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How To Treat Head Lice: The pros and cons of each remedy

It’s the post-playdate phone call every parent dreads: “We have lice.” Just the mention of head critters makes one itch! Even worse is the call from school claiming your child is infested and can’t return until he or she is “nit-free.”

Though kids (and adults) can contract head lice any time of year, the most prevalent seasons are fall and winter because that’s when kids are the closest in contact with each other. Lice spread from head-to-head contact and can be transmitted through shared linens, hats, brushes, and other hair accessories.

If you think your child has been exposed to lice, put on a pair of disposable gloves and place your child’s head under a bright light for examination. Start at the base of your child’s neck, behind the ears, then along the forehead, and at the crown. Lift small sections of hair in your fingers and work your way methodically around the entire head. You’ll want to look out for adult lice and nits, which are egg sacks. Live lice are about the size of a sesame seed and are grayish-white or tan. Nits are tiny yellow, tan, or brown dots that look a lot like dandruff and are usually located, at most, a few inches from the scalp. If you’re unsure, try flicking the hair – if it moves, it’s dandruff; if it doesn’t, it’s a nit. Scrape it off with your fingernails, look for more, and start thinking about treatment.

There are plenty of lice treatments available both over the counter and by prescription. Some are even preventatives. Here’s a look at your options:

  • Lice Shampoo

    Pesticide shampoos such as Rid and Nix are the most common lice treatments. Copious amounts of the shampoo are applied to dry hair, which is rinsed after 10 minutes and followed by dragging a nit comb through every strand of hair to remove the eggs and already hatched lice. These treatments typically require repeat shampooing in a week to 10 days. Standard lice protocol also calls for bedding to be washed in hot water; hats and other non-washables to be bagged and stored away for two weeks; and combs, brushes, and hair accessories to be soaked in rubbing alcohol for an hour.

    Pros: The shampoos work well and come in all-in-one kits that include the fine-toothed combs and gels, which make combing easier.

    Cons: Contain neurotoxins, price (8-oz. bottle starts at $20 – for thick, long hair, one bottle isn’t enough), not always effective since some lice have become resistant to the pesticides.

  • Tea Tree Oil

    Tea tree oil is a natural louse repellent, which makes it good for prevention. If there’s an outbreak at your kid’s school, wash his or her hair with a tea tree oil shampoo and conditioner to decrease his or her risk of getting the bug.

    Pros: Natural, safe, preventative

    Cons: They don’t kill lice or their eggs, shampoos can be expensive depending on brand

  • Nit Comb

    Lice cannot survive without nourishment from the human scalp. Going through every inch of hair with a fine-toothed nit comb should loosen or remove all nits from the hair shaft while also pulling adult lice away from the head. Since lice treatment is only effective when all the nits are killed or removed, repeat combing is required.

    Pros: Safe, no chemicals, cheap

    Cons: Time-consuming, not as effective with long or thick hair

  • Electric Lice Comb

    These battery-operated combs have the added feature of an electric charge that zaps nits and adult lice on contact. Though it kills adult lice instantly, an electric comb does not kill nits. Nits still have to be removed manually with a regular nit comb.

    Pros: Kills lice, helps remove nits, doesn’t require shampoos

    Cons: Expensive, requires lots of combing to ensure all the nits have been removed, the electric humming sound can be scary for little ones

  • Nuvo Method

    Developed by Dale Pearlman, MD, a Stanford University trained doctor and specialist in dermatology, this highly effective method uses Cetaphil face cleanser, which does not contain neurotoxins. Pearlman’s copyrighted lice treatment works by encasing each louse and suffocating it. The method does not kill nits, rather, it works by interrupting the life cycle of lice. The treatment is straightforward: coat every inch of dry hair with Cetaphil, comb out hair catching excess Cetaphil in a towel, comb the hair, blow dry completely, wait at least 8 hours before shampooing as normal. Repeat in one week to kill off any newly hatched lice. A week later repeat a third time to complete treatment. For specific details on the method, which should be followed closely for optimal effectiveness, go here. Pearlman recommends running all bedding in the dryer for 10 minutes at the time of each treatment (no washing necessary).

    Pros: No neurotoxins, inexpensive, doesn’t require nit-combing (unless your school has a no-nit policy)

    Cons: Time-consuming (especially for those with thick, long hair), day-after hair looks dull and flat, easy to forget third treatment

  • Prescription Treatments

    Thanks to ever-more-pesticide-resistant lice, some over-the-counter treatments aren’t as effective as they once were. But new studies show promise for Natroba Topical Suspension, a prescription-only hair rinse recently approved by the Food and Drug Administration, and Stromectol, a pill containing ivermectin, which has also been used to treat roundworm infections.

    Pros: Highly effective, sometimes covered by insurance

    Cons: Prescription-only, expensive if out-of-pocket, uncommon and new treatments, contain pesticides, do nothing about nit removal

  • Professional Lice Removal Service

    Sometimes as parents, we need to call in for back up. A multi-kid lice infestation might be one such occasion. Lucky for a growing number of parents, professional nit-picker operations are turning up everywhere (just Google “professional lice removal” and you’ll find millions of results). These lice treatment services each use their own combination of remedies such as shampoos, creams, and hours of fine-tooth combing to not only kill adult lice, but remove all eggs as well.

    Pros: Outsource the ick factor

    Cons: Expensive; one salon I found charges $75 per hour and requires three 1-hour treatments – with only a 14-day guarantee!

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