What can you do about head lice?

The best way to comb out lice is as follows:

• First, wet the hair or wash it. To avoid pulling the hair while combing it, you can use conditioner.
• Start combing right at the roots of the hair and then carefully pull the comb all the way through to the ends, section by section. Comb each section at least twice.
• Wipe the comb on a paper towel after combing through each strand so it's easier to see any lice.

The lice usually can't survive on the comb. But to make sure, you can place it in hot water (60 degrees Celsius / 140 degrees Fahrenheit) after combing.

Combing out allows you to check for lice and can help get rid of some of the lice, but you can’t be sure that you’ve removed all of them.

Insecticides have been an effective head lice treatment for decades. But because they have been used so much, lice have become resistant to them in some European countries. Recent studies have shown that insecticides are now far less effective in France, Great Britain, Denmark and the Czech Republic. Genetic changes have been detected in head lice in Germany, too, making some products less effective. Because of this, it's all the more important to regularly check for head lice in the days following treatment. This is best done with a lice comb.

The following insecticide-based treatments are considered to be effective and are available on prescription in Germany:

• Allethrin (trade name: Jacutin Pedicul Spray)
• Permethrin (trade name: e.g. InfectoPedicul, Ambush, Nix)
• Pyrethrins (trade name: e.g. Goldgeist, R&C Shampoo)

Each of these products is applied differently, so it's important to read the package insert.

Many parents would prefer to treat the lice without using insecticides. Non-insecticide products mainly contain a silicone oil known as dimethicone (also called dimeticone). Dimethicone is also found in many cosmetics and used in the production of food.

Products containing dimethicone kill head lice and their eggs by coating them in a thick layer of oil that suffocates them. One advantage of these products is that the lice can't become resistant to them.

Several studies have tested lice treatments containing dimethicone. They show that more than 70 out of 100 children no longer have head lice after the treatment. There is no research comparing the different products to find out which is the most effective one.

Several dimethicone products are available in Germany, most of which can be prescribed by a doctor and are considered to be effective. These products differ in terms of the active ingredients in them and the total time they need to stay on. Some of them need to stay on overnight, while others just need to be put on for ten minutes. You will find exact instructions in the information that comes with the product you are using.

Plant-based products for head lice contain plant oils. The different products work in different ways. Some aim to suffocate the lice, others act like a kind of neurotoxin (nerve poison). Only one of the plant-based products available in Germany has been tested in studies: a spray made from coconut oil, anise oil and ylang ylang oil (trade name: Paranix), which can also be prescribed. Products made of mineral oil or neem oil are available too.

There's not enough research on these plant-based treatments, so it's not clear how effective they are or what side effects they might have. The same is true for home remedies like vinegar, cooking oil or mayonnaise.

Some people try to kill lice and nits with hot air (for example, with a blow-dryer) but that can damage your scalp and hasn't been shown to work reliably. Spending time in a hot sauna isn't a suitable way to kill lice and their eggs, either.

All head lice products can irritate your scalp or cause itching for a while. Particularly products containing alcohol can cause a burning feeling. One disadvantage of sprays is that they may cause an allergic reaction if breathed in. Especially if a child has asthma or another respiratory disease, it's a good idea to use a liquid product that can be put on with the help of a comb, for instance.

Regardless of which product you choose, it's important to follow the accompanying instructions carefully so that the product can work. Some treatments aren’t recommended for very young children or pregnant women. You can ask a doctor about this.

Most of the treatments need to be applied again after 7 to 10 days because the nits (lice eggs) can survive the first treatment. The second treatment kills the lice that hatch during the week after the first treatment.

For the treatment to be able to work, it's important to

• apply a lot of the product to the scalp and hair,
• spread it evenly,
• leave it on for the amount of time specified in the instructions, and
• use it on dry hair (because wet hair can dilute the active ingredient).

The treatment is very likely to kill the lice. But it's still important to use a lice or nit comb every 3 days for about 2 weeks after the treatment, to check whether all the lice are really gone. Some children might need another round of treatment. Then you can try out a different product.

Because some products easily catch fire, you should stay away from candles and other flames while using them. Make sure that the head lice product doesn't get into your eyes, nose or mouth. If it does, it's best to rinse them out with water right away.

According to German law, children who have head lice can only return to their child care center or school after they've had a treatment that is known to be effective. Effective treatments include the insecticides and silicone-based products mentioned above.

So the child can return to their child care center or school on the day after first using the treatment. In other words, you don't need to wait a week until you've used it a second time. Your doctor or pharmacist can tell you more about this.

Most places only ask for a spoken or written statement from parents confirming that their child has been treated. Some ask for a note from the doctor, though.