I’m very vigilant about preventing lice with my children (telling them not to share hats, scarves, hairbrushes, etc.), however I have now heard about “super lice” that are resistant to treatment. Is that true? How can they be treated?


Telling your children to avoid sharing hats, scarves, and hairbrushes is a good preventative measure, and back-to-school season is a great time to remind them. Classrooms are the most common places for lice transmission, especially in the early elementary years when children are sitting closely together to complete classwork.


While lice should be prevented as much as possible and treated promptly, parents should also be aware that lice do not carry diseases. There is no cause for panic.


Across the U.S., strains of lice have emerged that are resistant to commonly used over-the-counter lice treatments, as well as some prescription treatments. Other than this resistance, “super lice,” as they are called, are no different from other forms of lice: They do not carry diseases, and they are not more contagious. As back-to-school time nears, parents will benefit from an understanding of super lice and how to treat them.  


Treating “Super Lice”


While super lice do not have any effects more harmful than standard forms of lice, they are resistant to many commonly used forms of over-the-counter treatments and some prescription treatments. In the event that a child over 6 months of age is experiencing an outbreak, parents are advised to try an over-the-counter treatment containing pyrethin or permethrin first. If this treatment is not effective, then a pediatrician should be consulted and will likely provide a prescription for malathion or ivermectin. These treatments are not higher in toxicity, rather, they simply work in a different way than over-the-counter and other prescription treatments.


Wet combing, in which lice and their eggs are manually removed from wet, detangled hair, provides an alternative to treating lice with an over-the-counter or prescription medication. This approach, while time-consuming, can be performed by a parent using wet combing, or outside help can be hired.


Over-the-counter and prescription lice treatments should not be used on children under 6 months of age due to the potential for neurotoxicity. In these cases, wet combing or a short haircut is a common approach.


Treating your home after a lice outbreak


When it comes to treating your home following a lice outbreak, the rules for super lice and standard, less-resistant forms of lice do not differ. All bedding, towels, hats, and other fabrics that come into contact with the hair should be washed in hot water and placed in the dryer. Stuffed animals can be washed and dried or placed in a sealed plastic bag for two weeks. Brushes and combs can be placed in boiling water or alcohol, or they can be replaced.


Checking for lice


There is no need for parents to regularly check for lice if there is no cause for concern. Parents should check if there is a report of a lice outbreak from their child’s school, or if they notice their child scratching his or her scalp. Parents can check for lice by parting the child’s hair under a bright light, and looking for small insects or eggs, called “nits.” The nits are laid close to the scalp.


Many people believe that lice result from a lack of cleanliness, but this is simply not the case. They are transmitted via contact (they do not jump or fly) and anyone can catch them. As children head back to school, parents should remind them not to share hats, scarves, or hairbrushes. While lice can be distressing, there should be no cause for panic. They do not carry diseases, and there are treatments out there that are highly effective.


Lynne Karlson, MD, is chief of General Pediatrics and Adolescent Medicine at Floating Hospital for Children at Tufts Medical Center, and an associate professor at Tufts University School of Medicine.