Best Ways to Treat Head Lice — Consumer Reports

Best Ways to Treat Head Lice

Lice are resistant to many of the products used against them, but there’s a better way to win this battle of bugs

If you have young children in school, you’ve probably worried about them picking up lice. An estimated 6 to 12 million people deal with this itchy problem every year, according to the Centers for Disease Control and Prevention (CDC).

A new Consumer Reports nationally representative survey of 2,016 U.S. adults found that among those with children under the age of 18, 21 percent said that someone in their home has had lice within the past five years.

Head lice are sesame-seed-sized, wingless insects that feed on human blood. “As far as we know, [they] do not transmit any human disease,” says L. Paul Guillebeau, Ph.D., professor of entomology at the University of Georgia.

That means their presence on your child’s head doesn’t constitute a medical emergency. Still, lice are distressing, and their bites cause intense itching, which can lead to sores and possible secondary infections.

You may have heard the term “super lice” lately—super lice are just like regular lice except that they’ve acquired genetic mutations that make them resistant to plant-derived insecticides called pyrethrins and their synthetic cousins, pyrethroids. These are the active ingredients in many over-the-counter lice treatment shampoos. Research suggests that super lice are becoming almost ubiquitous, says Michael Hansen, Ph.D., CR’s senior scientist.

That can make treating a head lice infestation tricky. Here, we explain how to protect your family from lice, plus what treatments you should turn to in case a family member picks up lice.

Protect Your Family

Lice can crawl from one head to another in seconds—for instance, when children touch their heads together during play or when they share a comb or a hat.

If a friend, a relative, or your child’s school reports a head lice infestation, inspect your child right away. A single female louse can lay up to six tiny, pearl-colored eggs, or nits, a day. They lay the eggs near the base of a hair shaft, especially behind the ears or on the back of the neck. A child’s first-ever infection might not be detected for a month, because that’s how long it takes to develop a sensitivity to the lice saliva, which is what causes the itching. During that first month, you might mistake a lice infection for dandruff or eczema—but a lice infestation doesn’t go away after shampooing.

If your child has head lice, all household members should be checked and treated, if necessary. You don’t need to go crazy with the housecleaning because head lice won’t survive long if they fall off a person and can’t feed. To prevent reinfestation, concentrate on cleaning the things that your child’s head came into direct contact with in the past few days.

Wash or dry clothing and bed linens at temperatures above 130° F. This will kill stray lice and nits. Seal clothing or other items that are not washable in a plastic bag for two weeks, or put them in the dryer. Soak combs and brushes in very hot water for 5 to 10 minutes.

Remind your children not to share combs, hair ornaments, or hats, and ask them to stuff their jackets into their backpacks at school, rather than hang them on a communal hook.

The Lowdown on Lice Treatment Products

To provide advice on lice treatments, members of CR’s product safety team and our senior scientist, Michael Hansen, Ph.D., reviewed existing evidence about lice treatment options. As we’ve done for several years, we recommend combing out lice from wet hair, without the use of any pesticide products, as a top choice for parents. Here, we offer more advice on how to perform combing, plus important information about a number of other available treatments.

If you do opt for a lice-fighting product, be sure to follow the directions carefully, and pay attention to whether or not a follow-up treatment is recommended. Because many products don’t kill nits (lice eggs), an additional treatment a few days later may be necessary to get rid of any newly hatched lice. Some products may also recommend combining treatment with combing.

And remember that even the most effective methods of tackling a lice infestation aren’t guaranteed—you may need to try more than one strategy.

Wet Combing
Although products abound for getting rid of lice, to eliminate the pests, no special substances or pesticides are needed. Wet combing involves carefully combing with a nit comb to physically pick out nits and lice.

What to know: Our experts say that wet combing is a great approach to treating head lice. It can be time consuming and requires perseverance, but no pesticides or pricey products are involved. Here’s how to do it:

Coat your child’s hair and scalp with conditioner or a safe lubricant such as olive oil. Use a wide-tooth comb to separate hair into sections. Follow with a metal nit or flea comb, available at drug or pet stores, concentrating on the area close to the scalp. After each comb-through, wipe the comb on a paper towel and inspect for lice. Continue combing until no lice are found; a single session can take 15 to 60 minutes, depending on the length and thickness of hair.

Repeat every three to four days for several weeks, and continue regular combings for two weeks after any session where an adult louse is found.

You can also hire people to do the combing for you—a quarter of our survey respondents told us they’d hired a professional nit picker or “lice lady” to do the combing for them when their child had lice.

Shampoo Shields
When we asked U.S. adults what products they used on their children to treat a lice infestation if they experienced one, the greatest proportion—35 percent—told us they used “natural shampoo,” such as the products Lice Shield or Hair Genies. These products claim they can prevent or reduce the risk of getting head lice.

What to know: These products aren’t labeled as treatments for an active lice infestation, though that’s how our survey respondents told us they’ve used them. We couldn’t find any evidence that suggests these products can treat an existing infestation.

And even as preventatives, these products may not be a great bet. In 2014, the Federal Trade Commission charged the manufacturer of one such product, Lice Shield, with false advertising for claiming that its product reduced the likelihood of a lice infestation. (The company, Lornamead, settled the complaint by paying $500,000 and was “prohibited from making further deceptive lice-prevention claims,” according to the FTC. We reached out to Lice Shield to find out what evidence they now have to back up their claims. We haven’t yet heard back from them, but we’ll update this story when we do.)

Using one of these preventative shampoos is likely to be a waste of money, says Jody Gangloff-Kaufmann, Ph.D., coordinator of community integrated pest management (IPM) at the New York State IPM Program. She doesn’t know of any substances that have been shown to repel lice effectively. “Lice are more compelled to eat than they are repelled by any smell,” she says.

Over-the-Counter Pesticides
As noted, over-the-counter products that contain pyrethrins or pyrethroids (like permethrin) are unlikely to offer much relief because many to most lice are now resistant to those chemicals. In one 2016 study published in the Journal of Medical Entomology, researchers collected lice from 138 different sites in 48 states. They found that 98 percent of those lice had genetic mutations that would make them resistant to permethrin and pyrethrin, the active ingredients in Nix and Rid.

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What to know: The scientific evidence on pesticide resistance suggests that these products are unlikely to be effective. Our experts recommend skipping them. “These products can cause side effects, like burning or skin irritation,” notes CR’s Michael Hansen, Ph.D. “Given that they’re highly unlikely to do any good, they’re just not worth the risk.”

In fact, they could prolong a person’s suffering, because it takes a few days to know whether the product is working. If you do try one of these products and it fails, switch to another method. It can be dangerous to do the same pesticide treatments over and over, says Gangloff-Kaufmann.

Household Pesticide Products
You may think that pesticide fogs or “bug bombs” could be used to control a lice infestation in the home. But these chemicals can be toxic if inhaled, and they pose an explosion risk near a heat source.

What to know: The CDC recommends against these, and so do CR’s experts. They are unnecessary. As noted, lice can’t live for very long away from actual human heads, where they draw their blood meals. So most lice around the house will die anyway.

Prescription Treatments
A variety of prescription treatments are available for head lice. The Food and Drug Administration has approved several of these in the past decade. One, topical spinosad (Natroba and generic), contains a chemical derived from bacteria that acts on the lice’s nervous systems (they become overexcited, then paralyzed, then die). Another, topical ivermectin (Sklice), works similarly (ivermectin is a common veterinary medicine, too).

A third non-pesticidal treatment that works by suffocating lice, benzyl alcohol lotion (Ulesfia), was recently discontinued by its manufacturer for business reasons. A post on the FDA’s website notes the discontinuation was not due to any problems with safety or efficacy. We reached out to the company for more information but have yet to hear back.

Two older prescription medications, malathion (Ovide and generic) and lindane (Scabene, Kwell, and generic) are also available.

What to know: According to clinical trials of the drugs, spinosad and ivermectin appear to work relatively well against lice. They act via different mechanisms than the pyrethrins or pyrethroids. But you’ll need to go to the doctor, and these products are expensive—$100 or more for a single bottle.

Also, because young children have thinner skin, they are more susceptible to absorbing these chemicals through the scalp and to the side effects that they might cause, such as skin or eye irritation, burning, and dryness.

Skip products containing lindane and malathion, our experts say. Lindane is neurotoxic and carcinogenic to humans, and it has been linked to reports of seizures and even deaths from improper use. Malathion hasn’t been proved safe on children under 6 years. It’s also highly flammable and in some cases can cause stinging and chemical burns.

Non-Pesticide Over-the-Counter Products
To address the problem of pesticide resistance in super lice, some companies have introduced products that claim to get rid of lice without pesticides.

One such product, Nix Ultra, includes a lotion made with dimethicone, which smothers lice. Another product, which is available in Canada, Resultz, uses the ingredient isopropyl myristate, which dissolves the bugs’ exoskeletons and dehydrates them.

What to know: These products aren’t pesticides, so lice are unlikely to adapt to become resistant to them. The active ingredients are common in a variety of cosmetics, and they’re unlikely to pose major risks, so these are reasonable options for people to try—just remember that even with these products, combing is likely to be involved (in the U.S., dimethicone as a lice treatment is sold as part of a kit that also contains a lice comb).

Home Remedies
You might have heard of home remedies for getting rid of lice, such as the application of mayonnaise, oil, or petroleum jelly. Some of these alternative treatments rely on suffocating or drowning lice.

What to know: The research on these options is slim, but some evidence suggests they may not be very effective. In one 2018 study, researchers subjected lice in a lab to suffocation and submersion in water. The scientists found that 100 percent of tested lice survived 8 hours in a sealed container without oxygen and 6 hours immersed in water. Many were able to survive under those conditions for much longer.

Gangloff-Kaufmann says that these types of treatment are often left on hair overnight, covered with a shower cap or plastic bag to keep the mayo or oil from getting everywhere. But this can pose a choking hazard, she notes.

Focusing your efforts on wet combing is likely to be a better bet.

Hot Air Treatment
At the lice treatment chain Lice Clinics of America, you can receive treatment with a hot air device called the AirAllé. The company guarantees elimination of nits and lice in one treatment.

What to know: We couldn’t find much evidence of the treatment’s effectiveness beyond the studies that the device’s inventors have published. Those studies do show promising results. Still, the treatment can be pricey—it varies by location, but we found clinics that list the price of this “signature” treatment as $175 to $199.

Additional reporting by Catherine Roberts.

What is the Best Shampoo for Lice in 2020?

One of the worst feelings in normal daily life has got to be when one of your kids comes home from school scratching their head.

I know there are lots of far worse things that can happen, but the prospect of dealing with an outbreak of head lice just fills me with dread.

The constant combing, the constant fights about the constant combing, the extra washing, separate towels, the constant reminders not to share hair brushes…it just adds to the list of daily chores.

It’s not just children, either. The trend of taking selfies requires us grown-ups to get more up close and personal, and this gives head lice the ideal opportunity to find a new host.

Lice have been around for a very long time. In fact, archaeologists have reported finding head lice in the remains of human hair which was found to be nine thousand years old. Head lice and pubic lice were also found in the mummy of Ferdinand II, King of Naples from 1467 to 1496.

What we really need to know here is the best way to deal with lice. Read on to discover more about these tiny little creatures and which shampoos are most effective in helping to get rid of them once and for all!

Head Lice Shampoo

In the Lice Shampoo category

  • OUR TEA TREE OIL SHAMPOO FOR HEAD LICE PREVENTION FOR KIDS relies on natural ingredients no harsh chemicals to eradicate.
  • ROSEMARY ESSENTIAL OIL FOR HAIR LOSS treatment for women & men repels lice as it improves your hair and stops shedding. Our.
  • TEA TREE LAVENDER SHAMPOO HEAD LICE REPELLENT SHAMPOO leaves your hair smelling fresh for you as it calms & soothes your.

Our #1 Rated

In the Lice Shampoo category

Lice Shampoo & Conditioner

In the Lice Shampoo category

  • Brand New in box. The product ships with all relevant accessories

Our #2 Rated

In the Lice Shampoo category

Lice & Nit Shampoo

In the Lice Shampoo category

  • 15 Minute Easy No Drip Application.
  • No Need to Buy or Combine Additional Products to Kill Lice and Nits.
  • 100% Pesticide Free Lice & Nit Removal System in ONE Family Size Bottle (6-9 Applications).

Our #3 Rated

In the Lice Shampoo category

Lice Killing Shampoo

In the Lice Shampoo category

  • Proven Effective Treatment: For more than 10 years, RID Lice Killing Shampoo has been a proven, effective treatment for.
  • SHAMPOO: RID Lice Killing shampoo and conditioner treatment is easy to use and proven effective
  • APPLY TO DRY HAIR: For the most effective treatment, read and follow the package directions carefully

Our #4 Rated

In the Lice Shampoo category

Natural Lice Shampoo

In the Lice Shampoo category

  • MAKE THE LOGICAL CHOICE — Mom approved and pediatrician recommended for kids over the age of two, this non-toxic lice.
  • SAFE FOR DAILY USE — Simply massage into the hair and scalp for 15 minutes. Detangle hair with comb or brush to ensure total.
  • LICE TREATMENT: Our non-toxic gentle formula is the safest thing for the kids and the whole family. Please watch our.
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Our #5 Rated

In the Lice Shampoo category

What Are Lice?

Lice are very small insects that live in human hair whenever they get the chance. Adult head lice are approximately the size of a sesame seed.

There are several different species of lice, but the particular species that prefers to live in human hair is exclusive to humans. This video gives a great insight into lice:

The adult lice live on the scalp and feed by tapping into our blood supply. Lice can affect other parts of the body, but they’re larger than head lice. When both head and body lice are present, they don’t breed with each other or move into each other’s territories.

Female adult lice are generally brown in color, but they may have a reddish color when seen shortly after feeding. The eggs they lay can range from transparent or white to a sandy or light brown color.

The female louse lays her eggs, or nits, near the roots of the hair, attaching them to the hair shaft with the lice equivalent of Super Glue—they’re very hard to remove from the hair without a special fine-tooth nit comb.

The good news about head lice is that unlike body lice, they don’t carry any diseases that are harmful to our health. Head lice are also not a result of poor hygiene; they are equally happy living in clean or dirty hair.

How Are Lice Transmitted?

Lice can’t fly or jump; they’re transmitted through direct contact. Just one case of head lice can cause a large scale infestation in families and schools if not treated appropriately.

This is a real issue for many parents because children tend to have lots of head to head contact with each other. Some experts, however, say that it’s an increasing problem in teenagers, too.

Marcy McQuillan, a head lice expert who runs two head lice removal clinics in California, told Time magazine that she has seen a dramatic increase in head lice cases in teenagers in the last few years. McQuillan thinks this is linked to the popular trend of taking selfies.

Taking selfies is not only limited to teenagers, though. I’d struggle to think of anyone of my friends who hasn’t appeared in some kind of selfie in the last couple of years.

So this is perhaps something which we all need to be aware of and understand the possible implications of selfies and other activities that require us to come into close contact with others.

That just leaves the problem of how to deal with asking someone you’re just about to take a selfie with whether or not they’ve got head lice…getting your magnifying glass out is not likely to be taken very well by most people!

Sharing personal items like hairbrushes and combs, hats, baseball caps and headbands and other accessories is another way in which adult lice and eggs can be transferred to a new host.

Making sure everyone in your family has their own hairbrush, and doesn’t share any of these items is a good way to avoid transferring head lice to other people.

What Happens if Lice Aren’t Treated?

Head lice progress through three life stages. The egg, once laid, incubates in the warmth of the scalp and hatches eight or nine days later.

The nymph, or baby louse emerges from the egg casing, which can remain stuck to the hair shaft and move further away from the scalp as the hair grows. The nymph matures for around 12 days before becoming an adult.

The adult stage of a louse’s life, which can be anywhere from 10 to 40 days, is focused on eating and reproducing.

When one female adult louse is fertilized by a male louse (one male can fertilize up to 18 females in a day), the female louse lays up to 10 eggs a day. Head lice continue to mate sporadically throughout their life.

If one female is transferred to a new host and lays 10 eggs on the first day, the chances are that you probably won’t spot the adult female or one of the 10 eggs, so she can go about her business as usual.

By the time the first eggs are hatched and the new nymphs have matured to adults, the original adult will have laid around 200 eggs. Once the first batch of new female adults start laying eggs, there’s going to be more than 50 new louse eggs laid per day, with an extra 50 or more added each time a new batch of eggs from the original female hatches and matures.

Once the ‘grandchildren’ of the original adult start to lay eggs, numbers of live lice and eggs start to rise rapidly, and can end up in severe infestations like this one (warning—don’t watch this if you’re eating…):

To avoid an infestation you need to be on your guard, checking family members regularly, and being alert to the symptoms of head lice.

What Are the Symptoms of Head Lice?

It’s possible to have head lice and experience no symptoms at all, so it’s extremely important to check all family members regularly.

Things like dandruff, specs of dust and dirt, and flakes that form from build-up of products such as hairspray can be mistaken for lice eggs, and can make a correct diagnosis difficult.

People with head lice often experience itching, and this can be one of the first signs, particularly if the itching is concentrated around the nape of the neck and behind the ears.

There can be a sensation of things moving in the hair. The lice are more active when it’s dark, and this can cause difficulty with sleeping, and the affected person can become tired and irritable.

Some people can have an allergic reaction to the head lice bites. This can cause extreme itchiness, and sores on the scalp to develop. One of the few complications of having head lice is that the sores can become infected.

As the symptoms of having head lice can be subtle until the numbers of lice start to grow, it’s extremely important to educate your family members on what to look for. It’s also essential to know how to check for head lice properly.

How to Check for Head Lice

To diagnose head lice, there are steps you need to follow to increase your chances of seeing and identifying live adult lice and eggs. We’ve put together a guide of how to check for lice correctly.


Find a comfortable place for the affected person to sit. You need to be able to move around the person freely to check specific areas.


Make sure you have lots of natural light so you clearly see the hair roots and scalp.

Be Quick

The adult lice move quickly, and will try to hide in the hair roots when they’re exposed. This means you need to be fast and focused when checking for lice. A magnifying glass may help.

Observe the Scalp

Part the hair and have a good look at the scalp. Observe the hair roots, looking for the eggs. If you see something you suspect to be an egg, try to remove it with your fingers. If it’s very difficult to remove, it’s highly likely that it’s a lice egg.

Keep parting the hair in different direction, concentrating first on the areas behind the ears and around the back of the head and gradually working your way across the whole scalp.

Each time you part the hair, look at the area from different angles to help identify eggs and increasing the chances of seeing the live adults.

Head Lice Shampoos and Nit Combs

These products are designed to use either chemicals or natural substances to kill the adult and nymph lice.

Because the egg casing provides a protective layer for the baby louse inside many head lice shampoos, including the ones that use pyrethrins as the active ingredient, don’t kill the eggs.

For this reason head lice shampoos are intended for use in conjunction with a head lice comb. This is a special comb with very fine teeth which pull the eggs, and the adult lice, out of the hair.

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The comb can be difficult to pull through the hair, especially with long hair. Nit combs can be used on wet hair, and it can help to comb the hair through with conditioner still in it, particularly for those with long hair.

It’s best to detangle the hair with a wide toothed comb first, then separate the hair into small sections. The nit comb needs to go through each strand of hair from root to the end; otherwise adult lice can avoid the comb and eggs may be left on the hair strands.

Treatment of head lice with a shampoo that doesn’t kill the eggs relies on eradicating the adult lice with the first treatment, then combing out the majority of the eggs.

It’s possible, though, that some eggs can remain in the hair, and we know that if only a couple of them hatch, the whole problem is likely to start all over again.

To prevent this from happening, many head lice shampoos require a second treatment around 10 days after the first application. This allows enough time for any of the eggs left behind in the hair to hatch, but the nymphs which emerge from the eggs are not mature enough to lay new eggs.

This means that the second application should kill all of the remaining live adult lice, and there shouldn’t be any more eggs left unhatched.

Natural Head Lice Shampoos

Many people like the idea of using health care products with natural ingredients. Some prefer to do so to protect the environment, others choose natural products to minimize the amount of harsh chemicals on their skin and hair.

This is completely understandable; many of the chemical based head lice treatments are based on chemicals such as pyrethrins, permethrin and DEET.

While unlikely to cause problems in very low doses, permethrin is actually a neurotoxin, and pyrethrin can cause skin irritation, headaches, nausea, tingling of the extremities and other nervous system problems.

There’s a concern for some people, however, that products based on natural ingredients may not be as effective as products that contain chemicals.

Well, it really depends on the ingredients in each individual product. What we do know, however, is that head lice are becoming increasingly resistant to some of the chemicals that have been used to treat them.

On the other hand, some natural ingredients have been proven to be very effective in killing head lice, and some of the natural remedies have been around for a very long time. The ancient Greeks, for example, noted the effectiveness of cedarwood oil in dealing with head lice.

One research trial found tea tree oil to be 100 percent effective at killing head lice when a 1 percent solution of tea tree oil was applied to the lice for 30 minutes.

The research also found that a 2 percent solution of tea tree oil also caused 50 percent of lice eggs not to hatch.

Further research has also indicated that several essential oils, including tea tree, eucalyptus, marjoram, pennyroyal and rosemary were more effective than two of the most common chemicals used to treat head lice.

Other oils, including sage, cade, clove bud, lavender, myrtle and rosewood were all just as effective as the chemical treatments.

One thing to note for the sake of safety, though, is that you shouldn’t just go out and buy these oils and apply them to hair as a DIY treatment. Many essential oils, including those mentioned here, are very powerful and can have detrimental side effects, especially if too much is used.

So natural treatments can be very effective in getting rid of head lice problem, but the best plan is to use a preparation that has been developed by experts—whether that’s a local aromatherapy practitioner or a store-bought product that contains essential oils.

Make Sure You Banish All the Lice

According to the Centers for Disease Control and Prevention (CDC), adult lice can survive for one to two days without food if they fall off the scalp.

Lice eggs are unable to hatch unless they’re maintained in optimum conditions—they need the warmth of the scalp to incubate and develop before they’re able to hatch.

The CDC doesn’t advise going as far as fumigating your home. It says that the routine cleaning of items in your home like rugs, carpets and other fabrics such as car seats is important, though, as live adults can survive in fabrics, and re-attach to the original host or find a new home in a second head!

Equally, laundering bed linen and any other fabrics the affected person has used within the last two days, such as towels, and clothes is very important to make sure none of the miniature monsters are lying in wait for you or any other members of your family.

Research indicates that washing bed linen on a regular hot wash and drying in a hot clothes dryer will kill any live lice. The hot wash must be over 60 degrees, and clothes and other fabrics, such as bed linen need to be in a hot clothes dryer for more than 15 minutes to be effective.

Precautions for Use

It’s important to follow the correct procedure when using treatment for head lice. Here are our top tips for making sure you get rid of the little critters safely.

Firstly, do not use any treatment for head lice unless you’re sure they’re present. Most treatments contain harsh chemicals which you don’t want to expose your hair and scalp to unless it’s absolutely necessary.

To check whether or not head lice are present, follow our guide to checking for head lice effectively. If you can’t identify any adult lice or eggs, don’t proceed with any head lice treatment, seek advice from your medical practitioner instead.

It’s essential to follow the manufacturer’s instruction to the letter, even if you’ve used the same product in the past, and think you know how to use it correctly. The manufacturer might have had to change the ingredients of their product for some reason and this could potentially mean they also changed the usage instructions. Reading or rereading the complete instructions is the best way to make sure you maximize your chances of success.

Don’t leave head lice treatments in contact with the hair and scalp for longer than the period of time specified by the manufacturer. This can cause skin irritation.

With all head lice treatments, including the natural ones, make sure eyes are protected from the shampoo. A face cloth or small towel will do the job nicely during application.

Have the person being treated close their eyes while rinsing the product out of the hair, and if any of the shampoo does get into the eyes, rinse thoroughly with clean running water.

All of the head lice treatment shampoos—again, including the natural ones—contain potent substances that are aimed at killing a living organism. If anyone happens to ingest any of the shampoo, it’s best to contact a poison control center, or your medical practitioner, for help and advice.

These kinds of products can cause skin irritation. If the person being treated experiences any redness, inflammation, an increase in the amount of itching, or any open sores, contact your medical practitioner immediately.

Head lice can also affect eyebrows and eyelashes. If these areas are affected, do not attempt to treat them yourself; seek medical advice.

Once you’ve eliminated all of the head lice, keep doing regular checks on all family members. This is important, as head lice can re-infest anyone at any time.

There are head lice repellent products, such as shampoos and leave-in sprays, which many people report are effective in preventing re-infestations.

What Is the Best Shampoo for Lice?

Hunting high and low through many different head lice shampoos, we’ve chosen five of the best products for closer inspection. We chose a range of different products, some which use traditional chemicals and others natural shampoos which contain no harsh chemicals.

There should be something here for everyone. Have a look through the good and bad points for each product to choose the shampoo that’s best suited to your needs.

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