How to get rid of head lice when treatment fails (2024)

If you recently used a lice-killing shampoo or cream rinse, it may have failed to work. This is happening in homes across the United States, leaving parents feeling anxious and worried.

Why head lice treatments fail to work

For years, parents have been buying these non-prescription shampoos and cream rinses. Because the active ingredients have remained the same all these years, new generations of head lice have become immune to them. Once lice become immune, the product no longer works. Scientists call this resistance.

Effective treatment for head lice is available

If a head lice treatment that you can buy without a prescription fails to work, the CDC recommends that you see a health care provider. Highly effective prescription treatments that you apply to the scalp are available.

The Food and Drug Administration (FDA) has approved prescription treatments for children as young as 6 months of age.

The prescription treatments work because they contain different active ingredients than the non-prescription shampoos and cream rinses.

If using a prescription treatment worries you, it may help to know that today’s non-prescription lice medications were once only available with a prescription. You can also take comfort in knowing that each of the newer prescription treatments was tested in clinical trials. Before the FDA approved each of these treatments, it was shown to be safe and effective for children.

Using extra amounts of lice medication can be harmful

The Centers for Disease Control and Prevention (CDC) warns that using extra amounts of lice medication can be harmful and you should only do this if your doctor or pharmacist recommends it.

Natural products can give parents false sense of safety

If using a natural product or one that you can buy without a prescription makes you feel safer, you should know that researchers have found many of these treatments can be harmful.

While studying lice-killing products that you can buy without a prescription, researchers found the some of these products contain:

  • Acetone (often found in nail polish remover)

  • Bleach

  • Vodka

  • A spray often used to lubricate metal

None of the above has proven effective in killing head lice, and the American Academy of Pediatrics (AAP) says that these ingredients “present an unacceptable risk to the patient.”

Using an herbal product can also be risky. While these products come from plants, research shows that some chemicals which plants make to protect themselves from insects and other pests can be toxic to humans.

We don’t always know which of these chemicals are toxic because the FDA does not regulate herbal products.

Home remedies can also be problematic. You may have heard claims that petroleum jelly, mayonnaise, butter, margarine, or olive oil can suffocate lice. None of these has been found to be effective. What may be happening is that these remedies make the lice less active for a while, which gives people the impression that the lice are dead.

A dermatologist can treat your child safely and effectively

For these reasons, the CDC recommends seeing your health care provider.

Seeing a board-certified dermatologist can be helpful because these doctors specialize in diagnosing and treating conditions that affect the skin and hair. Their expertise helps you to get an accurate diagnosis.

This is important. Researchers have also found that another reason non-prescription head-lice treatments fail to work is that the child doesn’t have lice.

Lice are small and fast, so they can be hard to see. Sometimes parents — and even medical professionals — mistake another medical condition for head lice. An allergy or irritated skin could be causing those itchy, red bumps and flakes on your child’s scalp.

If your child has head lice, a dermatologist can tell. A dermatologist can also recommend an effective treatment for your child. This may be one of the prescription treatments.

Sometimes, simply combing your child’s hair to remove the lice and nits (eggs) can be effective. While time-consuming, studies show that combing injures the lice, so they rarely survive.

When it comes to removing lice by combing, technique is crucial. By seeing a dermatologist, you can learn the right technique and other tips for getting rid of lice.

Seeing a board-certified dermatologist can also help you feel that your child is in good hands, which can reduce the anxiety and worry you feel.

Related AAD resources

  • - At-home and prescription treatments for head lice

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References
American Academy of Dermatology:

  • “Head lice bugging your family? Dermatologists’ tips for getting rid of lice.” News release issued Feb. 12, 2013.

  • Bedbug, scabies, and head lice — oh my.” News release issued Mar 4, 2010.

Centers for Disease Control and Prevention. “Head lice: Treatment.” Page last updated 8/19/2016.

Devore CD, Schutze GE; American Academy of Pediatrics, Council on School Health, Committee on Infectious Disease. “Head Lice.” Pediatrics. 2015;135:e1355-1365.

Koch E, Clark JM, et al. “Management of head louse infestations in the United States — A literature review.” Pediatr Dermatol. 2016;33:466-72.

How to get rid of head lice when treatment fails (2024)

FAQs

How to get rid of head lice when treatment fails? ›

If the initial treatments have failed and live lice are still being removed with the conditioner and comb treatment, see your doctor for a referral to a dermatologist for specialist treatment. A dermatologist may prescribe ivermectin . This is a tablet taken twice, 7 days apart.

How do you get rid of lice if treatment doesn't work? ›

If you live in one of these areas, or if you try over-the-counter treatments and they don't work, make an appointment with your primary care doctor or a dermatologist to seek prescription treatment. Prescription creams or shampoos may help eliminate head lice when over-the-counter treatments aren't effective.

What to do if lice is not gone after treatment? ›

After Treating with Lice Medicine

If some are still present but moving slowly, do not shampoo again. If lice are still active and no dead lice are found, call your health care provider.

Why am I still finding lice after treatment? ›

If your child or someone else in your family still has head lice after a few weeks, it means that the treatments did not work or the person got lice again. Make an appointment to see a dermatologist for help getting rid of the head lice.

Will dead lice fall out after treatment? ›

Hatched casings and dead nits can stay on the hair shaft for months, even after curing the lice infestation, unless you remove them manually. Because of this, finding nits alone doesn't always mean there's an active lice infestation.

How do you treat stubborn head lice? ›

Using insecticide products

If you use a lotion, apply the product to dry hair. For shampoo products, wet the hair, but use as little water as possible. Head lice live in the hair and go to the scalp to feed. Therefore, head lice products must be applied to all parts of the hair.

How to get rid of resistant head lice? ›

When to talk to your doctor about head lice. The AAP suggests calling your doctor or family's pediatrician if you live in an area with known resistance to an over-the-counter treatment. You may need a treatment with a prescription medication such as spinosad or topical ivermectin.

Why won't my head lice go away? ›

It's possible that you are dealing with head lice that are resistant to the active ingredient in your treatment product. Consult with your pediatrician or contact a pediatric dermatologist for a prescription head lice treatment.

What happens if you have head lice for too long? ›

If you have untreated head lice, a bacterial infection requiring antibiotics can result. In rare, severe cases , head lice and nits can lead to iron deficiency anemia due to blood loss. An unchecked infestation can also spread to your eyebrows and eyelashes, although this is rare.

What kills lice and eggs instantly? ›

Ivermectin (Sklice). This lotion kills most head lice, even newly hatched ones, with just one use. You don't need to comb out lice eggs (nits). Children aged 6 months and older can use this product.

How to get rid of dead nits from hair? ›

Wet-combing

Combing wet hair with a fine-toothed nit comb may remove lice and some nits. Studies show that wet-combing results vary. Start by wetting the hair and lubricating it with hair conditioner or olive oil. Comb the entire head from the scalp to the end of the hair at least twice during a session.

Do lice live on couches? ›

Lice are parasitic insects that feed on human blood and must live close to the body to maintain their temperature. Without a host, lice will die within a few days. Lice cannot live long on household items such as carpets and furniture, and people are unlikely to get them from these surfaces.

What kills super lice? ›

If lice are still present after treating with a traditional over-the-counter product, they may be superlice. Nix® Ultra is highly effective for killing lice, superlice and their eggs.

What if lice moves slowly after treatment? ›

According to the CDC, if the lice are moving slowly or dead 8 to 12 hours after treatment, then the pediculicide is probably effective. If, however, the lice are as active as before treatment, then an alternative agent may be required.

What if I still feel crawling after lice treatment? ›

Even after using lice treatments like shampoos or medications, you may still feel as if you have lice due to increased skin sensitivity or because the treatment wasn't effective. Lice are tiny insects that feed on your blood. They're commonly spread by sharing objects that touch your hair, such as hairbrushes or hats.

What color are dead nits? ›

Takeaway. Living lice eggs, or nits, range in color from white to light brown. Dead lice eggs are darker and can appear brown or black. The casings left behind by nits that hatch are typically translucent.

Why is head lice so hard to get rid of? ›

Lice can be tricky to get rid of because nits can remain unhatched on your head or you might pick up lice that are still on bedding or other items. Here's what to do if you've had lice — or someone in your family has: Wash bed linens and clothing that anyone with lice has used recently.

Will lice eventually go away without treatment? ›

Here's what treatment works. If you've ever experienced head lice, you know how uncomfortable they can be. These tiny, parasitic insects are also unsettling and can be tough to get rid of.

How to remove dead nits from hair? ›

Combing wet hair with a fine-toothed nit comb may remove lice and some nits. Studies show that wet-combing results vary. Start by wetting the hair and lubricating it with hair conditioner or olive oil. Comb the entire head from the scalp to the end of the hair at least twice during a session.

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