Prevention and Treatment of Head Lice in Children


Head louse infestations (pediculosis) are prevalent worldwide. In developed countries, the infestation rate of 4- to 13-year-old children remains high despite preventive efforts. This is due to the existence of numerous ineffective pediculicides, the incorrect use of the effective agents, toxicological concerns and the development of louse strains resistant to insecticides.

One of the most effective tools for the prevention and control of lice is the louse comb, which should be used regularly for the detection of living lice at an early stage of infestation, and as an accessory to any treatment method to remove living and dead lice. The louse comb can also be used systematically for the treatment of infestations, for confirmation that treatment with pediculicides has been successful, and for the removal of nits (dead eggs or egg shells).

Most pediculicides are only partially ovicidal. Therefore, 10 days after beginning treatment with any antilouse product, the scalp of the child should be examined. If no living lice are found, the treatment should be discontinued. If living lice are still present, treatment should be continued with a product containing a different active ingredient.

Suffocating agents such as olive, soya, sunflower and corn oils, hair gels and mayonnaise are able to kill a significant number of lice only if they are applied in liberal quantities for more than 12 hours. However, they lubricate the hair and therefore may facilitate combing and removing lice and eggs from the scalp.

Nits may remain glued on the hair for at least 6 months, even after a successful treatment, and lead to a false positive diagnosis of louse infestation. If nits are seen on the hair, the child should be examined, but treatment should be initiated only if living lice are found. Formulations containing 5% acetic acid or 8% formic acid, as well as acid shampoos (pH 4.5 to 5.5) and conditioners, in combination with a louse comb, can be helpful for removing nits.

There is no conclusive evidence that using essential oils to repel lice is effective. Regular examination of the child’s head using a louse comb is the best measure to detect re-infestation at an early stage. Educating caregivers, nurses and teachers about louse biology, epidemiology, prevention and control is of paramount importance. The psychological effect of an infestation with lice is significant and often associated with anxiety and fear. The child should not be made to feel responsible for having lice, or be punished or reprimanded.

This is a preview of subscription content, log in to check access.


  1. 1.

    Gratz N. Human lice, their prevalence and resistance to insecticides. Geneva: WHO, 1998

    Google Scholar 

  2. 2.

    Taplin D, Meinking TL. Pyrethrins and pyrethroids for the treatment of scabies and pediculosis. Semin Dermatol 1987; 6: 125–35

    Google Scholar 

  3. 3.

    Anonymous. Lice — yes, lice again a problem [editorial]. Infect Dis 1976; 6: 1

  4. 4.

    Atkinson L, Clore ER, Kisel BE, et al. Internal and external parasites. Pediatrics 1986; 1: 1–7

    Google Scholar 

  5. 5.

    Tamir D, Noam P, Tor A, et al. Prevalence of head lice in schools in Jerusalem during 1979–1982 [in Hebrew]. Harefuah 1984; 107: 45–50

    Google Scholar 

  6. 6.

    Sarov B, Neumann L, Herman Y. Evaluation of an intervention program for head lice infestation in school children. Pediatr Infect Dis 1988; 7: 176–9

    Article  CAS  Google Scholar 

  7. 7.

    Mumcuoglu KY, Miller J, Gofin R, et al. Epidemiological studies on head lice infestation in Israel: I: parasitological examination of children. Int J Dermatol 1990; 29: 502–6

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Mumcuoglu KY, Miller J, Gofin R, et al. Head lice in Israeli children: parents’ answers to an epidemiological questionnaire. Isr J Zool 1990/1991; 39: 177–83

    Google Scholar 

  9. 9.

    Altschuler, DZ, Kenney LE, Pediculicide performance, profit, and the public health. Arch Dermatol 1988; 122: 260

    Google Scholar 

  10. 10.

    Mumcuoglu KY, Miller J. The efficacy of pediculicides in Israel. Isr J Med Sci 1991; 27: 562–5

    PubMed  CAS  Google Scholar 

  11. 11.

    Anonymous. Essai comparatif antipoux [Comparison of anti-louse treatments]. Mensuel de l–Institut National de la Consommation 1994; 276: 9–12, 44

  12. 12.

    Taplin D, Meinking TL. Permethrin.Curr Probl Dermatol 1995; 24: 255–60

    Google Scholar 

  13. 13.

    Vander Stichele RH, Dezeure EM, Bogaert MG. Systematic review of clinical efficacy of topical treatments for head lice. BMJ 1995; 311: 604–8

    Article  CAS  Google Scholar 

  14. 14.

    Buxton PA. The louse: an account of the lice which infest man, their medical importance and control. 3rd rev. ed. London: Arnold, 1950

    Google Scholar 

  15. 15.

    Nuttall GHF. The biology of Pediculus humanus. Parasitology 1917; 10:80–185

    Article  Google Scholar 

  16. 16.

    Lyons P. The most dangerous medicine. Available from: National Pediculosis Association. [Accessed 1999 Jul 2]

  17. 17.

    Surber C, Rufli T. Lindane [in German]. Hautartz 1995; 46: 528–36

    Article  CAS  Google Scholar 

  18. 18.

    Anonymous. POM-to-P shift proposed for budesonide and P-to-POM for carbaryl. Pharm J 1995; 255: 138

  19. 19.

    Ibarra J, Hall DMB. Head lice in schoolchildren. Arch Dis Child 1996; 75: 471–3

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Brown AWA, Pal R. Insecticide resistance in arthropods. WHO Monogr Ser 38, 1971

    Google Scholar 

  21. 21.

    Gratz N. Treatment resistance in louse control. In: Orkin N, Maibach HI, Parish LC, et al., editors. Scabies and pediculosis. Philadelphia: Lippincott, 1977: 179–90

    Google Scholar 

  22. 22.

    Vector resistance to pesticides. Fifteenth report of the WHO expert committee on vector biology and control. World Health Organ Tech Rep Ser 1992; 818: 1–62

  23. 23.

    Anonymous. Concern over development of resistance to pyrethroid head lice treatments. Pharm J 1995; 255: 490

  24. 24.

    Nassif M, Osman K. A field trial with permethrin against body lice, Pediculus humanus humanus, in Egypt. Pesticide Sci 1977; 8: 301–4

    Article  CAS  Google Scholar 

  25. 25.

    Taplin D, Meinking TL, Catillero PM. Permethrin 1% creme rinse for the treatment of Pediculus humanus var. capitis infestation. Pediatr Dermatol 1986; 3: 344–8

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Brandenburg K, Deinard AS, DiNapoli J, et al. 1% permethrin creme rinse vs 1% lindane shampoo in treating pediculosis capitis. Am J Child Dis 1986; 140: 894–96

    CAS  Google Scholar 

  27. 27.

    Bowerman JG, Gomez MP, Austin RD, et al. Comparative study of permethrin 1% creme rinse and lindane shampoo for the treatment of head lice. Pediatr Infect Dis J 1987; 6: 252–5

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Mumcuoglu KY, Hemingway J, Miller J, et al. Permethrin resistance in the head louse Pediculus humanus capitis from Israel. Med Vet Entomol 1995; 9: 427–32

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Mumcuoglu KY, Miller J, Galun R. Susceptibility of the human head and body louse (Pediculus humanus) (Anoplura: Pediculidae) to insecticides. Insect Sci Applic 1990; 11: 223–6

    Google Scholar 

  30. 30.

    Hemingway J, Miller J, Mumcuoglu KY. Pyrethroid resistance mechanisms in the head louse Pediculus capitis from Israel: implications for control. Med Vet Entomol 1999; 13 (1): 89–96

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Chosidow O, Chastang C, Brae C, et al. Controlled study of malathion and d-phenothrin lotion for Pediculus humanus var. capitis-infested schoolchildren. Lancet 1994; 344: 1724–7

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Rupes V, Moravec J, Chmela J, et al. A resistance of head lice (Pediculus capitis) to permethrin in Czech Republic. Cent Eur J Public Health 1994; 3: 30–2

    Google Scholar 

  33. 33.

    Mumcuoglu KY, Klaus S, Kafka D, et al. Clinical observations related to head lice infestation. J Am Acad Dermatol 1991; 25: 248–52

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    DeFelice J, Rumsfield J, Bernstein JE, et al. Clinical evaluation of an after-pediculicide nit removal system. Int J Dermatol 1989; 28: 468–70

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Peock S, Maunder JW. Arena tests with piperonal, a new louse repellent. J R Soc Health 1993; 113: 292–4

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Mumcuoglu KY, Galun R, Bach U, et al. Repellency of essential oils and their components to the human body louse, Pediculus humanus humanus. Entomol Exp Appl 1996; 78: 309–14

    Article  CAS  Google Scholar 

  37. 37.

    Rosenfeld J, Manor O, Mumcuoglu KY. Relationship of sociodemographic variables and head-lice infestation among elementary school children in Bet Shemesh. Isr J Zool 1993; 39: 177–83

    Google Scholar 

  38. 38.

    Mumcuoglu KY. Head lice in drawings of kindergarten children. Isr J Psychiatry Relat Sci 1991; 28: 25–32

    PubMed  CAS  Google Scholar 

  39. 39.

    Tabashnik BE. Modeling and evaluation of resistance management tactics. In: Roush RT, Tabashnik BE, editors. Pesticide resistance in arthropods. New York: Chapman and Hall, 1990: 153–82

    Google Scholar 

  40. 40.

    Mumcuoglu KY, Miller J, Rosen L, et al. Systemic activity of ivermectin on the human body louse (Anoplura: Pediculidae). J Med Entomol 1990; 27: 72–5

    PubMed  CAS  Google Scholar 

  41. 41.

    Glaziou P, Nguyen NL, Moulia-Pelat JP, et al. Efficacy of ivermectin for the treatment of head lice (Pediculosis capitis). Trop Med Parasitai 1994; 45 (3): 253–4

    CAS  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Dr Kosta Y. Mumcuoglu.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mumcuoglu, K.Y. Prevention and Treatment of Head Lice in Children. Pediatr-Drugs 1, 211–218 (1999).

Download citation


  • Adis International Limited
  • Malathion
  • Head Louse
  • Louse Infestation
  • Body Louse