20 ways to kill head lice

Don't freak out if your child has head lice, there are lice treatments that actually work.
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How to get rid of head lice

Six to 12 million kids in the U.S. get head lice each year, and just as many tears are shed by kids—and adults—trying to get rid of them. Rx insecticides can be toxic, and over-the-counter treatments may not work. The result? Frustration.

"The biggest problem today is that lice have become resistant to the over-the-counter stuff," said Anna Albano-Krosche, owner of the head lice removal salon, The Lice Lady of Westchester in Elmsford, N.Y.

Natural remedies can get rid of lice, they're just not as well studied as commercial treatments. Here are a variety of home remedies, over-the-counter, and prescription treatments used to treat head lice.

By Karen Pallarito

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Chill out

First things first: Take a deep breath and don't freak out if your child has head lice. Sure, they're gross (just talking about them can make your head itch), but they're not actually harmful to health.

It's best to approach lice as a war on many fronts: You need to use a variety of techniques to kill not only adult lice, but also their tiny eggs (called nits), which are glued to the hair shaft. The nits can survive treatments that kill the adults and vice versa (These bugs have evolved over a millennium to live in hair, so they're tricky).

It's best to steel yourself for weeks or months of vigilance since lice can reappear due to repeated exposure or a missed nit. What doesn't help is panic.

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Nitpicking and combing

The gold standard for head lice removal, you'll need to do this in conjunction with almost all other treatments. First you comb hair section by section with a special comb (you can buy one at the drugstore) to remove lice and nits.

Years ago Albano-Krosche spent hours extracting nits by hand from her kids' hair. These days, she wields a fined-toothed metal comb. "It's so much quicker and cleaner and neater," she said. After a comb-through, she uses a magnification light to find and pick out any strays.

"No matter what kind of (lice-killing) product you use, the combing it the key," she said. You cannot get rid of lice until you've picked every last egg, she noted.

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Pyrethrins/Pyrethrum

Pyrethrum, the active ingredient in Rid and similar over-the-counter products (A-200 and Pronto, for example) comes from chrysanthemum flowers that harbor natural insecticides called pyrethrins. Pyrethrins attack the nervous systems of live lice but don't always work because some lice have become resistant to the toxin.

Apply product to dry hair, wait 10 minutes, add water to form a lather and rinse. Comb for nits. A second application is recommended 7 to 10 days later to kill any live bugs that remain. Watch for allergic reactions.

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Olive oil

This kitchen staple is thought to be an excellent smothering agent. Lice supposedly suffocate and die when the ooze plugs their breathing holes, but it needs to be applied overnight under a shower cap because lice can survive without breathing for hours. You'll also have to comb to remove nits, but the olive oil should help loosen them from the hair shafts.

Albano-Krosche has had success with an olive oil-and-combing regimen. Joan Sawyer, co-author of the book Head Lice to Dead Lice, promotes a "5-Step Battle Plan" that involves applying olive oil on specific days over the course of a 21-day period. For more details, visit HeadLiceInfo.com.

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Permethrin lotion 1%

Permethrin, the active ingredient in over-the-counter products like Nix, is a synthetic version of pyrethrins. Permethrin works in much the same way as pyrethrins to attack live lice, although there are reports of lice becoming resistant to this medicine. Allergic reactions are possible.

On damp, shampooed (but not conditioned) hair, saturate head with the lotion. Leave for 10 minutes, rinse and comb out nits. Repeat if live lice appear 7 or more days after the initial treatment.

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Hair dryers

In a study, hot-air methods proved highly effective in killing nits, but less so in eradicating live lice. An old-fashioned bonnet dryer killed nearly 89% of nits but just 10% of lice, while a blow dryer using direct heat got rid of nearly 98% of nits and 55% of lice. So use a hair dryer on freshly washed hair to increase your chance of eradicating the little buggers.

But never use hot air after applying a chemical lice treatment. Some may contain flammable ingredients.

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Spinosad

This prescription lotion (brand name Natroba) contains spinosad, a natural insecticide derived from bacteria found in soil. It was approved in January 2011 for patients 4 years of age and older. In two clinical trials, 84.6% and 86.7% of patients were lice-free 14 days after treatment, versus 44.9% and 42.9% with permethrin.

Coat the scalp and work the liquid through dry hair from roots to ends. Leave on for 10 minutes, rinse and comb for nits. The common side effects are eye and skin irritation.

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Hair dunk

You could try drowning lice by immersing hair under water in the bathtub. But chances are it won't work all that well. Various reports suggest lice can survive total submersion for many hours at a time. Not even chlorinated pool water can kill off head lice, says the U.S. Centers for Disease Control and Prevention.

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Ivermectin

Approved in February 2012, ivermectin lotion 0.5% (brand name Sklice) comes from bacteria found in soil. It paralyzes and kills lice and their eggs and can be used with kids over 6 months of age. In clinical trials, roughly three-quarters of patients were lice-free after a single application (without nit combing) two weeks after treatment. Fewer than 1% experienced side effects, such as eye and skin irritation.

Apply the lotion to dry hair and scalp. Rinse after 10 minutes.

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