The treatment of human lice is the removal of head lice parasites from human hair. It has been debated and studied for centuries. However, the number of cases of human louse infestations (or pediculosis) has increased worldwide since the mid-1960s, reaching hundreds of millions annually. There is no product or method that assures 100% destruction of the eggs and hatched lice after a single treatment. However, there are a number of treatment modalities that can be employed with varying degrees of success. These methods include chemical treatments, natural products, combs, shaving, hot air, and silicone-based lotions. Treatment is recommended only after a clear diagnosis since all treatments have potential side effects. Louse eggs hatch 6–9 days after oviposition. Therefore, a common recommendation is to repeat treatment with a pediculicide at least once after 10 days, when all lice have hatched. Between the two treatments (Days 2–9) the person will still be infested with lice that hatch from eggs not killed by the anti-louse product. Between the treatments, it is advised to wet the hair and comb daily with a louse-comb to remove the hatching lice. If no living lice are found, the treatment was successful, even if nits (eggs) are visible on the hair. If living lice are still present, the treatment is repeated using an anti-louse product with a different active ingredient. This is kept in the hair for 2 hours and then rinsed out, with the head and hair cleaned before sleep. Prophylactic treatment with pediculicides is not recommended.
Medications Insecticides used for the treatment of head lice include lindane, malathion, carbaryl, pyrethrum, piperonyl butoxide, permethrin, phenothrin, bioallethrin, and spinosad. Many of the pediculicides in the market are either not fully effective or are ineffective when they are used according to the instructions. Pediculicides may rapidly lose their efficacy because of the development of resistance. Resistance of head lice to insecticides such as lindane, malathion, phenothrin and permethrin has been reported. A 2021 systematic review and meta-analysis found that the mean frequency of pyrethroid resistance of lice was 77% globally, and even 100% in several countries (Australia, England, Israel, and Turkey). It concluded that treatment with current insecticides may not be effective and is likely the cause of increased levels of infestations. Ivermectin by mouth has been shown to reduce levels of louse infestation. Ivermectin is approved by the U.S. Food and Drug Administration (FDA) for pediculosis. Agents approved by the FDA for treatment of pediculosis include abametapir, topical ivermectin lotion, lindane, malathion, permethrin, and piperonyl butoxide with pyrethrins.
Heated air
A standard home blow dryer will kill 96.7% of eggs with proper technique. To be effective, the blow dryer must be used repeatedly (every 1 to 7 days since eggs hatch in 7 to 10 days) until the natural life cycle of the lice is over (about 4 weeks). A number of commercial head lice treatment companies across the country offer a heated air treatment.
Combing A special fine-toothed comb that can pick out lice is used. For a treatment with louse comb alone, it is recommended to comb the hair for an hour to an hour and a half (depending the length and type of the hair) daily or every second day for 14 days. Wetting the hair especially with water and shampoo or conditioner will facilitate the combing and the removal of lice, eggs and nits. Electronic louse combs use a small electrical charge to kill lice. The metal teeth of the comb have alternating positively and negatively charged tines, which are powered by a small battery. When the comb is used on dry hair, lice make contact with multiple tines of the fine-toothed comb, thereby closing the circuit and receiving an electrical charge. A non-peer-reviewed letter has been published in a dermatology journal claiming effectiveness based on personal experience (total of 6 uses).
Procedures Shaving the head or cutting the hair extremely short can be used to control lice infestation. Short hair, baldness, or a shaven scalp are generally seen as a preventive measure against louse infestation. This will also eliminate – particularly if maintained for the length of the parasites' reproductive cycle – louse infestation. Infestation with lice is not a serious disease and the medical symptoms are normally minimal. In any case, health providers and parents should try not to create emotional problems for children during examination and treatment. Shaving of the area above and behind the ears and the upper part of the neck while leaving the crown of the head with hair is commonly used to prevent lice among tribes in Africa, Asia, and America (in America – Mohawk style).
School treatment
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