Head lice are a common and frustrating problem for parents and children, with the main symptom being an itchy scalp from the bites.

Fortunately, lice are not dangerous and do not spread disease, but they are contagious, so it is important that those infected get proper treatment as soon as possible.  There are a number of treatment options available for children depending on their age. Most medicated lice treatments are not approved for children under the age of 2, except for the newly released benzyl alcohol lotion.

By hand

Lice and nits (head lice eggs) should be removed by hand using a fine-tooth comb on your child's wet, conditioned hair every 3 to 4 days for 2 weeks after the last live evidence of lice.  Nit combs can be found in lice medicine packages, online or at drug stores. 

Medicated shampoos

Medicated lice treatments usually kill the lice and nits, but it may take a few days for the itching to stop.  It is important to follow the directions on the package because these products are insecticides. Applying too much or too frequently can cause harm. 

Over-the-Counter

Many head lice medications are available without a prescription.  Each over-the-counter product approved to treat head lice contains one of the following active ingredients.
  
Pyrethrins - Brand names: A-200, Pronto, R&C, Rid, Triple X

• Naturally occurring extracts from the chrysanthemum flower.
• Safe and effective when used as directed.
• Only kills live lice, not unhatched eggs (nits).
• Second treatment recommended in 9-10 days to kill any newly hatched lice before they can produce new eggs.
• Treatment failures possible depending on whether lice are resistant to pyrethrins in the patient’s geographic location.
• Should not be used by individuals allergic to chrysanthemums or ragweed.

Permethrin lotion 1% - Brand name: Nix

• Synthetic, but similar to naturally occurring pyrethrins.
• Safe and effective when used as directed.
• Kills live lice but not unhatched eggs.
• May continue to kill newly hatched lice for several days after treatment.
• Second treatment often necessary in 9-10 days to kill newly hatched lice before they can produce new eggs.
• Treatment failures possible depending on whether lice are resistant to pyrethrins in the patient’s geographic location.

Prescription Medications

If over-the-counter treatments do not work, your doctor may prescribe shampoos or lotions that contain different ingredients.  The following medications approved by the U.S. Food and Drug Administration (FDA) are available by prescription only.
  
Malathion lotion 0.5% - Brand name: Ovide

• Safe and effective when used as directed.
• Kills live lice and kills some lice eggs.
• Second treatment recommended if live lice still are present 7-9 days after treatment.
• Intended for patients 6 years and older.
• Can irritate skin and scalp.
• Contact with eyes should be avoided.
• Flammable. 

Lindane shampoo 1% - Brand name: None

• Available as a cream, lotion or shampoo.
• Not recommended as a first-line therapy.
• Overuse, misuse, or accidentally swallowing can be toxic to the brain and other parts of the nervous system.
• Should only be used by those patients who have failed treatment with or cannot tolerate other medications.
• Should never be used to treat infants, children, individuals with a seizure disorder, or those with irritated skin or sores where the lindane will be applied.

Benzyl alcohol lotion - Brand name: Ulesfia

• Newly approved treatment that should not be used in children younger than 6 months.
• Side effects may include irritations of the skin, scalp and eyes.
• According to FDA, serious side effects—such as seizures, coma or death—may occur if this product is used on premature infants.

By Sandi Schwartz - Science writer and mom