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2 to 4 mm in length (a sesame seed)


Pale tan or gray in color


Lifespan: 3-4 weeks


Females lay 10 eggs (nits) per day

- Attach to the hair shaft via a glue like substance

- Empty casings are easiest to see -white

- Eggs incubate thanks to our body heat

- Hatch in 7-12 days


Nymphs leave their casings and grow for 9-12 days only to mate again!


Itching is due to small amounts of saliva injected into the scalp when the lice

  feed every few hours


Lice will not survive for more than a day away from a room temperature scalp


Eggs won’t hatch at a temperature lower than that near the scalp


Do not transmit any known diseases


Transmission is by direct contact –they do not hop or fly!


Spread through contact with personal belongings is less common

Diagnosing Head Lice

Finding a live louse!


Finding nits -especially at the nape of the neck or behind the ears and

  close (<1 cm) to the scalp


Live lice move quickly and can be hard to capture or even see. A magnifying

  glass can help.


Look also for nits —If you have trouble removing the suspicious speck, it’s

  probably a nit.


If it brushes right off, it’s far more likely to be dandruff or something else.

Treating Head Lice



Permethrin 1% (Nix)

Currently recommended first treatment of choice

Very low risk of toxicity

Applied as a cream rinse

Shampoo hair with a non-conditioning shampoo and towel dry

Apply Nix to hair and leave on for 10 minutes then rinse off

Residue on hair kills 20-30% of the emerging nymphs not killed during the application

Repeat in 7 to 9 days and again on day 13-15

Resistance has been reported


Pyrethrins (RID, Pronto)

Derived from the chrysanthemum plant

Rare allergic reaction in those allergic to ragweed

Shampoo hair with a non-conditioning shampoo and towel dry

Apply RID to hair and leave on for 10 minutes before rinsing in cold water

Repeat in 7 to 9 days and again on day 13-15

Does not kill unhatched nymphs

Resistance has been reported


Malathion 0.5%

Organophosphate (Cholinesterase inhibitor)

Available only by prescription for kids over 2 yrs old

Apply lotion to hair and allow to air dry

Wash off after 8 to 12 hours

Avoid using a hair dryer due to high alcohol content

High ovicidal activity…but repeat treatment in 7 to 10 days may be needed

Use in resistant cases


Permethrin 5% (Elimite)

Prescription cream

Usually used for scabies

Used for resistant lice

Apply and leave on for several hours before rinsing


Conditioning Agents


Lice MD

Slick hair conditioner to make nit removal easier


Occlusive Agents


Ulesfia (Benzyl Alcohol)

Prescription lotion for ages 6 months and up

Apply and leave on for 10 minutes and repeat in 1 week

Effective in 75% of cases –Not very effective on nits.


Spinosad (Natroba, ParaPRO)

Prescription suspension for 4 years old and up

86% of children were lice free 2 weeks after treatment

Does NOT require nit combing

Apply and leave on for 10 minutes. Can repeat in one week


Other Products (Not formally proven)

Petroleum jelly


olive oil

Clean 1-2-3

eucalyptus-clove oil

Cetaphil helmet (Nuvo lotion)

Apply large amounts to dry hair followed by low heat from a hair dryer.

Leave on overnight, then wash off in the morning

Apply once a week for three weeks.


Manual Removal

Difficult and Tedious but quite effective

Use nit comb close to the scalp and repeat daily


Itch Relief

Topical Steroids and Oral Antihistamines

Other Tips For Lice

Any item which has come in contact with the person’s head over the

  previous 24 to 48 hours should be cleaned.


Wash bed linens in hot water (130°) and dry at high heat for 20 minutes to

  kill any runaway lice.


Put all cloth materials (stuffed animals) that have come in contact with the

  infected person’s head in the dryer.


All household members should be checked.


Furniture, carpeting, and car seats can be vacuumed.


Items that can’t be washed can be bagged in plastic and put aside for 2



School nurses can assist in rechecking heads and in aiding families having

  difficulty with treatment.


The AAP recommends return to school as soon as possible.


The presence of nits should not prevent a treated child from returning to school.

704 PALISADE AVE, TEANECK, NJ 07666 201-836-4301
570 PIERMONT RD, CLOSTER, NJ 07624 201-768-8811

Metropolitan Pediatric Group, Pediatricians, Teaneck & Closter, NJ, Bergen Co 

704 Palisade Avenue, Teaneck, NJ 07666 201-836-4301

570 Piermont Road, Closter, NJ 07624 201-768-8811