Head lice are tiny insects that live on the scalp and feed on blood. They cause itching but do not carry or spread disease and rarely lead to serious medical problems. Head lice do not clear up on their own, so an infestation has to be actively treated — either by repeated wet combing or with a medicated (pediculicide) lotion or shampoo, plus checking and treating close household contacts on the same day. Most cases can be handled at home without seeing a doctor.
Available without a prescription — follow each label.
Permethrin 1% lotion/creme rinse Nix Topical pyrethroid pediculicide | A common first-line over-the-counter option in the US. Apply to clean, towel-dried hair and scalp per the Drug Facts label, leave on, then rinse and comb out lice and nits. It kills live lice but not all eggs, so a second application is usually needed (around day 9). Per CDC it is approved for children 2 months and older. Some lice populations have developed resistance, so see a pharmacist or doctor if it does not work. (Note: the UK's NHS does not recommend permethrin; it is used as an OTC treatment in the US.) |
Pyrethrins + piperonyl butoxide Rid, A-200, Pronto, R&C, Triple X Botanical pyrethrin pediculicide | Another genuine OTC option, derived from chrysanthemum extract. Kills live lice but not eggs, so a second treatment is required about 9-10 days later. Per CDC it is approved for children 2 years and older. Do NOT use if you are allergic to chrysanthemums or ragweed. Follow the Drug Facts label exactly and do not over-apply. |
Dimeticone 4% lotion/spray Hedrin (UK; sold OTC in pharmacies) Physical/silicone-based pediculicide | A non-insecticide option that coats and physically disrupts lice rather than poisoning them, so chemical resistance is less of an issue. The NHS lists medicated lotions and sprays as an alternative when wet combing fails (without naming a specific brand); a repeat treatment after about a week is typically advised. Availability and exact products differ in the US versus the UK — ask a pharmacist what is stocked locally. |
A doctor may prescribe these — not for self-treatment.
Benzyl alcohol 5% lotion Ulesfia Prescription topical pediculicide | A prescription-only lotion a clinician may choose, sometimes for resistant cases. Per CDC it is approved for children 6 months and older and usually needs a repeat treatment after 7 days. Do not self-start — it requires a prescription and clinician instructions. |
Ivermectin (topical lotion 0.5% or oral, off-label) Sklice (topical) Prescription antiparasitic | A doctor may prescribe ivermectin lotion (CDC: approved for 6 months and older), which CDC describes as effective in most patients as a single application, or oral ivermectin off-label for difficult cases. Both are clinician-prescribed only and require a proper diagnosis — never take oral ivermectin on your own or use animal/veterinary products. |
Malathion 0.5% lotion Ovide Prescription organophosphate pediculicide | A prescription option a clinician may use when other treatments fail. CDC lists it for children 6 years and older; it is flammable and must be kept away from heat, flames, and electric heat sources (e.g. hair dryers). Use only under a clinician's direction. |
Spinosad 0.9% topical suspension Natroba Prescription topical pediculicide | A prescription option that, per CDC, kills live lice as well as unhatched eggs, so retreatment is usually not needed. Approved for children 6 months and older. A clinician should decide whether it is appropriate — do not self-prescribe. |
Start practical and low-cost. The NHS recommends wet combing first: wash with ordinary shampoo, apply plenty of conditioner, then comb the whole head from root to tip with a fine-toothed detection/nit comb on days 1, 5, 9 and 13 (checking again on day 17). This is medicine-free and is generally considered safe in pregnancy and for young children. If wet combing alone does not clear the infestation, an OTC pediculicide is the usual next step in the US — permethrin 1% (Nix) or pyrethrins/piperonyl butoxide (Rid). Crucially, these kill live lice but not all eggs, so you almost always need a second application about 7-10 days later, and you should still comb out dead lice and nits. Be honest about the limits: head-to-head evidence that one OTC product is clearly "best" is limited, and lice in some areas have grown resistant to the older pyrethroid products, which is part of why a second dose or a switch is sometimes needed. (Note: the NHS does not recommend permethrin, though it remains a standard OTC option in the US.) For self-care, check everyone in the household on the same day and treat only those who actually have live lice, machine-wash recently used bedding and clothing in hot water, and do not waste money on heavy household "fumigation" — lice die quickly off the human head. If two or three correctly-applied courses of the same OTC product fail, stop repeating it and ask a pharmacist or doctor about a prescription alternative rather than over-applying.
See a pharmacist first if OTC treatment and wet combing are not working — they can suggest a different product. See a doctor (routine visit) if: live lice are still present after two or three properly applied courses of an OTC treatment; the person is pregnant or breastfeeding, or is a baby under the age limits on the product; lice are in the eyebrows or eyelashes; or you are unsure whether it is really head lice. Seek prompt medical care if the scalp or neck skin becomes red, swollen, warm, tender, or develops pus or crusting — that can signal a skin infection from scratching that may need antibiotics. Prescription medicines for lice should only be started on a clinician's advice, never self-prescribed.
General reference, not medical advice, and not a substitute for your doctor or pharmacist. The right choice depends on your symptoms, health conditions, age, and other medicines — always read each label and confirm before taking anything.