Head lice

Search for head lice when hair is wet. Use a fine-toothed comb (or a louse comb), clear tape (to stick on hair to pick up nits), a magnifying glass, and a strong light. A comb used to remove fleas from dogs and cats works well to remove head lice

Wet combing should be done every two to three days over a two-week period, with small sections of hair, working out from the scalp. Some call this "bug busting," and it can be very effective. The entire scalp should be inspected, not just the neck region.

If lice are found, treat with an anti-lice agent and repeat in seven to 10 days to kill newly hatched nits.

How to use anti-lice agents

Over-the-counter treatment is available and should be used first. If after two applications, lice are still present, then prescription anti-lice agents may be needed from your doctor. Apply the anti-lice agent to dry hair for the time listed on the product (usually 10 minutes). Shampoo and rinse hair and comb as directed with a fine-toothed comb. Repeat anti-lice treatment in seven to 10 days to kill nits that may have hatched.

Nonprescription anti-lice agents include Nix Lotion (permethrin 1%) and Rid, A200, and Pronto shampoos (pyrethrum products).

Check all household members and treat only if lice or nits are seen. Pyrethrin kills only lice. It does not kill nits and thus requires retreatment seven to 10 days later to kill the newly matured lice. Permethrin kills both nits and newly hatched lice for several days after treatment. However, a repeated treatment is also recommended seven to 10 days later for optimum results. Current recommendations favor Permethrin over Pyrethrin as a first-line treatment.

If a child is younger than 2 years, comb to remove lice and nits but do not use over-the-counter anti-lice agents. A prescription product is available from your doctor.

Hair conditioners may coat or cover the lice, so they should not be used before applying anti-lice agents.

Wash all bed linens and clothing that have been in contact with the infested person in the past two days. Use hot water and the hot cycle in the dryer.

Some recommend that water be at least 140°F to effectively kill the lice and nits. Most hot-water heaters are set at 120°F for child safety. This lower temperature may be effective.

All no washable items such as stuffed animals should be placed in plastic bags for two weeks then opened outdoors. Dry cleaning may be an alternative.

Disinfect combs and brushes in hot water or rubbing alcohol. Soak for more than five minutes in very hot water (greater than 131°F or 55°C).

Vacuum floors and furniture, especially couches and areas used by children. Throw away the vacuum bag immediately.

Herbal therapy and oil treatments (for example, olive oil, butter, petroleum) have been used in an attempt to suffocate lice. A small study done in 2004 did not show any benefit of these measures..

Do not use gasoline, kerosene, or oils. Burns have occurred. A comb using an electric current generated by a AA battery has been developed but any reported success is anecdotal and has not been scientifically proven.

Do not shave the person's head. This drastic measure is not necessary.

If lice are seen in a school-aged child, notify the school nurse or teacher in order to limit the spread.

Treatment failures commonly reflect repeated exposure to those untreated and infected or lack of compliance with therapy. While resistance is growing to topical treatments, resistant infestation will often respond when an alternative product is used. It has been recommended that, should reinfestation occur within one month after successful treatment, an alternative topical insecticide should be used.

Body lice

• Wash the body thoroughly.
• Wash and dry all bed linens and clothes in hot cycles. Destroy what you can because these nits can survive longer without human contact (up to 30 days).
• Anti-lice agents are usually not needed if clothing is thrown away and bed linens are thoroughly washed.
• Check all household members or close contacts. Treat them only if lice or nits are seen.
• Vacuum floors and furniture. Throw the vacuum bag away immediately.
• Chemical insecticide sprays in the home are not effective and not recommended.
• Use over-the-counter antihistamines (such as diphenhydramine, Benadryl) for itching.

Pubic lice

• Treat with anti-lice agents and repeat in seven to 10 days.
• Remove nits with a fine-toothed comb.
• Check all close contacts. Treat them only if lice or nits are found.
• Wash and dry all clothes and bed linens in hot cycles.
• Check eyelashes and eyebrows. If lice or nits are seen, apply petroleum jelly (Vaseline) twice daily for eight days
• Use over-the-counter antihistamines (such as diphenhydramine, Benadryl) for itching.

Prevention

Families are encouraged to look for lice routinely because it can recur.

Safe sexual practices may lower the risk of transmitting pubic lice and other diseases.

Wash clothes, bed linens, combs, and brushes to prevent recurrence

Preventive treatments with anti-lice agents are not recommended and can lead to illness and persistent itching.

Outlook

With appropriate home care or prescription medication, more than 90% of lice infestations can be cured.

• Treatments are more effective in killing lice than nits. This is why combing is so important to remove nits -- as is repeating the anti-lice treatment in seven to 10 days.
• Children can return to their usual activities and school or daycare after the first treatment, even if nits are still in the hair. Re-treat in seven to 10 days as discussed above.