There are both over-the-counter medicines and prescription products to treat head and pubic lice. Most products come as a shampoo, creme rinse, or lotion (topical treatment) that is applied to the affected areas, left on for a period of time, and then rinsed off. Doctors sometimes prescribe the pill ivermectin to treat lice when two or more approved topical medicines have not been effective.

Permethrin 1% creme rinse (such as Nix) is also a common first method of treating lice because it is safe and effective and continues to kill lice and their eggs (nits) even after the cream has been rinsed off. This product is available without a prescription.

When treating lice with medicine, keep in mind:

• A second treatment 7 to 10 days after the first treatment is usually recommended to ensure that any newly hatched lice are also killed.
• Itching may persist even after successful treatment. Do not reapply medicated products unless you are advised to do so by a doctor. Excess use of these products may increase the risk of negative side effects such as nausea, headaches, or more serious side effects.

If lice infest the eyelashes, applying petroleum jelly (such as Vaseline) to the eyelashes several times a day for a week can kill the lice.

Generally, drugs are not needed to treat body lice-since the lice live in clothing, not on the body-unless the person is severely infested. The most common way to treat body lice is to wash clothing and bedding in hot water [130F or higher] in an automatic washing machine in order to kill the lice and eggs.

Medication Choices

Nonprescription products for head and pubic lice

• Permethrin creme rinse 1% (Nix) is a common first choice for treating head lice. It kills lice and their eggs for 2 weeks or more after it has been rinsed off.
• Shampoos containing pyrethrins and piperonyl butoxide (Pronto, Rid, A-200) are left on the hair for 10 minutes and then rinsed out. A second treatment is needed 1 week after the first to kill newly hatched lice.

Prescription products for head and pubic lice

• Permethrin cream 5% (Elimite) is a cream that is applied to the skin or scalp, left on for 8 to 14 hours, and then rinsed.
• Malathion lotion (Ovide) is applied to hair and left on for 8 to 12 hours before rinsing off. A second treatment must be done 7 to 9 days later if lice are still present.
• Lindane (Kwell, G-Well) is a lotion or a shampoo that should only be used when other products fail to get rid of lice or when a person cannot use any of the other products. Lindane contains potentially harmful toxins that can cause negative side effects when it is not used properly.⁴
• Carbaryl, which comes in lotion or shampoo form, is used only in Europe. It currently is not available for human use in the United States or Canada.