Assessing Over the Counter (OTC) Lice Treatment Options


What do you do if you get the dreaded call to pick up your child from school? It’s tempting to freak out when you’re told they may have lice.

I mean ugh, those nasty little bugs can be persistent. You’re worried the entire household might be infested, and what will your boss think when you take time off from work?

Don’t panic! The (good?) news is that lice are extremely common. They’re not a reflection on your parenting or cleanliness. According to the CDC, every year six to twelve million children aged three to eleven are infested with lice.

You’re not alone, but you need a plan of attack. OTC lice treatment options are created to “get behind enemy lines” and kill and remove lice as quickly as possible. Your next mission is to assess the available treatment options. How do they perform for safety, efficacy and convenience?

Permethrin and pyrethrin lice treatments

Many common OTC lice treatments use permethrin or pyrethrin as their active ingredients. Permethrin and pyrethrin are both pyrethroids, synthetic chemicals derived from the chrysanthemum flower. Pyrethroids are used as insecticides in many different capacities.

It all sounds kind of natural, right? Surely a shampoo derived from a plant would be safer than some of the chemical prescription options? This sort of assumption has led to the common use of pyrethroids for lice treatment since the 1980s.  But, more recent research gives reason for caution.

Pyrethroids are a known neurotoxin and can cause any of several possible side-effects. These can range from the relatively minor, such as mild skin irritation, to more serious affects such as trouble breathing, or scalp infections. The US National Library of Medicine warns that you should “call your doctor if you have any unusual problems while using this medication” – not exactly comforting!

Of course, many people may not suffer any ill-effects at all. However, they also may not get the desired effect – getting rid of the lice! In this age of “super” everything, super lice are also a thing. The effectiveness of common OTC treatments like pyrethroids has been found to be declining. While these treatments were once 100 percent effective, they’ve slipped to somewhere around 20 to 30 percent. In some parts of the U.S., lice are completely resistant to pyrethroid treatments.

Another consideration is the application of the product. The advice for pyrethroids is to stay fully dressed and apply the product over a basin or sink. This limits contact with skin anywhere else on your body. Not exactly the most convenient process!

The bottom line is that a pyrethroid OTC treatment might work, but there’s a 70 to 100 percent chance that it won’t. There’s also a chance that you’ll go through the messy application process, only to experience side-effects.

Dimethicone lice treatments

Dimethicone is a silicone-based product and does not contain any nasty pesticides. The treatment acts as a lubricant which coats the lice and stops them from getting the water they need to stay alive. You will usually find this OTC lice treatment in a shampoo or gel.

As a polymer, dimethicone is not an insecticide. Researchers think that it will be unlikely that lice are able to develop any kind of resistance to the treatment. Studies using 100 percent dimethicone treatment and 4 percent dimethicone treatment revealed that it is effective on lice. One noted that dimethicone users reported much less irritation from using the treatment as compared to insecticide users.

It is still relatively early in terms of research into the impacts of dimethicone. Overall, scientists don’t expect that it has high risk in terms of side-effects. However, the Environmental Working Group lists “suspected environmental toxin” as a concern.

The application process can be lengthy. Dimethicone is applied to dry hair, and either kills or disables lice. It does not impact the eggs, although it makes them easier to comb out. The process of combing lice and eggs thoroughly out of hair may take up to two hours. Treatment may need to be repeated over a 10-day period.

Electric lice combs

Electric lice combs are a completely chemical-free lice treatment option. This OTC lice treatment zaps live lice on contact, stunning or killing them to make removal easy.

The combs are safe to use as they zap the lice, but not the user. Compared to shampoo- and gel-based treatments, electric lice combs are a breeze to use. There are no stinky solutions and there is no mess to clean up after use.

How effective are these electric combs? Most people who use them can get rid of lice infestations very safely and effectively. Some people with thick or curly hair have reported difficulties with using a comb. A key tip is that users section their hair to treat it properly. If you have thick hair, you may need to section in layers. Treatment may need to be repeated over 10 days, as the combs do not kill the nits. However, this is a treatment that can be done anywhere without the need for sinks or other equipment.

Generally, OTC lice treatment options are a safer choice than chemical prescription products. However, there is still concern over safety and efficacy, especially with pyrethroids.

Once you’ve chosen an OTC lice treatment you’re comfortable with, be vigilant about washing clothes and bedding that have been in contact with the lice. The good news is that lice don’t live very long without their blood supply, and you don’t have to worry about treating any pets.

Finally, take a breath! Parents can expect to encounter lice at some point, and it’s no reflection on you. With swift treatment, everything will be back to normal soon.


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