Head lice treatments guide

Which products are most effective at dealing with this perennial childhood problem?
 
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  • Updated:21 Aug 2007
 

01 .The lice lowdown

Head lice

In brief

  • Herbal treatments are increasingly popular, but unlike insecticidal products, most haven’t been clinically tested or independently assessed for effectiveness or safety.
  • It’s important to use treatments as directed. Misusing products could contribute to lice resistance and adverse reactions.
  • The comb and conditioner technique is an effective way to detect and remove head lice and nits (the eggs), but it’s time-consuming. 

Please note: this information was current as of August 2007 but is still a useful guide today.


The treatments

 There are two types of treatment used to kill head lice and some eggs, based on their active ingredients:

  • Insecticides: Organophosphates (such as maldison or malathion), pyrethrins and synthetic pyrethroids (such as permethrin and bioallethrin). See Insecticide treatments for details.
  • Herbal: Various combinations of essential oils (commonly tea tree, melaleuca; eucalyptus; and lavender oils) and herbal extracts, with or without natural (as opposed to synthetic) pyrethrins, such as pyrethrum. See Herbal treatments for details.

Are lice resistant to treatment?

Tenacious parasites are becoming increasingly resistant to conventional insecticide treatments.

Resistance to the major insecticides used in Australia — malathion and permethrin — has developed in many other parts of the world. Research is not conclusive here, but resistance to malathion has already been reported in parts of Tasmania and Queensland and it’s likely that resistance to commonly used ingredients will become more widespread.

This increase in resistance, combined with apprehension about using insecticides on children, might explain why parents are increasingly choosing to ‘go natural’ and why CHOICE found twice as many herbal treatments as when we last reviewed head lice treatments in 2001.

Product effectiveness

Generally speaking, treatments in lotion form seem to be more effective than corresponding shampoos. Effectiveness can also vary as a result of:

  • differences in formulation (concentration of active ingredient)
  • how they’re applied (to dry versus wet hair)
  • how long they’re left on.

See How to treat lice for a guide to effective treatment.

Lice lowdown: 10 interesting facts

  • Head lice are small bloodsucking insects, about 2 to 3mm long. Their colour varies from whitish-brown to reddish-brown.
  • Lice are wingless and can’t jump, but they can crawl and swing through the hair very quickly.
  • People get lice from direct hair-to-hair contact with another person who has them.
  • Having clean hair doesn’t protect you against lice –– they feed on blood from your scalp, not dirt, so it makes no difference if your hair’s dirty or clean.
  • Lice live in the hair and move to the scalp to feed. They can live for up to 35 days.
  • After mating, a female louse lays between three and eight eggs per day.
  • Lice eggs (nits) are oval and about the size of a pinhead. Eggs are laid close to the scalp and are ‘cemented’ to the hair shaft.
  • Eggs hatch about seven days after they’re laid. Young lice are called nymphs until they develop into adults 10 days later.
  • Eggs and adult lice can only survive one to two days without the right temperature, humidity and food (your blood).
  • Any egg found more than 10 to 15 mm from the scalp has either hatched or is dead.
 
 

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Products reviewed

Categorised by active ingredient

Bioallethrin/piperonyl butoxide

  • Paralice Aerosol Spray

Malathion Bottles of headlice treatments

  • HL7 Shampoo
  • KP24 Medicated Foam
  • KP24 Medicated Lotion


Permethrin

  • Lice Breaker Pyrifoam Treatment with Conditioner
  • Orange Medic Plus Head Lice Treatment
  • Quellada Head Lice Treatment

Pyrethrin/piperonyl butoxide

  • Banlice Mousse
  • Pyrenel Foam

Piperonal/triclosan (antibacterials)

  • KP24 Lice Spray

Price paid

From $7.40 for Pyrenel Foam (100mL) to $12.95 for Paralice Aerosol Spray (100mL).

Do they work?

All these products are registered with the Therapeutic Goods Administration (TGA), which means they were evaluated before they went on the market to ensure they were both effective and safe. Look for the AUST-R number on the label.

CHOICE's advice

If your child is heavily infested with head lice, you might want to try an insecticide-based product before going herbal.  

Reasons why a treatment might not work

There are several reasons why a head lice product might fail to work. These include:

  • not using enough of it to adequately cover the scalp and hair
  • not repeating the treatment after 7 to 10 days (to kill eggs, which often survive the first application)
  • getting reinfested due to head-to-head contact with another person with lice
  • resistance to the active ingredient of a product.

When it comes to resistance, results can vary by region. Even if there are reports of resistance to certain insecticide ingredients, it may still work in your local area.

Misuse can contribute to lice resistance and adverse reactions, so it’s important you use treatments as directed (see Treatment tips).

Products reviewed

  • Ecokid Daily Leave-in Tonic
  • Ecokid Prevent Shampoo
  • Ecokid Prevent Sensitive Shampoo
  • Ecokid Lice Bomb
  • Ego Moov Head Lice Foaming Gel
  • Ego Moov Head Lice Solution
  • Electric Blue Natural Headlice Cream natural headlice treatments
  • KP24 Natural Head Lice Mousse
  • KP24 Natural Head Lice Cream
  • KP24 Natural Head Lice Lotion
  • Lice Attack Lotion
  • Lice Blaster
  • Licetec Head Lice Preventative Spray
  • Nads NitWits Head Lice Foam
  • Neutra Lice Spray
  • Neutra Lice Lotion
  • No Nitz Natural Nit Gel
  • PPS Fried Lice Gel
  • Praneem Repel Shampoo
  • Praneem Natural Head Lice Treatment
  • Sunspirit Lice Scents To Kill
  • Thursday Plantation Tea Tree Head Lice Gel
  • Wild Child Quit Nits Head Lice Defence Spray
  • Wild Child Quit Nits Advance Medicated Cream
  • Wild Child Quit Nits Head Lice Eliminator

Price

From $9.95 for Neutra LICE Lotion (200mL) to $23.95 for Ecokid Lice Bomb (50mL).

Do they work?

Many herbal ingredients have been evaluated for treating head lice in lab tests or small clinical trials. Results for some products are promising (see The evidence below).

However, most of the herbal head lice products we looked at haven’t been clinically tested on children’s heads. (Ego Moov Head Lice Solution, a registered herbal head lice treatment, is the exception.)

Products that haven't been clinically tested are usually only listed with the Therapeutic Goods Administration (TGA), indicated by an AUST-L number on the label. This means they don’t get the same pre-market grilling as registered products (noted as AUST-R).

AUST-R marked products contain approved ingredients, which have been previously assessed for safety and quality, but their effectiveness hasn’t been evaluated.

There’s also the potential for composition of herbal products to vary depending on location, plant source, season and over time, which can impact on effectiveness.

CHOICE's advice

If you’re having no success with insecticide treatments, some herbal treatments could be worth a try.

The evidence

The TGA’s Medicines Evaluation Committee reviewed the evidence for effectiveness of herbal head lice treatments sold in Australia and found just two studies — both unpublished — comparing the effectiveness of herbal products with that of insecticide treatments:

The first compared Lice Blaster (a combination of herbal extracts and tea tree oil) with KP24 Medicated Foam, which contains maldison. Fourteen days after treatment, 71.4% of patients were rated as cured in the Lice Blaster group, compared to 47.3% in the KP24 group. This result seems promising, however the researchers couldn’t rule out that the low success rate with the KP24 foam may have been due to resistant lice, or insufficient contact time between the product and hair.

The second study compared a product containing 1% permethrin and 2% tea tree oil with a product containing just 1% permethrin. There was no significant difference in the reported success between the two groups who tried them, which suggests that the tea tree oil didn’t contribute to the effectiveness of the product. However, no firm conclusions could be made as the two formulations differed in other respects as well.

Combing is the backbone of effective head lice removal, so it’s not surprising there’s an array of different combs available. What is surprising is that even the humble lice comb gets a wave of the marketing wand: “superior long pin technology”, “technologically advanced design”, “patented two row technology … greater torque and effectiveness” and “patent microgrooved teeth” are just some of the descriptions you’ll read on the packs.

There’s no published research comparing combs, however. And fancy features aside, they can be roughly categorised as follows:  

Combs with plastic teeth

Plastic headlice combPrice range: $1.95 to $2.95 (for pack of two)

  • Gentle on scalp and hair.
  • When used with conditioner they remove most lice and some eggs.

 

Combs with metal, cylindrical teeth

Headlice comb with metal teethPrice range: $7.95 to $13

  • Gentle on scalp and hair.
  • When used with conditioner they remove: most lice; most eggs.
  • Long lasting.

 

Combs with metal, flat teeth

Price range: $6.95 to $10 All metal headlice comb

  • Can damage the hair shaft.
  • When used with conditioner they remove some lice and few eggs.
  • Long lasting.

Electronic comb

Price: $47.95 (plus ongoing cost of batteries)

  • Use on dry hair.
  • They remove most lice, but no eggs.
  • Can’t be used on babies.
  • Shouldn’t be used by people with epilepsy, heart disease, a pacemaker.  

CHOICE's advice

You’ll probably need to experiment with combs to find the best one for your child’s hair, but bear in mind that while plastic combs are cheap, they can be a false economy. Faced with a head of infested hair, it’s probably worth spending a bit more and buying a comb with metal, cylindrical teeth.

Worried about lice? Decide whether your situation matches A or B below, then follow the steps.
Read our Treatment tips for more information.

The letter AYou know that your child has lice. Either treat using the conditioner and comb method or
if you'd prefer to use a dedicated head lice treatment go straight to Step 2.

The letter BYou check for lice as a weekly routine or
your child’s friends or school is infested. Go to Step 1.


Step 1: Check

Check for/remove head lice and nits using the conditioner and comb method. Live lice or eggs?

  • Yes. Either repeat (the conditioner and comb method can be used to treat light infestations) OR go to Step 2. Check all other members of the family. After use, wash combs and hairbrushes in just-boiled water for at least 30 seconds
  • No. No treatment is required, but it’s still advisable to check for head lice weekly (so repeat step 1 weekly)

Step 2: Treat

Purchase an insecticide treatment or a herbal treatment. Apply according to label instructions. Lice are dead?

  • Yes. Go to Step 3.
  • No. The lice may be resistant to this product so try one with a different active ingredient. Return to Step 2 using alternative treatment

Step 3: Repeat treatment

Whichever product you use, you’ll need to repeat treatment as instructed after 7 to 10 days. Treatment is successful if no live head lice are found for 10 consecutive days. Return to Step 1.

The conditioner and comb method

The conditioner and comb method can be used for detecting and removing eggs and lice, as well as for treating light infestations. Here’s how to do it:

  • Apply any type of thick, white conditioner to dry, brushed (detangled) hair and comb through with a normal comb. The conditioner stuns lice for up to 20 minutes and makes it difficult for them to grip the hair or crawl around
  • Systematically comb sections of the hair from the roots to the ends with a head lice comb (see Combs)
  • Regularly wipe the comb onto a tissue to check for lice and eggs
  • Comb every part of your child’s head several times
  • If you find live lice or nits, you need to treat your child’s hair. You can recognise live eggs because they’ll pop when you squeeze them.
  • Using this method once a week will help you detect lice early, reducing the need to resort to chemical treatments. But it’s very labour intensive and good technique is vital. And if you’re using it as your sole treatment method it needs to be carried out at regular intervals for two to three weeks to get rid of all lice and eggs.

Treatment tips

  • Always use treatments as directed. Pay special attention to instructions for how much to use, how long the treatment should be left on and whether rinsing the hair afterwards is recommended
  • No treatment kills all lice in one hit, so it’s suggested you do two applications 7 to 10 days apart. The purpose of the first treatment is to kill all live lice; the second treatment is to kill young lice hatched in the interim
  • There’s no need to treat the whole family if they don’t have live lice and eggs
  • Avoid head-to-head contact until the lice are under control
  • Tell your close contacts immediately and report it to your kids’ school. Experts say synchronising treatment with your child’s direct contact group gives the best chance of stopping reinfection
  • The risk of transmitting lice by sharing hats, hairbrushes or bed linen with someone who’s infested is extremely low, so there’s no need to blitz the house the moment you spot a live louse. To be safe, use a hot wash (at least 60°C) for the pillowcase, or dry it on the hot or warm setting in your clothes dryer — heat kills lice and their eggs
  • There’s no product available that prevents head lice. Using the conditioner and comb method once a week will help you detect any head lice early and minimise the problem
  • Tying back long hair can help prevent the spread of head lice
  • If your child has head lice, most Australian states require them to have started treatment before they’re allowed back to school.

How to reduce risks

Whether it’s registered or listed with the Therapeutic Goods Administration (TGA), no insecticide or herbal product is completely safe. The following tips will help reduce any risk:

  • Herbal treatments as well as insecticides can be toxic if swallowed, so treat them as you would any medical or chemical product and keep them out of reach of children.
  • All products can cause skin irritation, especially if the skin is sensitive or broken. They can also cause eye irritation, so use a visor or cover the eyes with a cloth or towel. Use them in a well-ventilated area and apply with gloves.
  • Any product containing alcohol/ethanol or that’s packaged as an aerosol is highly flammable so don’t use it near a naked flame.

Report adverse reactions

If you have an adverse reaction to any type of TGA-registered or listed product, report it to your pharmacist or GP or call the Adverse Medicines Events Line on 1300 134 237 — the information will be sent to the Adverse Drugs Reaction Committee in the TGA.

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