Manual removal involves the use of a fine-toothed comb to pick out all adult lice, nymphs (baby lice), and nits (eggs) from the hair and scalp. Chemical removal can require the use of a shampoo, mousse, spray, or treatment gel containing ingredients that either repel, stun, or kill the live lice. The manual removal of nits must follow chemical treatments.
When looking for head lice treatments, consider the ingredients of chemical treatments. Look for piperonyl butoxide and pyrethrum extract. We researched dozens of head lice treatments and evaluated them for ingredients, methods, price, and effectiveness.
Here are the best lice treatments on the market.
We chose RID’s Lice Killing Shampoo as our top pick because it’s powered by a combination of piperonyl butoxide and pyrethrum extract to remove louse, nymphs, and nits. You can apply it safely to dry hair, let it work, and rinse it away easily without leaving any chemical residue behind. Remember to thoroughly comb through the clean hair afterward with a lice comb to remove any remaining nits. It’s also advised that you repeat the treatment a second time within seven to 10 days for optimal effectiveness. This shampoo is safe for use on adults and kids over the age of 2.
Price at time of publication: $43
Instead, invest in a high-quality Nit Free Terminator Comb. Called a “must-have” by experts and users alike, this professional comb is able to get underneath and remove even the smallest of lice eggs thanks to its spiral micro-grooved teeth. The microscopically rounded tooth ends also protect the scalp from unwanted pricking, scratching, and pulling. And because it’s made with durable and corrosion-resistant stainless steel, it can be effectively sterilized between uses.
Price at time of publication: $12
This special formulation also enables you to use it daily during an infestation without the worry of skin irritation. Simply spray it all over your hair until it is fully saturated, let it dry completely, and then use a comb to remove dead louse and eggs. Users report that it works well on both super lice and nits, and they love how it begins working on contact. The spray application also makes it easier to use as a self-treatment.
Price at time of publication: $15
Apply pumps of the mousse to damp hair, working it throughout layers in a massaging motion to loosen the nits. After letting it sit for 20 to 25 minutes, comb each section throughout to remove the mousse, louse, and nits. The manufacturer labels this product as safe for kids and does not list any age restrictions on the label.
Price at time of publication: $19
Price at time of publication: $19
Coat the scalp and dry hair with olive oil until it’s fully saturated. Since it can be a bit messy, it’s best to use some sort of head wrap or shower cap to secure the hair and oil in place. Louse can live for hours without breathing, so leave the olive oil on the hair overnight for best results. Then comb through the hair section by section, removing all louse and nits along with the oil (the olive oil helps loosen nits from the hair). Once all signs of lice are gone, wash your hair as you normally would.
Price at time of publication: $5
Price at time of publication: $13
“Lice can infect both children and adults at all socioeconomic levels; however, children are more often infected compared to adults. This may be because of the mode of transmission (direct contact or possibly sharing hats). There is no difference in the mechanism of treatment for adults and children, but adults may need more product due to larger head sizes. We also have more safety concerns with younger children who may absorb more product relative to their size.
“Unless there is widespread resistance in the community, over-the-counter preparations made with permethrin are the first-line treatment. In some communities, lice are becoming resistant to that treatment. If a prescription is needed, I prefer benzyl alcohol or spinosad. Malathion is also a commonly prescribed medication, but it smells bad and may be flammable. It is also important to follow the directions for the specific product because they are applied for differing amounts of time, and some are applied on wet hair while others are applied on dry hair.
“When rinsing the hair, we recommend using cool water to limit the risk of absorption. When blood vessels get warm, they get bigger and increase absorption through the skin. Rinsing over a sink rather than a shower or bath also lessens contact with other skin. Many products are irritating to the eyes, so care should be used not to rinse it into the eyes.” — Adam Keating, MD, a pediatrician at Cleveland Clinic Children’s.
Manual vs. Chemical
“For the most part, lice treatment is the same for all age groups. It is important to read the contraindications for any product to check for age restrictions or other vulnerable populations (like pregnant women) and for allergies. Most over-the-counter and prescription lice treatments are safe if the directions are followed appropriately. However, many people do not follow directions. For example, when the product label says to leave it in the hair for one hour, some people rinse it out after 10 minutes.
“As with many things, there are many options for lice treatment, and some are better than others. However, it’s just as important to have good lice comb as it is to use a good lice treatment product. Most combs that are supplied with a treatment kit are not effective. We use and recommend the Nit Free Terminator Comb. It is a “must-have” for successful treatment. For any person that is concerned about any ingredient in a product, it is possible to have a successful treatment using an inert product, such as a conditioner, olive oil, or coconut oil combined with the Nit Free Terminator Comb. Combing (manual or mechanical removal) is also a treatment method on its own.” — Anna Warren, the owner of The Asheville Lice Treatment Center in North Carolina
Ingredients
“Key features of lice treatment include topical neurotoxic agents, oral agents, combination therapy, and mechanical removal therapy. Washing all bedding, sheets, and towels in hot water for at least 30 minutes is also important in the treatment and prevention of reinfestation. Items that cannot be washed can be placed in a Ziploc bag for more than one week as lice cannot survive without blood from a human for longer than 48 hrs. Wash all surfaces. Any other siblings and adults should be treated also if live lice are visualized in the scalp. Also important to note, the removal of nits must be done on a daily basis manually after topical treatments. It is very important to make sure patients are aware of side effects and age recommendations of certain treatment methods. Always be sure to check with your healthcare provider and/or pediatrician for the best advice for your child. All treatment options work similarly but can have more side effects in younger-age children.
“I usually recommend Nix or RID over-the-counter treatments, up to two applications one week apart, as the first line of defense. It is very important to comb wet hair with a fine-toothed comb, removing all nits. If one nit survives, reinfestation can occur. Treatment of all family members in the home, and washing all sheets, towels, and bedding at the same time of treatment is important. If the first treatment fails, I recommend Sklice or Ovide therapy (prescription options). It is important to discuss with your primary medical provider all concerns relating to the safety and efficacy of different treatments of lice.” — Sara Siddiqui, MD, a pediatrician at NYU Langone Health
Why Trust Verywell Health
As a seasoned health writer, Alena Hall understands how important it is to know exactly what you’re getting in a wellness product. Over the years, she has reviewed dozens of products, from athletic recovery aids to homeopathic essential oils to ever-trendy CBD topicals, to help readers like you discover products that can help you live your best life.
In addition to OTC products, the following lice treatments are available only by prescription:
Benzyl alcohol 5%Ivermectin 0. 5% lotionMalathion 0. 5%Spinosad 0. 9% suspension
