There are both over-the-counter medicines and prescription products to treat head lice and pubic lice. Most products come as a shampoo, creme rinse, or lotion (topical treatment) that is applied to the affected areas, left on for a period of time, and then rinsed off. Doctors sometimes prescribe a pill to treat lice when two or more approved topical medicines have not worked.
If lice infest the eyelashes, your doctor may prescribe an eye ointment for you.
Because body lice live in clothing, not on the body, medicines are generally not needed unless the person is severely infested. The most common way to kill body lice and eggs is to wash clothing and bedding in hot water [130°F (54.5°C) or higher] in a washing machine.
Over-the-counter (OTC) medicines that are recommended for head or pubic lice include:1
- Permethrin creme rinse 1% (such as Nix), which is a common first choice for treating head lice. It kills lice and their eggs for 2 weeks or more after it has been rinsed off.
- Shampoos containing pyrethrins and piperonyl butoxide (such as Rid), which are left on the hair for 10 minutes and then rinsed out. A second treatment is needed 9 days after the first to kill newly hatched lice.
There are other OTC products for lice, but not all of them have good evidence that their benefits outweigh the side effects and other risks. Check the product label . Be sure to follow the directions about proper use and safety. And talk to your doctor or pharmacist about whether these products are safe for young children.
Prescription medicines that are recommended for head or pubic lice include:1
- Benzyl alcohol 5% (Ulesfia), which is used to treat head lice. It is applied to the hair on the head, left on for 10 minutes, and then rinsed off.
- Malathion lotion (Ovide), which is used to treat head lice. It is applied to hair on the head, left on for 8 to 12 hours, then rinsed off. If lice are still present 7 to 9 days later, a second treatment must be done.
If these OTC or prescription medicines aren't working, your doctor may prescribe a different medicine to help get rid of lice. These include ivermectin (Sklice or Stromectol), permethrin 5% (Elimite), and spinosad (Natroba). In rare cases, lindane may be prescribed. But lindane is falling out of favor because of the potential for serious nervous system side effects. The American Academy of Pediatrics no longer recommends lindane as a treatment for head lice.
Antihistamines (both prescription and nonprescription) can help relieve the itching that often occurs with lice. These medicines may cause drowsiness. Don't give antihistamines to your child unless you've checked with the doctor first.
What to think about
It is not necessary to remove lice eggs from hair after treatment with topical medicines, but some people may wish to remove them for cosmetic reasons.
Most products used to treat lice may cause side effects if they are not used properly. Never use a product more than two times (with less than 7 days between uses) without first consulting a doctor.
There is some concern that lice are becoming resistant to (can no longer be killed by) permethrin or other medicine used to treat lice infestations. It is also possible that lice may persist after treatment because the medicine was not used properly or because the person was reinfected by someone else who was still infected with lice.
Wet combing is an option for infants who can't use lice medicines.