If you just mention lice to someone, their scalp will start to itch.  You need lice treatment — STAT! The stigma around lice is literally palpable.  The truth is there is no shame in it.  Millions of cases are identified every year. 

Don’t Lose Your Head

Lice has nothing to do with hygiene (the little buggers actually prefer clean hair) or low income (it can happen to ANY of you).  It has everything to do with bad luck. Knowing more about lice and what to do about it will keep you from losing your head.

1 — Lice do not jump. 

They crawl.  This means that you cannot get it without direct head to head contact. Be sure not to share hats, scarves, or other head gear, i.e. coats with hoods.  Lice can live off the human host for up to 24-48 hours and can crawl onto another person if given the chance.

2 — Understand the life cycle. 

There are three stages: the nit (egg), nymph (baby), and louse (adult).  The lifespan of lice is 3-4 weeks. A mature louse can lay up to 10 eggs per day, and eggs will hatch within 7-12 days.  To break the cycle, you need to remove both live lice and nits from the scalp.  It only takes one left behind to start a world of trouble.

3 — Control your environment. 

You do not want to take the chance that one of those little buggers crawled off the scalp and is waiting for you in your bed or on your furniture.  The house must be cleaned and pronto.  All sheets, bedding, and pillows should be laundered in hot water and run through the dryer on the highest setting, twice if you have the time.  Vacuum your beds, floors, and even your cars. Be thorough and diligent. You will reap the rewards when your house is squeaky clean and you have reduced your re-exposure risk.

4 — Learn about available lice treatments.

Some people prefer to try more “natural” remedies as opposed to chemical lice treatments. Others prefer to be more aggressive from the get-go.  If you understand how any given method works and how to use it to its full potential, you increase your odds of success.  If lice treatments do not kill nits, please know that you should repeat that treatment in 7-10 days to kill any lice that may hatch from any nits left behind during the first treatment.

Over-the-Counter Lice Treatments

Treatment	How It Works	Disadvantages	Advantages
Conditioner	Apply a thick layer of conditioner directly to dry hair for 10-30 minutes.  The hair becomes too slippery for the lice to stick on so that nit combing is more effective.	Does not kill lice or nits	Cheap
Electrocution	A gentle battery-operated pulse can kill live lice on contact.  For one such apparatus, see the Robicomb at www.liceguard.com.	Does not kill nits	Cheap
Hair drying	Blow drying hair at 140 degrees Fahrenheit can kill live lice.	Does not kill nits Can be drying to the scalp	Cheap
Mayonnaise	Apply to the scalp from the roots to the hair ends and cover with a shower cap for 6-8 hours.  Wash out with shampoo and follow-through with a nit comb.  Lice breathe through their skin and are smothered by overnight applications.	Does not kill nits Can be messy	Cheap Moisturizes the scalp
Olive oil	Apply to the scalp from the roots to the hair ends and cover with a shower cap for 6-8 hours.  Wash out with shampoo and follow-through with a nit comb. Lice breathe through their skin and are smothered by overnight applications.	Does not kill nits Can be messy	Cheap Moisturizes the scalp
Permethrin (Nix 1%)	Wash first with shampoo WITHOUT conditioner.  Apply cream rinse to wet hair from the roots to the hair ends and leave on for 10 minutes. Rinse out with water and follow-through with a nit comb.	Does not kill nits Possible resistance in the community, especially at lower doses	Cheap Long-lasting effect may kill lice hatched from nits several days after application
Tea tree oil	Mix 3-10 drops of oil into the normal amount of shampoo you would use to wash your hair. Cover your hair in a shower cap to let the fumes do their work and let the mixture sit on the scalp for 10 minutes before washing out.  Follow-through with a nit comb. Lice are repelled by the anti-fungal properties of the oil.	Does not kill lice or nits Can irritate/burn the scalp if left on the skin for too long	Cheap
Vacuuming	Vacuum suctioning kills lice and physically removes them from the scalp.  To review available vacuum-comb attachments, visit liceaway.com.		Cheap
Vinegar (apple cider)	Apply warm vinegar to the scalp for a minimum of 30 minutes to overnight and cover with a shower cap.  Follow through with a nit comb. Vinegar loosens the glue that fastens nits to the hair shaft. Vinegar is also an antiseptic.	Does not kill live lice or nits	Cheap

Prescription Lice Treatments

Treatment	How It Works	Disadvantages	Advantages
Benzyl alcohol (Ulesfia)	Apply cream to dry hair from the roots to the hair ends and leave on for 10 minutes. Rinse out with shampoo and follow-through with a nit comb.  Benzyl alcohol suffocates live lice.	Does not kill nits Expensive
Ivermectin – oral(Stromectol)	Take pills on an empty stomach with a full glass of water. Ivermectin is a pesticide.	High risk for side effects Not FDA-approved for treatment of lice	Kills both lice and nits
Ivermectin – topical (Sklice)	Apply cream to dry hair from the roots to the hair ends and leave on for 10 minutes.  Rinse out with shampoo.  Product claims no nitpicking is required.  Ivermectin is a pesticide.	Expensive	Kills both lice and nits
Lindane	Wash with shampoo WITHOUT conditioner at least one hour prior to treatment.  Apply the shampoo to dry hair and leave on for no longer than 4 minutes.  Do NOT cover the head.  Add a small amount of water to form a good lather, then rinse completely and follow-through with a nit comb. Lindane is a pesticide.	High risk for side effects Cannot be used by pregnant or nursing women, infants, children, people who weigh less than 110 pounds, the elderly, people with seizure disorders and people with open sores/irritated skin	Kills both lice and nits
Malathion (Ovide)	Apply to dry hair from the roots to the hair ends and allow hair to air dry.  Do NOT cover the head.  Shampoo out in 8-12 hours and follow-through with a nit comb.  Malathion is a pesticide.	High risk for side effects Flammable	Kills both lice and nits
Permethrin (Elimite 5%)	Wash first with shampoo WITHOUT conditioner.  Apply cream rinse to wet hair from the roots to the hair ends and leave on for 10 minutes.  Rinse out with water and follow-through with a nit comb.	Does not kill nits Possible resistance in the community, especially at lower doses	Cheap Long-lasting effect may kill lice hatched from nits several days after application
Spinosad (Natroba)	Apply to dry hair from the roots to the hair ends and leave on for 10 minutes.  Rinse out with water and follow-through with a nit comb. Spinosad is a pesticide.	Expensive	Kills both lice and nits

5 — Don’t forget the nit-picking. 

No matter which approach you take, you need to comb through your hair and remove lice and nits.  Make those lice treatments count! Do not be fooled by anyone who says otherwise. The only sure fire way to beat a lice infestation is to remove each and every bug from the scalp.  For the record, you are better off getting a metal nit comb as opposed to a plastic one.  Hair can be combed through when wet or dry, though the wet approach is much more effective.  It is harder for the little buggers to crawl on wet hair and therefore easier to trap them with the comb.