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TreatmentGeneralGuidelinesTreatmentforheadliceisrecommendedforpersonsdiagnosedwithanactiveinfestation.Allhouseholdmembersandotherclosecontactsshouldbecheckedthosepersonswithevidenceofanactiveinfestationshouldbetreated.Someexpertsbelieveprophylactictreatmentisprudentforpersonswhosharethesamebedwithactivelyinfestedindividuals.Allinfestedpersons(householdmembersandclosecontacts)andtheirbedmatesshouldbetreatedatthesametime.

Somepediculicides(medicinesthatkilllice)haveanovicidaleffect(killeggs).Forpediculicidesthatareonlyweaklyovicidalornotovicidal,routineretreatmentisrecommended.Forthosethataremorestronglyovicidal,retreatmentisrecommendedonlyiflive(crawling)licearestillpresentseveraldaysaftertreatment(seerecommendationforeachmedication).Tobemosteffective,retreatmentshouldoccurafteralleggshavehatchedbutbeforeneweggsareproduced.

Whentreatingheadlice,supplementalmeasurescanbecombinedwithrecommendedmedicine(pharmacologictreatment)however,suchadditional(nonpharmacologic)measuresgenerallyarenotrequiredtoeliminateaheadliceinfestation.Forexample,hats,scarves,pillowcases,bedding,clothing,andtowelswornorusedbytheinfestedpersoninthe2dayperiodjustbeforetreatmentisstartedcanbemachinewashedanddriedusingthehotwaterandhotaircyclesbecauseliceandeggsarekilledbyexposurefor5minutestotemperaturesgreaterthan53.5C(128.3F).Itemsthatcannotbelaunderedmaybedrycleanedorsealedinaplasticbagfortwoweeks.Itemssuchashats,groomingaids,andtowelsthatcomeincontactwiththehairofaninfestedpersonshouldnotbeshared.Vacuumingfurnitureandfloorscanremoveaninfestedperson'shairsthatmighthaveviablenitsattached.

Treattheinfestedperson(s):RequiresusinganOverthecounter(OTC)orprescriptionmedication.Followthesetreatmentsteps:

1. Beforeapplyingtreatment,itmaybehelpfultoremoveclothingthatcanbecomewetorstainedduringtreatment.

2. Applylicemedicine,alsocalledpediculicide,accordingtotheinstructionscontainedintheboxorprintedonthelabel.Iftheinfestedpersonhasverylonghair(longerthanshoulderlength),itmaybenecessarytouseasecondbottle.Payspecialattentiontoinstructionsonthelabelorintheboxregardinghowlongthemedicationshouldbeleftonthehairandhowitshouldbewashedout.

WARNING:Donotuseacombinationshampoo/conditioner,orconditionerbeforeusinglicemedicine.Donotrewashthehairfor12daysafterthelicemedicineisremoved.

3. Havetheinfestedpersonputoncleanclothingaftertreatment.4. Ifafewlivelicearestillfound812hoursaftertreatment,butaremovingmoreslowly

thanbefore,donotretreat.Themedicinemaytakelongertokillallthelice.Combdeadandanyremainingliveliceoutofthehairusingafinetoothednitcomb.

5. If,after812hoursoftreatment,nodeadlicearefoundandliceseemasactiveasbefore,themedicinemaynotbeworking.Donotretreatuntilspeakingwithyourhealthcareprovideradifferentpediculicidemaybenecessary.Ifyourhealthcareprovider

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recommendsadifferentpediculicide,carefullyfollowthetreatmentinstructionscontainedintheboxorprintedonthelabel.

6. Nit(headliceegg)combs,oftenfoundinlicemedicinepackages,shouldbeusedtocombnitsandlicefromthehairshaft.Manyfleacombsmadeforcatsanddogsarealsoeffective.

7. Aftereachtreatment,checkingthehairandcombingwithanitcombtoremovenitsandliceevery23daysmaydecreasethechanceofselfreinfestation.Continuetocheckfor23weekstobesureallliceandnitsaregone.Nitremovalisnotneededwhentreatingwithspinosadtopicalsuspension.

8. Retreatmentismeanttokillanysurvivinghatchedlicebeforetheyproduceneweggs.Forsomedrugs,retreatmentisrecommendedroutinelyaboutaweekafterthefirsttreatment(79days,dependingonthedrug)andforothersonlyifcrawlingliceareseenduringthisperiod.Retreatmentwithlindaneshampooisnotrecommended.

SupplementalMeasures:Headlicedonotsurvivelongiftheyfalloffapersonandcannotfeed.Youdon'tneedtospendalotoftimeormoneyonhousecleaningactivities.Followthesestepstohelpavoidreinfestationbylicethathaverecentlyfallenoffthehairorcrawledontoclothingorfurniture.

1. Machinewashanddryclothing,bedlinens,andotheritemsthattheinfestedpersonworeorusedduringthe2daysbeforetreatmentusingthehotwater(130F)laundrycycleandthehighheatdryingcycle.Clothinganditemsthatarenotwashablecanbedrycleaned

OR

sealedinaplasticbagandstoredfor2weeks.

2. Soakcombsandbrushesinhotwater(atleast130F)for510minutes.3. Vacuumthefloorandfurniture,particularlywheretheinfestedpersonsatorlay.However,

theriskofgettinginfestedbyalousethathasfallenontoarugorcarpetorfurnitureisverysmall.Headlicesurvivelessthan12daysiftheyfalloffapersonandcannotfeednitscannothatchandusuallydiewithinaweekiftheyarenotkeptatthesametemperatureasthatfoundclosetothehumanscalp.Spendingmuchtimeandmoneyonhousecleaningactivitiesisnotnecessarytoavoidreinfestationbyliceornitsthatmayhavefallenofftheheadorcrawledontofurnitureorclothing.

4. Donotusefumigantspraystheycanbetoxicifinhaledorabsorbedthroughtheskin.

PreventReinfestation:

Moreon:Prevention&Control(/parasites/lice/head/prevent.html)

OverthecounterMedicationsManyheadlicemedicationsareavailable"Overthecounter"withoutaprescriptionatalocaldrugstoreorpharmacy.EachOverthecounterproductapprovedbytheFDAforthetreatmentofheadlicecontainsoneofthefollowingactiveingredients.Ifcrawlinglicearestillseenafterafullcourseoftreatmentcontactyourhealthcareprovider.

1. PyrethrinscombinedwithpiperonylbutoxideBrandnameproducts:A200*,Pronto*,R&C*,Rid*,TripleX*.

Pyrethrinsarenaturallyoccurringpyrethroidextractsfromthechrysanthemumflower.Pyrethrinsaresafeandeffectivewhenusedasdirected.Pyrethrinscanonlykilllivelice,notunhatchedeggs(nits).Asecondtreatmentisrecommended9to10daysafterthefirsttreatmenttokillanynewlyhatchedlicebeforetheycanproduceneweggs.Pyrethrinsgenerallyshouldnotbeusedbypersonswhoareallergictochrysanthemumsorragweed.Pyrethrinisapprovedforuseonchildren2yearsofageandolder.

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2. Permethrinlotion,1%Brandnameproduct:Nix*.

Permethrinisasyntheticpyrethroidsimilartonaturallyoccurringpyrethrins.Permethrinlotion1%isapprovedbytheFDAforthetreatmentofheadlice.Permethrinissafeandeffectivewhenusedasdirected.Permethrinkillslivelicebutnotunhatchedeggs.Permethrinmaycontinuetokillnewlyhatchedliceforseveraldaysaftertreatment.Asecondtreatmentoftenisnecessaryonday9tokillanynewlyhatchedlicebeforetheycanproduceneweggs.Permethrinisapprovedforuseonchildren2monthsofageandolder.

PrescriptionMedicationsThefollowingmedications,inalphabeticalorder,approvedbytheU.S.FoodandDrugAdministration(FDA)forthetreatmentofheadliceareavailableonlybyprescription.Ifcrawlinglicearestillseenafterafullcourseoftreatment,contactyourhealthcareprovider.

Benzylalcohollotion,5%Brandnameproduct:Ulesfialotion*

Benzylalcoholisanaromaticalcohol.Benzylalcohollotion,5%hasbeenapprovedbytheFDAforthetreatmentofheadliceandisconsideredsafeandeffectivewhenusedasdirected.Itkillslicebutitisnotovicidal.Asecondtreatmentisneeded7daysafterthefirsttreatmenttokillanynewlyhatchedlicebeforetheycanproduceneweggs.Benzylalcohollotionisintendedforuseonpersonswhoare6monthsofageandolderanditssafetyinpersonsagedmore60yearshasnotbeenestablished.Itcanbeirritatingtotheskin.

Ivermectinlotion,0.5%Brandnameproduct:Sklice*

Givenasatabletinmassdrugadministrations,ivermectinhasbeenusedextensivelyandsafelyforovertwodecadesinmanycountriestotreatfilarialworminfections.Ivermectinlotion,0.5%wasapprovedbytheFDAin2012fortreatmentofheadliceinpersons6monthsofageandolder.Itisnotovicidal,butappearstopreventnymphs(newlyhatchedlice)fromsurviving.Itiseffectiveinmostpatientswhengivenasasingleapplicationondryhairwithoutnitcombing.Itshouldnotbeusedforretreatmentwithouttalkingtoahealthcareprovider.

Malathionlotion,0.5%Brandnameproduct:Ovide*

Malathionisanorganophosphate.TheformulationofmalathionapprovedintheUnitedStatesforthetreatmentofheadliceisalotionthatissafeandeffectivewhenusedasdirected.Malathionispediculicidal(killslivelice)andpartiallyovicidal(killssomeliceeggs).Asecondtreatmentisrecommendediflivelicestillarepresent79daysaftertreatment.Malathionisintendedforuseonpersons6yearsofageandolder.Malathioncanbeirritatingtotheskin.Malathionlotionisflammabledonotsmokeoruseelectricalheatsources,includinghairdryers,curlers,andcurlingorflatirons,whenapplyingmalathionlotionandwhilethehairiswet.

Moreon:Malathion(/parasites/lice/head/gen_info/faqs_malathion.html)

Spinosad0.9%topicalsuspensionBrandnameproduct:Natroba*

Spinosadisderivedfromsoilbacteria.Spinosadtopicalsuspension,0.9%,wasapprovedbytheFDAin2011.Sinceitkillsliveliceaswellasunhatchedeggs,retreatmentisusuallynotneeded.Nitcombingisnotrequired.Spinosadtopicalsuspensionisapprovedforthetreatmentofchildren4yearsofageandolder.Itissafeandeffectivewhenusedasdirected.

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Pagelastreviewed:September24,2013Pagelastupdated:September24,2013Contentsource:GlobalHealthDivisionofParasiticDiseasesandMalariaNotice:LinkingtoanonfederalsitedoesnotconstituteanendorsementbyHHS,CDCoranyofitsemployeesofthesponsorsortheinformationandproductspresentedonthesite.

CentersforDiseaseControlandPrevention1600CliftonRd.Atlanta,GA303294027,USA800CDCINFO(8002324636)TTY:(888)2326348ContactCDCINFO

Repeattreatmentshouldbegivenonlyiflive(crawling)liceareseen7daysafterthefirsttreatment.

Forsecondlinetreatmentonly:

Lindaneshampoo1%Brandnameproducts:Noneavailable

Lindaneisanorganochloride.TheAmericanAcademyofPediatrics(AAP)nolongerrecommendsitasapediculocide.Althoughlindaneshampoo1%isapprovedbytheFDAforthetreatmentofheadlice,itisnotrecommendedasafirstlinetreatment.Overuse,misuse,oraccidentallyswallowinglindanecanbetoxictothebrainandotherpartsofthenervoussystemitsuseshouldberestrictedtopatientsforwhompriortreatmentshavefailedorwhocannottolerateothermedicationsthatposelessrisk.Lindaneshouldnotbeusedtotreatprematureinfants,personswithHIV,aseizuredisorder,womenwhoarepregnantorbreastfeeding,personswhohaveveryirritatedskinorsoreswherethelindanewillbeapplied,infants,children,theelderly,andpersonswhoweighlessthan110pounds.Retreatmentshouldbeavoided.

Whentreatingheadlice

1. Donotuseextraamountsofanylicemedicationunlessinstructedtodosobyyourphysicianandpharmacist.Thedrugsusedtotreatliceareinsecticidesandcanbedangerousiftheyaremisusedoroverused.

2. Allthemedicationslistedaboveshouldbekeptoutoftheeyes.Iftheygetontotheeyes,theyshouldbeimmediatelyflushedaway.

3. Donottreataninfestedpersonmorethan23timeswiththesamemedicationifitdoesnotseemtobeworking.Thismaybecausedbyusingthemedicineincorrectlyorbyresistancetothemedicine.Alwaysseektheadviceofyourhealthcareproviderifthisshouldhappen.He/shemayrecommendanalternativemedication.

4. Donotusedifferentheadlicedrugsatthesametimeunlessinstructedtodosobyyourphysicianandpharmacist.

*UseoftradenamesisforidentificationpurposesonlyanddoesnotimplyendorsementbythePublicHealthServiceorbytheU.S.DepartmentofHealthandHumanServices.