Head lice - Treatment 

Treating head lice 

Head lice and clothing

Healthy head lice do not deliberately transfer onto clothing, bedding or soft toys.

Their life span is about three weeks and when they fall from the head they are dying and unable to breed.

Hot washing or fumigation is not necessary to control head lice.

Lice that fall from the head during chemical treatment should be promptly disposed of. They may recover if they are resistant to the insecticide or have not been fully coated in the product.

Head lice can be difficult to treat due to a high re-infestation rate and their ability to develop resistance to traditional insecticides contained in some medications.

It is thought head lice will not develop immunity to the newer silicone and oil-based preparations, because they have a physical rather than a chemical action on lice.

After a head lice infestation has been confirmed, you can treat the lice at home by wet combing the hair using a head lice comb, or by using medicated lotion (see below).

However, neither will protect against re-infestation if head-to-head contact is made with someone with head lice during the treatment period.

Wet combing

The wet combing method involves removing the head lice by systematically combing the hair using a special fine-toothed comb.

The comb's teeth should be spaced 0.2-0.3mm apart. Lice can be trapped between the teeth of nit combs with a tooth spacing of less than 0.19mm and remain unseen. 

Combs are available from pharmacies, or you can order them online from the Community Hygiene Concern.

Medicated products do not need to be used for wet combing. This is good because head lice are becoming more resistant to the insecticides commonly used to remove them.

However, for wet combing to be effective, it needs to be regular and thorough. This is the method you should use: 

  • Wash the hair using ordinary shampoo and apply plenty of conditioner, before using a wide-toothed comb to straighten and untangle the hair.
  • Once the comb moves freely through the hair without dragging, switch to the louse detection comb. Make sure the teeth of the comb slot into the hair at the roots, with the bevel-edge of the teeth lightly touching the scalp.
  • Draw the comb down to the ends of the hair with every stroke, and check the comb for lice.
  • Remove lice by wiping or rinsing the comb.
  • Work methodically through the hair, section by section, so that the whole head is combed through.
  • Rinse out conditioner and repeat the combing procedure.
  • Repeat the procedure on days 5, 9 and 13, so that you clear young lice as they hatch, before they have time to reach maturity.

The length of time it will take to comb your child’s hair will depend on the type of hair your child has and how long it is. For example, short, straight hair can be quickly prepared and can be fine-toothed combed in a few minutes, whereas longer, curlier hair will take longer to comb.

Medicated lotion or spray

Using medicated lotion or spray is an alternative method of treating head lice. However, no medicated treatment is 100% effective. Your pharmacist will be able to recommend an over-the-counter lotion or spray.

Medicated treatments should only be used if a living (moving) head louse is found. Crème rinses and shampoos are not thought effective and are therefore not recommended.

Ensure you have enough lotion to treat everyone in your family who is affected. Use enough to coat the scalp and the length of the hair during each application.

Follow instructions that come with the medicated lotion or spray when applying it. Depending on the product you are using, the length of time it will need to be left on the head may vary, from 10 minutes to 8 hours.

The normal advice is to treat the hair and repeat the treatment after seven days. Some medicated products also supply a comb for removing dead lice and eggs.

Traditional insecticides must not be used more than once a week for three weeks in a row. Some products also carry a fire warning.

Some medicated products may be capable of killing eggs as well as lice, although there is no certainty of this. Check for baby lice hatching from eggs 3-5 five days after you use a product, and again 10-12 days afterwards.

At least two applications of lotion are needed to kill lice over the hatching period, because the lotions do not always kill louse eggs.

If the lice appear unaffected by the product (some lice may develop resistance to particular insecticides), or if the problem persists, seek advice from your school nurse, health visitor, pharmacist or GP.

Cautions

Always seek the advice of a healthcare professional before using medicated head lice lotions on the following groups:

  • young babies (under six months old)
  • pregnant women
  • people with asthma or allergies

It is recommended that pregnant women use either wet combing or 4% dimeticone lotion, which is licensed for use during pregnancy and breastfeeding.

You should always carefully read instructions before using medicated head lice lotions.

Afro hair

Afro hair or tightly curled hair can make treating a head lice infestation particularly difficult.

If your child has afro hair and they develop head lice, keeping their hair short will make treating it easier. Alternatively, you could try plaiting or braiding their hair, as this can make it difficult for head lice to attach themselves to the bottom of the hair strand.

Using a medicated lotion, such as dimeticone, and methodically combing small sections of hair at a time with a lice comb, will usually prove effective.

Page last reviewed: 27/06/2012

Next review due: 27/06/2014

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Comments

The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Baileywoo said on 16 October 2013

I have been battling headlice on my daughter for 12 years, with very few breaks. I agree we are at the mercy of those parents who don't bother. The fashion for girls to have long hair and the trend for sleepovers all conspire against us! I can get rid of the live lice but the problem we have are the nits ie the eggs. They stick really well to hair and at the moment my daughters hair is covered. I have been combing them for days and having little impact. They look awful and make it seem as though she is infested when actually there are no lice, dead or alive, in her hair at the moment. Any tips?

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corinne0407 said on 04 August 2013

Desperately seeking advice.... Myself and my husband are first time parents, our daughter (8 months soon) is with a childminder during the day whilst we go to work. Twice now i have found live lice in her hair and have informed the childminder on both occasions (who might i add is very apologetic and very embarrassed poor love). What i need to know is can i treat my daughter with these insecticides or is the best solution to just keep up the wet combing? which she hates :(
Please help!!!!!

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john55 said on 09 January 2013

Mm these blighters must be able to smell hair. I combed them out of my daughters head into the empty but dry bath. There must have been about a dozen or so. I left them there attending to my daugther first thinking that I could easily flush them away later and watching them only move slowly. When I returned to commit the act of genocide 20 minutes or so later I found that they had all returned to one single strand of hair that was close by in the bath and they were actively running up and down it. Amazing, so don't think that these little devils can't get back on, I have seen it with my own eyes !!

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emily10towers said on 08 June 2011

Head lice will only let go of hair when they are to weak or damaged to hold on and although they will stay alive away from human for several hours they cannot transfer to another person in this way. They will only transfer from prolonged head to head contact.

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esiuol1965 said on 24 January 2011

I agree! my son (9) had never had lice before and wanted to see what they looked like. we "bug busted" for half an hour in the bath.I fished one out of the sink thinking it would be unrecognisable and very dead. He was fascinated and it was intact though lifeless. We put it in a bug pot and left it. More than a day later my daughter noticed it was crawling about and is still going strong!!! We are amased as we have avoided them so far as a family so far.
Another bug busting session tonight and all bedding on the washing line after a hot wash.

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mimi54 said on 14 December 2010

There were nits at my daughter's school and now we all have them in the family.I did not dream that it was so hard to treat them as the medicated shampoos do not kill them all and the lice remain alive.I've paid £25 for different shampoos so far and fear the problem is still unresolved.I have yet to do the wet combing properly as first attempts at it hardly worked as well.It's a nightmare! Then my daughter told me her little friends have told her they've had them,too and moms treated them. I notified the teacher about my daughter and she said that the problem was they were now ,new guidance,not allowed to tell the parents if they see their child has nits or put up a poster notifying all the parents of the existing problem. So,parents can choose not to treat their children (their human right,apparently),which makes the struggle of the parents like us almost pointless as recurrance is inevitable.If true,it is more than ludicrous and even frightening.

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mumof2NewMalden said on 16 October 2010

I would also like to add that head lice stay alive for many hours, even in uncosy conditions! I have used the wet combing method and when rinsing the nit comb, have left a live head louse that has not gone down the plug hole, in the sink. Many hours later, it was still alive... I guess the thing is that on the whole the little blighters make sure they don't let go of the hair, so effectively it is only hair to hair transfer by which they find pastures new.

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sue463 said on 16 October 2010

My 8 year old has just been treated painstakingly ,but eventually successfully ,for headlice. I read your pages after the infestation and treatment and found them useful and informative but you failed to mention the presence of the dark greyish coloured droppings from the louse which can be found in large quantities on bedding, clothes, and in the hair , and can sometimes be the first indication of an infestation

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User328887 said on 24 September 2009

That's what I came on here to say - my school uses the text from this page as advice sent home to parents. I combed several live lice out of my son's hair one night before bed onto a piece of white paper. In the morning I looked again at the paper and there were three lice still alive and moving around. I think advice not to wash sheets may need revision, as the lice seem able to lay in wait, even without being warm and cosy, for at least twelve hours according to my experiment.

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mumof8 said on 25 May 2009

A warning about not needing to wash clothing etc. I found a live head louse on my 6 year old daughter's pyjama top at bedtime. The top had been folded and placed under her pillow that morning and it was obviously nice and cosy for the louse.

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Head lice on combs

Healthy lice that get caught on brushes or combs can get back onto a person's head. Inspect brushes and combs that are used during treatment, and remove any lice before the next stroke.

While wet, head lice appear lifeless, but start to move as they become dry. However, these lice will die after a day or two if they do not feed on human blood.

You should also be aware that head lice can be flicked from dry hair during vigorous combing. If they land on someone, they will try to climb up to the head. 

Useful links

How to treat nits

Head lice, sometimes called nits, are common in children. Find out how to get rid of them if your child is affected.