Have head lice? Don’t panic — here’s how to treat it, according to experts
You should use both a primary treatment and a physical method (like a nit comb) to fully get rid of head lice.
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Here are the key factors I kept in mind to pull together this list, as recommended by my experts:
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This treatment is a favorite of Dr. Carmen Castilla, a board-certified dermatologist at the New York Dermatology Group in Manhattan, because it comes in a two-pack (which is great for treating multiple family members), includes a fine tooth comb to remove nits and it’s safe for kids ages two months and up. It prevents lice reinfestation for up to 14 days after an initial application, according to the brand.
All of my experts recommend using a fine-toothed metal nit comb in conjunction with a primary treatment because it makes finding and getting rid of nits easier (which a primary treatment may not fully kill). This Nit Free metal comb comes recommended by Dr. Svetlana Danovich, a cosmetic surgeon and founder of SD Medical Arts — and it’s one that my mom used on me as a child. It has rounded teeth that won’t cause painful scratches on the scalp, and has an anti-slip handle to ensure a secure grip. In addition to a good metal lice comb, use a bright light and a magnifier to spot tiny eggs, says Danovich.
When NBC Select editorial operations associate Jem Alabi got head lice last year, she used this all-in-one spray to treat it. “My case was so bad, I almost shaved my head,” says Alabi. “I tried everything to get rid of them, but the thing that finally saved me was this $15 spray from Amazon.” Alabi sprayed this treatment on her braids and noticed it worked without needing to comb the product through the hair. “Plus, you only need to leave it on for 20 minutes before washing out. I used a bonnet after applying the spray and was able to pick out/wash all the dead lice/eggs that same day,” she says. The spray kills lice and their eggs using dimethicone, an active ingredient that suffocates them, experts say. It’s also safe for sensitive skin, according to the brand, and comes with a fine tooth comb.
This kit includes a lice treatment solution and a lice shampoo and conditioner, all of which are pesticide-free and made from suffocating agents (like oils) for “super lice” that are resistant to common insecticides like permethrin (more on these types of treatments below). The brand recommends using the treatment solution twice, two weeks apart, and the shampoo and conditioner daily until lice is fully gone. The kit comes with a nit comb to remove lice eggs, too. Rid also has a kit to treat lice in both hair and home.
If you want to avoid head lice altogether, consider this Lice Shield shampoo and conditioner combo, which repels lice using suffocating agents like citronella, rosemary, lemongrass, cedar and geraniol. It’s gentle enough to use on your child’s sensitive skin and leaves hair soft and clean, according to the brand.
Typically, you can treat head lice using topical treatments and/or physical methods of removal to rid of the nits, says Dr. Kristin Lo Sicco, a board-certified dermatologist and hair specialist at NYU Langone Health. “You need to ensure that you kill both the adult lice, nymphs (or “baby lice”) and nits (lice eggs), says Castilla.
There are two main types of lice treatments:
OTC head lice treatments are considered the first-line treatment by the American Academy of Pediatrics. Here are a few to consider:
You should also use a physical method of lice and nit removal in combination with topical therapies, says Lo Sicco. “This takes patience as it takes about 30 minutes and may be required daily for several weeks,” she says. Using a nit comb (a metal fine-toothed comb long) on wet hair is usually the most effective physical method because it removes lice and their eggs from hair, experts say. “Start at the top of the hair shaft, closest to the scalp, then comb away from the scalp,” says Lo Sicco. “You really have to be methodical about manual removal, break the hair up into quadrants and be extremely thorough,” says Castilla. To make the process easier and avoid snagging hair with a nit comb, apply conditioner, says Lo Sicco.
Here are a few prescription head lice treatments to keep in mind, according to Castilla:
Head lice are tiny, parasitic insects that can infest the scalp. They’re the most common type of lice (there’s also body lice that live in clothing and pubic lice found in the pubic area or armpits) and result in itching of the scalp, caused by an allergic reaction to louse bites. Though they mostly live on the scalp, you can also find them on eyebrows or eyelashes, says Danovich.
In addition to adult lice, there’s also nits, the eggs laid by lice. They’re tiny, oval-shaped and about the size of a grain of rice. “Nits look like water bubbles on the hair shaft. You can distinguish them from normal hair debris flakes because they don’t slide down the hair shaft when you push on them,” says Castilla. Nits take about a week to turn into young lice.
Head lice are very contagious and usually spread by close head-to-head contact or sharing infested objects that touch the scalp, like brushes, hats, scarves or bedding. Since lice don’t have wings and cannot hop, jump or fly, they crawl from one head to another by attaching themselves to hair shafts using their claws.
Adult lice can live on a person’s head for up to 30 days, however, they cannot live without feeding, so they’ll die within two days once they fall off a person, according to the Centers for Disease Control and Prevention. That means it’s unlikely you’ll get lice from hats or wigs if they haven’t been worn by someone in the past 48 hours, according to the CDC.
When people are first infested with head lice, they may not have any symptoms at first. In fact, it may take four to six weeks for itching to start, according to the CDC.
Here are a few expert tips to help prevent lice in the first place:
Most OTC medications will require you to use them twice, typically seven to 10 days apart. “This is to treat any remaining eggs that may have survived the first insecticide application,” says Lo Sicco. It’s also very important to treat all family members simultaneously, otherwise you risk continued transmission, she says.
Some people may be tempted to go the natural route, using coconut oil, tea tree oil, neem oil, eucalyptus oil or anise oil with the idea that they can smother the lice. Though they might help a bit, they usually aren’t as reliable as proven treatments, says Danovich.
“Lice can survive for several hours through these treatments,” says Castilla. “These are better adjunctive methods, not the sole method for removal.”
All of my experts recommend informing your child’s school or daycare immediately and checking all household members for head lice every two to three days. However, students with head lice do not need to be sent home from school early, nor do they need to stay home once they begin an appropriate treatment (nits may stay in hair after treatment, but successful treatment will kill crawling lice), according to the CDC.
The American Academy of Pediatrics, the National Association of School Nurses and the CDC all recommend against “no-nit” policies (a child being free of nits before returning to school). Students with lice can go home at the end of the day, start treatment and return to class afterward, according to the CDC.
As for adults, there are no specific head lice policies for work or other activities. However, if you do have a head lice infestation, you should start an appropriate treatment immediately, experts say.
At NBC Select, we work with experts who have specialized knowledge and authority based on relevant training and/or experience. We also take steps to ensure all expert advice and recommendations are made independently and without undisclosed financial conflicts of interest.
I’m an updates editor at NBC Select who has written about skin care, hair care and wellness since 2021. For this article, I spoke to three dermatologists and hair specialists to find the best head lice treatments and how to get rid of them for good.
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