easy to administer, as it only requires a single application and rinse cycle with no nit combing. However, it comes at a higher cost than other non-prescription treatments with a single tube costing as much as $300.
Spinosad is approved for use in eliminating lice for children older than four years and can be used to treat both lice and scabies. It is another topical medication that mitigates the risk for neurotoxic side effects and is generally well tolerated.
Spinosad is a liquid medication applied to the scalp, hair and skin. After spinosad is applied, it should be left to sit for 10 minutes before being washed completely out of hair. A second treatment is recommended if live lice are present a week after the initial treatment cycle. For children with long or thick hair, the entire bottle may be needed to coat the scalp and hair. Dr. Dracker notes that spinosad is effective but usually needs to be repeated.