We used to be subjected to random “lice checks” when I was in elementary school in the 1980s. The business-like school nurse, Mrs. Crow, would line all of the students up in the back of the classroom and run a comb through our hair one-by-one in search of those tiny little blood-suckers. It was a nerve-wracking experience. I was always terrified that Mrs. Crow would find lice in my hair and then out me in front of all my classmates, leaving me ostracized and ultimately needing years of therapy to overcome a fear of combs and nurses.
Luckily, Mrs. Crow never spotted any lice in my hair, nor do I recall her finding it in anyone else’s. Maybe Mrs. Crow was more subtle and sensitive in her lice diagnoses than I previously thought, or perhaps everyone’s parents had read an article such as this and eliminated the lice before it created a school-wide epidemic. To save your child (or yourself) the embarrassment of being caught by the nurse’s dreaded lice comb, read this simple step-by-step guide on how to remove lice from your hair and home.
Head lice are tiny parasites that colonize on the hair and scalp and feed off of human blood. Symptoms of head lice include itching on the scalp, a tickling feeling on the head and small red bumps on the scalp, neck and around the ears. Head lice do not carry diseases and are not dangerous, but they are easily transferable by head-to-head contact. Infestations are most common among young children.
If you’re a parent of a young child, you might want to kept a bottle of lice shampoo in the cupboard just in case—an estimated 6 to 12 million children in the United States between the ages of 3 and 11 get head lice each year.
Step 1: Check everyone in the household for lice. If someone in your household has lice, it is important to check everyone else to be certain it hasn’t spread. If more than one person has it, everyone should be treated at the same time to prevent recurrences and further contamination. To check for lice, make sure the person you are examining is seated in a well-lit spot. Take a metal, fine-toothed “nit comb” (a fine-toothed plastic comb can also work, but a nit comb is ideal) and run it through his or her hair from the nape of the neck on up (lice often live toward the bottom of the scalp where it is warmer). Adult lice will look like tiny white specks, while the eggs (“nits”) are usually a brownish color. Then part the individual’s hair down the middle and look for lice on the hair shaft. Continue by parting the hair in sections and closely examining the roots and warm areas such as the nape of the neck and around the ears. (photo: lice_step1)
Step 2: Purchase an over-the-counter lice shampoo or treatment containing permethrin or pyrethrin. Permethrin and pyrethrin are both effective insecticides that kill lice by paralyzing them and making them unable to breathe. Permethrin is a synthetic ingredient that kills both adult lice and nits. It is available as a 1% cream rinse (such as Nix) or in a lotion or spray (look for the Licefreee! brand). Pyrethin, which is derived from the chrysanthemum flower, is combined with piperonyl butoxide to kill adult lice, though it is not always effective on eggs. Products that contain pyrethrin include Rid, Pronto and R&C. Neither permethrin nor pyrethrin should be used on children under the age of 2; consult your doctor before attempting to treat head lice in a child younger than 2.
Step 3: Wash hair with lice treatment, closely following instructions. In order for your lice treatment or shampoo to work, it is extremely important that you understand and follow the product’s instructions. You should first give the bottle a vigorous shake so that the medication is evenly mixed. Apply the shampoo or cream rinse to dry hair and scalp. Start at the nape of the neck and behind the ears and then cover the rest of the head, being careful to avoid getting the product in the eyes or on the face. Leave the product in for as long as the instructions say—most shampoos are supposed to be left in for 10 minutes—and then thoroughly rinse it out with warm water. Do not leave the product in too long, as it can damage your hair and scalp.
Step 4: Monitor the hair for eight to 12 hours after treatment to be sure it is working. Most of the lice should be dead within 12 hours, but lice are sometimes resistant to treatment. If the lice aren’t completely dead but appear to be moving slower than before, the treatment is probably working. However, if the lice are still active and no dead lice are found after 12 hours, chances are the treatment was not successful. If that is the case, contact your doctor to see about obtaining a prescription lice treatment.
Step 5: Use a nit comb to remove dead lice and eggs. It is difficult to remove the dead lice from your own hair, so it is best to have someone assist you. (That’s what friends are for, right?) To remove lice and nits, divide the freshly washed, still-wet hair into small sections and slowly run a sturdy metal nit comb through it, starting at the scalp and lifting the hair up as you comb. If the hair is long, you may want to pin it into sections with bobby pins to make combing easier. The comb should pull the dead lice off, but be sure to comb each section of hair several times to remove all of it. After each comb-through, wipe the comb off with a tissue and flush the tissue (and dead lice and nits) down the toilet. Make sure the comb is completely clean before using it again.
Step 6: Use the nit comb every two days; repeat lice treatment after 7-10 days. Run the nit comb through wet hair every two days for at least two weeks, or longer if lice are still present, to continue to remove the dead lice and nits and prevent reinfestation. Most lice shampoos or treatments should be repeated after seven to 10 days (read the product’s instructions to find out how long to wait between treatments) to kill any newly hatched eggs or lingering nits.
Lice are hungry little buggers and they do not live long if they are kept away from a food source. Adult lice die within one or two days after falling off a person and eggs cannot hatch unless they are kept at a consistently warm temperature. Therefore, if someone in your household is quickly diagnosed and treated for lice it is generally not necessary to disinfect your entire home. However, you should wash any clothing, stuffed animals, bedding or furniture recently used by someone with head lice. Follow these steps to avoid contamination and re-infestation:
(Top-left to bottom-right: Male human head louse, Female human head louse, Dead egg (nit) on hair, Typical size of louse.)
Mayonnaise and vinegar. Apply one to two handfuls of mayonnaise evenly on the scalp, including around the ears and neck. Place a plastic shower cap over the head and wait two hours. Wash hair using regular shampoo. Rinse first with vinegar and then rinse with hot water. While hair is still wet, comb the dead lice and nits out with a nit comb. Once the hair is dry, check again for lice and nits. If any are present, repeat the vinegar and hot water rinse and combing process.
Petroleum jelly. Apply 4 tablespoons of petroleum jelly (such as Vaseline) evenly on the scalp and rub it into the roots of the hair. Place a plastic shower cap over the head and wait eight hours. After removing the shower cap, wet the hair with warm water. Wash the hair with 1 teaspoon of grease-fighting dish detergent to remove the sticky petroleum jelly. After the detergent has been rinsed out, wash the hair with shampoo as usual (you may have to shampoo more than once to remove all of the petroleum jelly). While hair is still wet, use a nit comb to remove the dead lice and nits.
Garlic and lemon juice. Mix 2 tablespoons of lemon juice with 1 tablespoon of garlic paste or one crushed clove of garlic. Apply evenly on the scalp and massage into the roots of the hair. Secure a tight plastic shower cap or head wrap over the hair and leave on overnight. Wash hair with shampoo as usual in the morning. Carefully run a nit comb through wet hair to remove the dead lice and nits.
Jim Hatch, M.D.
Sanford Health
