Treatment for head lice is recommended for individuals identified with an active problem. All family members and other close contacts should be inspected; those persons with proof of an active problem should be dealt with. Some experts think prophylactic treatment is sensible for individuals who share the same bed with actively-infested people. All plagued persons (household members and close contacts) and their bedmates need to be treated at the same time.
Some pediculicides (medications that eliminate lice) have an ovicidal impact (kill eggs). For pediculicides that are just weakly ovicidal or not ovicidal, regular retreatment is suggested. For those that are more strongly ovicidal, retreatment is suggested only if live (crawling) lice are still present a number of days after treatment (see suggestion for each medication). To be most effective, retreatment must occur after all eggs have hatched out however before new eggs are produced.
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Head Lice Most Effective Treatment
When treating head lice, supplemental measures can be integrated with suggested medication (pharmacologic treatment); however, such extra (non-pharmacologic) measures generally are not needed to eliminate a head lice infestation. For example, hats, scarves, pillow cases, bed linen, clothes, and towels used or used by the infested person in the 2-day duration prior to treatment is started can be machine washed and dried utilizing the hot water and hot air cycles due to the fact that lice and eggs are eliminated by direct exposure for 5 minutes to temperatures greater than 53.5 ° C(128.3 ° F). Products that can not be washed might be dry-cleaned or sealed in a plastic bag for 2 weeks. Items such as hats, grooming aids, and towels that can be found in contact with the hair of a plagued individual should not be shared. Vacuuming furnishings and floors can remove an infested individual’s hairs that may have sensible nits connected.
Treatment of the infested individual(s): Requires implementing an Over-the-counter (OTC) or prescription medication. Follow these treatment actions:
- Prior to applying treatment, it may be valuable to remove clothing that can become damp or stained during treatment.
- Apply lice medication, likewise called pediculicide, according to the instructions contained in the box or printed on the label. If the plagued person has very long hair (longer than shoulder length), it may be essential to make use of a 2nd bottle. Pay unique attention to guidelines on the label or in the box concerning for how long the medication must be left on the hair and how it should be rinsed.
Do not make use of a mix shampoo/conditioner, or conditioner before making use of lice medicine. Do not re – clean the hair for 1 – 2 days after the lice medicine is removed. These measures might reduce the efficiency of the lice medications.
- Have the plagued person placed on clean clothing after treatment.
- If a couple of live lice are still found 8 – 12 hours after treatment, however are moving more gradually than before, do not retreat. The medicine may take longer to kill all the lice. Comb dead and any continuing to be live lice from the hair making use of a fine – toothed nit comb.
- If, after 8 – 12 hours of treatment, no dead lice are found and lice appear as active as previously, the medication might not be working. Do not pull away up until consulting with your healthcare supplier; a various pediculicide might be needed. If your health care supplier recommends a different pediculicide, thoroughly follow the treatment directions contained in the box or printed on the label.
- Nit (head lice egg) combs, commonly found in lice medication plans, must be used to comb nits and lice from the hair shaft. Lots of flea combs produced felines and pets are likewise reliable.
- After each treatment, examining the hair and combing with a nit comb to get rid of nits and lice every 2 – 3 days might reduce the opportunity of self – reinfestation. Continue to look for 2 – 3 weeks to be sure all lice and nits are gone. Nit removal is not required when treating with spinosad topical suspension.
- Retreatment is indicated to kill any making it through hatched out lice before they produce brand-new eggs. For some drugs, retreatment is recommended consistently about a week after the first treatment (7 – 9 days, depending on the drug) and for others only if crawling lice are seen throughout this period. Retreatment with lindane hair shampoo is not suggested.
- Supplemental Measures: Head lice do not survive long if they fall off an individual and can not feed. You don’t have to invest a lot of time or money on housecleaning activities. Follow these steps to help avoid re – infestation by lice that have recently fallen off the hair or crawled onto clothes or furnishings.
- Machine wash and dry clothing, bed linens, and other items that the plagued person wore or used during the 2 days before treatment using the warm water (130 ° F )laundry cycle and the high heat drying cycle. Clothes and products that are not washable can be dry – cleaned OR sealed in a plastic bag and kept for 2 weeks.
- Soak combs and brushes in hot water (a minimum of 130 ° F) for 5 – 10 minutes.
- Vacuum the floor and furnishings, specifically where the plagued person sat or lay. However, the risk of getting plagued by a louse that has actually fallen onto a rug or carpeting or furnishings is really low. Head lice survive less than 1 – 2 days if they fall off a person and can not feed; nits can not hatch and usually pass away within a week if they are not kept at the exact same temperature as that discovered near the human scalp. Spending much money and time on housecleaning activities is not needed to prevent reinfestation by lice or nits that may have fallen off the head or crawled onto furniture or clothes.
- Do not utilize fumigant sprays; they can be toxic if inhaled or taken in through the skin.
Lots of head lice medications are readily available “over the counter” without a prescription at a local drug shop or pharmacy. Each over-the-counter product authorized by the FDA for the treatment of head lice includes among the following active ingredients. If crawling lice are still seen after a full course of treatment contact your health care carrier.
- Pyrethrins integrated with piperonyl butoxide;
Brand name products: A – 200*, Pronto*, R&C*, Rid*, Triple X*, Licide*.
Pyrethrins are naturally happening pyrethroid extracts from the chrysanthemum flower. Pyrethrins are safe and effective when used as directed. Pyrethrins can only kill live lice, not unhatched eggs (nits). A second treatment is recommended 9 to 10 days after the first treatment to eliminate any recently hatched out lice before they can produce new eggs. Pyrethrins typically need to not be used by individuals who are allergic to chrysanthemums or ragweed. Pyrethrin is authorized for use on children 2 years of age and older.
- Permethrin lotion, 1 %;
Trademark name item: Nix*.
Permethrin is an artificial pyrethroid much like naturally taking place pyrethrins. Permethrin lotion 1 % is accepted by the FDA for the treatment of head lice. Permethrin is safe and reliable when made use of as directed. Permethrin eliminates live lice but not unhatched eggs. Permethrin may remain to kill recently hatched lice for a number of days after treatment. A 2nd treatment commonly is essential on day 9 to kill any freshly hatched lice prior to they can produce brand-new eggs. Permethrin is approved for use on children 2 months of age and older.
The following medications, in alphabetical order, accepted by the U.S. Food and Drug Administration (FDA) for the treatment of head lice are readily available just by prescription. If crawling lice are still seen after a full course of treatment, call your health care provider.
- Benzyl alcohol lotion, 5 %;
Brand name product: Ulesfia lotion*.
Benzyl alcohol is an aromatic alcohol. Benzyl alcohol cream, 5 % has been authorized by the FDA for the treatment of head lice and is considered safe and effective when implemented as directed. It eliminates lice but it is not ovicidal(i.e., does not kill lice eggs). A second treatment is required 9 days after the first treatment to eliminate any recently hatched out lice prior to they can produce new eggs. Benzyl alcohol lotion is intended for usage on persons who are 6 months of age and older and its safety face to faces aged more 60 years has not been established. It can be annoying to the skin.
- Ivermectin cream, 0.5 %;
Brand item: Sklice*.
Ivermectin cream, 0.5 % was authorized by the FDA in 2012 for treatment of head lice in persons 6 months of age and older. It is not ovicidal, however appears to prevent nymphs (recently hatched lice) from making it through. It is effective in the majority of patients when given as a single application on dry hair without nit combing. It must not be made use of for retreatment without speaking to a doctor.
Offered as a tablet in mass drug administrations, oral ivermectin has been utilized thoroughly and safely for over 20 years in lots of countries to treat filarial worm infections. Although not FDA-approved for the treatment of lice, ivermectin tablets given up a single oral dose of 200 micrograms/kg restarted in 10 days or 400 micrograms/kg repeated in 7 days has actually been shown effective versus head lice. It must not be implemented in children weighing less than 15 kg or in pregnant females.
- Malathion lotion, 0.5 %;
Trademark name product: Ovide*.
Malathion is an organophosphate. The solution of malathion approved in the United States for the treatment of head lice is a lotion that is safe and reliable when made use of as directed. Malathion is pediculicidal (kills live lice) and ovicidal (eliminates lice eggs). A single application is sufficient for the majority of patients. Nevertheless, a second treatment is advised if live lice still are present 7 – 9 days after treatment. Malathion is planned for usage on persons 6 years of age and older. Malathion can be irritating to the skin. Malathion cream is combustible for that reason hair needs to be permitted to dry naturally; do not make use of electrical heat sources, including hair clothes dryers, curlers, and curling or flat irons, or smoke when applying malathion cream and while the hair is wet.
- Spinosad 0.9 % topical suspension;
Brand item: Natroba*.
Spinosad is originated from soil bacteria. Spinosad topical suspension, 0.9 %, was approved by the FDA in 2011. Considering that it eliminates live lice as well as unhatched eggs, retreatment is normally not required. Nit combing is not needed. Spinosad topical suspension is accepted for the treatment of children 6 months of age and older. It is safe and efficient when implemented as directed. Repeat treatment must be offered just if live (crawling) lice are seen 7 days after the first treatment.
For second – line treatment only:
- Lindane hair shampoo 1 %;
Brand name items: None available.
Lindane is an organochloride. The American Academy of Pediatrics (AAP) no more advises it as a pediculocide. Although lindane shampoo 1 % is approved by the FDA for the treatment of head lice, it is not suggested as a first – line treatment. Overuse, misuse, or accidentally swallowing lindane can be poisonous to the brain and other parts of the anxious system; its usage ought to be restricted to patients for whom prior treatments have failed or who can not tolerate other medications that posture less risk. Lindane needs to not be utilized to deal with premature babies, persons with HIV, a seizure disorder, females who are pregnant or breast – feeding, persons who have extremely inflamed skin or sores where the lindane will be used, infants, children, the senior, and individuals who weigh less than 110 pounds. Retreatment ought to be prevented.
When treating head lice
- Do not implement extra quantities of any lice medication unless advised to do so by your doctor or pharmacist. The drugs used to deal with lice are insecticides and can be harmful if they are misused or excessive used.
- All the medications noted above ought to be kept out of the eyes. If they get onto the eyes, they need to be immediately flushed away.
- Do not deal with a plagued individual more than 2 – 3 times with the very same medication if it does not seem to be working. This might be triggered by utilizing the medicine improperly or by resistance to the medication. Constantly seek the suggestions of your health care provider if this need to take place. He/she may suggest an alternative medication.
- Do not implement different head lice drugs at the very same time unless advised to do so by your physician or pharmacist.