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Lice are commonly transferred from schoolchildren or by sharing combs, brushes, and towels. You can use over-the-counter (OTC) treatments, prescription treatments, or home remedies to kill and remove head lice.

Like a lice infestation, the exact estimate of how many people get head lice per year is hard to pin down.

The Centers for Disease Control and Prevention (CDC) estimates that there are about 6 to 12 million cases each year in the United States among children ages 3 to 11.

Since lice can only crawl and survive outside your head for 24 hours, most infestations come from direct head-to-head contact. If someone you know has lice, it’s likely they got it from a friend, family member, or stranger with whom they had close contact. Shared items like hats or brushes can also facilitate an infestation.

Common situations that can lead to the transfer of lice include:

  • being in school, for children
  • sitting in close proximity to others
  • sleeping in the same bed, like during slumber party
  • sharing combs, brushes, or towels

A national survey asked moms about removing lice and found that most didn’t have accurate facts. Almost 90 percent of moms believe they need to remove eggs (nits,) and half of moms thought they should apply multiple treatments for head lice.

The CDC says that complete removal of nits is unnecessary, though using a lice comb can help. And when it comes to treatment, you should use only one product at a time.

Read on to learn about the most effective ways to kill head lice and how to keep them away.

TreatmentApplicationNit combing?Caution
Malathion (Ovide)Apply this medication to your hair and then rub it into your hair and scalp. A second treatment may be necessary if lice are seen seven to nine days after treatment.Extremely flammable and should only be used for pregnant or breastfeeding women in consultation with a doctor. Not for children less than 6 years of age.
Ivermectin lotion (Sklice)Apply to dry hair and scalp. Rinse after 10 minutes with water. It’s effective with only one treatment.XNot for children under 6 months.
Spinosad topical suspension (Natroba)Apply to dry hair and scalp. Rinse after 10 minutes with water. Repeated treatment is typically not necessary. Not necessaryNot for children under 6 months of age.
Benzyl alcohol lotion (Ulesfia)Apply this lotion to your scalp and dry hair for 10 minutes, completely saturating the scalp and hair. Rinse with water. Repeat treatment is needed, as it kills the lice but not the eggs. Not for children under 6 months. Safe in pregnancy and breastfeeding.
LindaneApply shampoo to dry hair and scalp. Leave for four minutes before adding water for a lather. Rinse afterward. Retreatment should be avoided.XLindane causes serious side effects. Use only if other prescriptions fail. Not for premature infants, those with HIV, women who are pregnant or breastfeeding, children, the elderly, or those weighing less than 110 pounds.

As a first line of defense, try a few lifestyle changes and home remedies to combat lice.

You won’t need to call pest control. The CDC says there is no need to fumigate your house or treat your pets for lice. Having lice has nothing to do with cleanliness or environment, as they don’t come from the outdoors or your pets.

According to Sanofi Pasteur’s 2014 survey, moms who chose prescription treatments were more likely to be satisfied (91 percent) than moms who chose over-the-counter treatments (79 percent).

There are several prescription products that kill head lice. Always start with clean hair, but avoid using a combination shampoo-and-conditioner product before lice treatment application. In addition, you shouldn’t wash your or your child’s hair one to two days after you remove the lice medicine. Keep the application on the hair and scalp only. Follow the instructions on the package.

Possible side effects of prescription treatment include:

  • dandruff
  • a burning sensation where you apply the medication
  • eye redness
  • skin, scalp, and eye irritation

If you’re looking at over-the-counter (OTC) treatments for lice, keep an eye out for these ingredients:

Pyrethrins: This is a natural extract from chrysanthemums. It’s safe for children age 2 years and older. But this ingredient only kills live lice, not nits. You’ll need a second treatment after nine to 10 days if existing eggs have hatched. This shouldn’t be used by any individuals allergic to chrysanthemums or ragweed.

Permethrin lotion, 1 percent (Nix): This is a synthetic treatment similar to natural pyrethrins. It kills both live lice and nits. Permethrin also leaves a residue on the hair that is designed to kill any newly hatched lice arising from eggs not killed in the initial application. Shampoos and conditioners may interfere with the effectiveness of this residue, so you may need to do a second treatment after 7-10 days if live lice are seen. Permethrin is safe for children age 2 months and older. Talk to your doctor if you still see lice after full treatment. Your doctor can prescribe something stronger.

OTC treatments for kids

Children younger than 2 years shouldn’t use most OTC lice-removal products, so try simply using a fine-toothed comb or a special nit comb when your child’s hair is wet. Metal combs are more effective than plastic. Repeat this combing every three to four days for no less than two weeks. Ask your pediatrician if combing should be used in conjunction with other treatments for your young child.

After each treatment, you should continue checking the hair to remove nits or lice.

Remember to:

  • remove dead or live lice with a fine-toothed comb eight to 12 hours after treatment
  • avoid using regular shampoo one to two days after
  • continue checking for two to three weeks for nits and lice
  • soak combs and brushes in boiling water for five to 10 minutes
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What if the treatment doesn’t work?

Sometimes treatment doesn’t work because lice are resistant. Other times it’s because someone didn’t follow the instructions carefully enough. OTC products don’t kill nits, so application is a matter of timing. It’s also possible for someone to become infested again. Talk to your healthcare provider if a full course of treatment doesn’t work. They’ll be able to help prescribe a different medication and recommend prevention tips.

For people interested in natural home remedies, there are many options. Most alternative treatments, like olive oil, mayonnaise, or butter, don’t have enough evidence to indicate they work to suffocate lice. Some treatments like tea tree oil show promise, but they may require more time and more frequent applications. You can find tea tree oil on Amazon.com. Shaving the head does also get rid of lice, but it doesn’t prevent them.

If you’re looking for fast and easy results, prescription products may be a better choice. Talk to your healthcare provider to find out which treatment is the most effective, safe, and easy to use.