Head Lice (Pediculosis capitis) – Paul Miller, M.D., F.A.A.P.

Did you know that Sept. is National Pediculosis Prevention month? Neither did I.But with school starting this week it is the right time to think about head lice and their prevention and treatment.

First of all it is important to note that although head lice are a nuisance they do not transmit disease. A local infection from scratching and spread to others are the main complications.

Secondly, there has been recent coverage of so-called ‘Super lice,’  resistant to the standard pyrethrin-based agents (Nix, Pronto, A200, RID). This is true, with a recent study (data collected 2013-2015) showing near universal resistance in most states, including IL. However, calling them ‘SuperLice’ is neither helpful nor correct.

There are several new effective prescription treatments available, but they are quite costly. Examples are Natroba (Spinosad 0.9% topical suspension), Ulesfia (Benzyl alcohol 5% lotion) and Sklice (Ivermectin 0.5% lotion). Topical Malathion is inexpensive but comes with concern of flammability and local irritation and is not indicated for use under 6 years of age. A two dose of oral Ivermectin has also been shown to be effective.

Perhaps a better alternative is to go back to non-chemical detection and treatment using wet combing. Although this technique is labor intensive it can be quite effective and avoids the expense and possible side effects of chemical treatments. This would also be the first line treatment for children under 2 years of age.

2 of the most widely recommended nit combs are the Fairy Tales Terminator and LiceMeister. The LiceMeister comb is marketed by the not-for-profit National Pediculosis Association (www.headlice.org). The Terminator comb can be found at Ulta stores and various sites on-line. Electric ‘bug zapper’ combs are generally not recommended.

Here is a link to a wet combing video:


There are several salons devoted to treating lice in the Chicagoland area (e.g. Nitpickers, Hair Fairies, LiceBusters, Disentangle) for those wishing to use their services.

The AAP recommends against a nit-free return to school for several reasons. These are discussed in the link below:


In summary, if a lice infestation is suspected do a careful and thorough exam, including the front hairline, top of scalp as well as behind both ears and nape of neck. A wet combing session can also be helpful in both detecting and removing adult lice and nits.

Feel free to contact our office with any questions.



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