Lice and Scabies: Treatment Update

Karen Gunning, PharmD; Bernadette Kiraly, MD; Karly Pippitt, MD


Am Fam Physician. 2019;99(10):635-642. 

In This Article

Nonpharmacologic Treatment of Head Lice

Wet combing for the treatment of head lice involves washing with ordinary shampoo, moistening the hair with commercially available leave-in conditioner, combing with a wide-tooth comb until detangled, and then systematically combing the hair from root to tip with a lice comb. The conditioner should then be rinsed out and the hair combed with a lice comb again.[21] Wet combing alone does not have adverse effects and is often preferred by parents wanting to avoid a chemical treatment; however, it can be time-consuming. Wet combing should be done every three days until no lice are detected on four to five consecutive occasions. Cure rates vary considerably (47% to 75%), although studies are not high quality.[22,23]

Several substances, including vinegar, formic acid solution, nit-removal conditioners, water, regular conditioner, and almond oil, have been evaluated as methods to remove nits by loosening the nit from the hair shaft.[23] Water and regular conditioner were the most effective in the removal of nits in an in vitro study.[23] Use of herbal and alternative products (e.g., tea tree oil, eucalyptus oil) is not recommended in children because their safety and efficacy have not been evaluated by the U.S. Food and Drug Administration, and evidence of benefit is limited.[1,12]

Head-to-head contact is the most prevalent form of lice transmission. Fomite transmission is a common misconception. Although fomite transmission is rare, items that have come into direct contact with the head (e.g., pillowcases, hats, clothing) within the two days before treatment should be washed. Bringing the items to a temperature of at least 130°F (54°C) in the washing machine or dryer can effectively eradicate the lice.[1] Placing items in a sealed plastic bag for two weeks is also effective. Sprays, carpet treatments, and other chemical environmental decontamination measures should not be used.[1]