Prescription Lice Treatment Online
Head lice can be frustrating, especially when drugstore treatments have not worked, or you are not sure the specks in the hair are actually lice. With Your Doctors Online, you can send photos and speak with a board-certified doctor from home 24/7. When medically appropriate, your doctor can prescribe lice treatment and send it to the pharmacy you choose.
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Hi Dr. Nicole, I have head lice that cause intense itching. What should I do?
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Prescription
- Spinosad 0.9% suspension (Natroba)
- Apply to a dry scalp and dry hair, then rinse after 10 minutes.
- Repeat only if you still see live lice 7 days later.
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What are the treatment options for head lice?
Head lice can be treated with over-the-counter or prescription medication. Most people start with an over-the-counter treatment, but a different treatment may be needed if live lice remain after treatment.
- Over-the-counter treatment: Common options include permethrin, pyrethrins, and ivermectin lotion. Some lice have developed resistance to these treatments, so they do not always work.
- Prescription treatment: A doctor may recommend a prescription lice treatment when over-the-counter products have not worked. Some prescription options can also kill the eggs, which may reduce the need for repeated nit combing.
- Nit combing: Use a fine-toothed lice comb on damp hair every few days for two to three weeks to remove lice and nits. It can be used with medication or on its own.
- Check after treatment: Look for live lice 8 to 12 hours after treatment. Do not apply the same product again just because you see a few slow-moving lice. If the lice are still active or treatment has not worked, talk to a doctor about another option.
What prescription lice medications can we prescribe online?
Two prescription lice treatments are available at U.S. pharmacies. A doctor can review your case and send an online prescription for either of them when medically appropriate.
- Spinosad (Natroba): Applied to the dry scalp and rinsed off after 10 minutes. It kills both lice and their eggs, so one treatment is often enough and nit combing is usually not needed. It is approved for children 6 months and older.
- Malathion (Ovide): Applied to dry hair and left on for 8 to 12 hours before shampooing. It is flammable, so keep it away from hair dryers, curling irons, and cigarettes while the hair is wet. It is approved for children 6 years and older.
What are the symptoms of head lice?
The most common sign of head lice is an itchy scalp, but some people have no itching at all. Other signs can include:
- A tickling or crawling feeling in the hair
- Small red bumps or sores on the scalp, neck, or shoulders from scratching
- Tiny eggs (nits) stuck to the hair, usually close to the scalp, especially behind the ears or at the back of the neck
- Trouble sleeping or irritability, especially in children
Seeing specks in the hair does not always mean you have lice. Dandruff, hairspray, and old empty egg shells can look similar. The best way to confirm an active case is to find a live louse.
Head lice spread mainly through close head-to-head contact, especially among children, and they cannot jump or fly. They do not spread disease and have nothing to do with how clean someone’s hair or home is. Body lice and pubic lice are different types of lice and require different treatment.
Can you treat head lice at home?
Most cases of head lice can be treated at home with the right lice treatment and careful combing.
- Check everyone who may have been exposed: Look for live lice and treat anyone who has them on the same day.
- Use enough treatment: Follow the product instructions and make sure you have enough to cover all the hair, especially if it is long or thick.
- Skip conditioner before treatment: Conditioner can make some lice treatments less effective.
- Comb the hair regularly: Use a fine-toothed lice comb every few days for the next two to three weeks to remove lice and nits.
- Wash recently used items: Wash clothing, bedding, and towels used during the two days before treatment in hot water and dry them on high heat. Soak combs and brushes in hot water.
- Clean the home normally: You do not need to deep-clean your entire house. Vacuuming floors and furniture is enough.
- Skip home remedies: Mayonnaise, olive oil, butter, and similar treatments have not been proven to get rid of head lice.
Children usually do not need to stay home from school once treatment has started. Talk to a doctor if live lice are still present after treatment and retreatment, the scalp becomes very red or starts oozing, or the lice are around the eyelashes or eyebrows.
How much does online lice treatment cost?
With Your Doctors Online, membership starts at $20/month and includes unlimited doctor consultations, so you do not pay a separate fee every time you need care.
Your membership also includes:
- Unlimited consultations with licensed doctors
- Prescription treatment when medically appropriate
- Doctor’s notes for school or work when needed
- No insurance required and no per-visit fee
You only pay the pharmacy separately for the medication. For straightforward cases, an over-the-counter treatment may be enough, but YDO can be valuable when treatment has failed, you are unsure what you are treating, or you need a doctor to guide the next step.
FAQs About Lice
What is the best head lice treatment for long thick hair?
There is no separate product for thick hair. What changes is how much you use. CDC's guidance is that shoulder-length hair or longer may need a second bottle, and not using enough is one of the listed reasons a treatment fails. Coat all of the hair and all of the scalp, paying attention to the back of the head and the nape of the neck, then work through it in small sections with a fine metal comb.
Why is my head still itchy after lice treatment?
Because the itch was never the lice, it was your body reacting to their bites. That allergic reaction can carry on for a week or two after the last louse is dead. An antihistamine can take the edge off. What is worth a doctor's eye is skin that turns red, tender or oozing, because scratching can let a skin infection in.
How to get rid of lice without treatment?
You cannot clean lice off a head. They live on the scalp and feed there, so scrubbing the house does nothing to the ones causing the problem. The only medicine-free option that has been studied is wet combing, which means combing damp hair root to tip with a fine metal comb, repeatedly, over a couple of weeks. It clears lice for some people, and cure rates in the research vary a lot. Cleaning still has a small role, since lice die within two days once they fall off a person, but CDC is explicit that heavy housecleaning is not necessary.
How long after lice treatment are you contagious?
Once there are no live lice on the head, you are not passing them on. Nits still glued to the hair are very unlikely to transfer to anyone else, which is why CDC says a child can return to class as soon as treatment has started. Check the scalp eight to twelve hours after rinsing. If live lice are still moving normally, CDC says the medicine may not have worked, and you should ask a doctor before trying again. If it did work, most treatments need one more round at day seven to nine to catch anything that hatches after the first. Spinosad kills the eggs too, so it usually does not.
What lice treatment is safe during pregnancy?
Ask a doctor before you use any of them. Every one of these labels says so, including the over the counter ones. Of the prescription options, spinosad has the most reassuring label: the FDA label states it is not absorbed into the bloodstream from the scalp, so exposure to the baby is not expected, and the same applies while breastfeeding as long as you wash the product off the breast area first. Malathion is an organophosphate and its label says to use it in pregnancy only if clearly needed, and to speak to a doctor first. Ivermectin tablets are not used in pregnancy at all. Lindane must never be used in pregnancy, and it is no longer sold here anyway.
Why after lice treatment still feel crawling?
Partly the same allergic itch, partly the product drying out your scalp. Here is the part people get wrong: a few lice still moving slowly eight to twelve hours after treatment is normal, and CDC says not to reapply. It takes time for them to die. Comb the slow ones out. But if you find nothing dead, or the lice look as active as they did before, CDC says the medicine may not be working, and the next step is a doctor rather than another bottle of the same thing.
What is the fastest way to get rid of lice in your home?
Faster than you would think, because there is less to do than people assume. Machine wash and hot-dry anything that was worn or slept in during the two days before treatment, at 130 degrees Fahrenheit. Anything you cannot wash goes in a sealed plastic bag for two weeks. Soak combs and brushes in water of at least 130 degrees Fahrenheit for five to ten minutes. Vacuum the floor and the furniture where the person sat or lay. That is the whole list. Do not use a fumigant spray or fog, because they do not help and they are toxic if you breathe them in or absorb them through your skin.
How to treat lice without going to the doctor?
Most people do exactly this. Buy an over the counter treatment, either permethrin 1 percent, pyrethrins with piperonyl butoxide, or ivermectin 0.5 percent lotion. Do not use conditioner beforehand. Follow the timing on the box exactly, then check the scalp eight to twelve hours later. Comb every two or three days for the next two to three weeks and treat everyone in the house who has live lice on the same day. Where the do-it-yourself route runs out is CDC's ceiling of two to three attempts with the same medicine. Past that, the answer is a different drug, not another go with the one that has already failed.
What is lice treatment for color-treated hair?
Colored hair does not change which treatment you need. What does matter is what you put on the hair around it, and this is where color-treated hair usually goes wrong: conditioner or a two-in-one shampoo before the medicine stops it working, and the hair should not be washed again for a day or two after you rinse the treatment out. If you would rather keep chemicals off your hair altogether, wet combing is the one approach with no medicine in it, though it takes real patience and does not work for everyone.
How long do lice stay in hair after treatment?
The lice themselves die within hours of a treatment that works, though CDC notes a few may still be moving slowly at the eight hour mark. The eggs are the confusing part: empty shells stay cemented to the hair shaft for months after the infestation is over, so finding specks weeks later does not mean anything is alive. What settles it is a live louse. Eggs sitting more than a quarter inch from the scalp have almost always hatched or died already, since they need the warmth of the scalp to survive.
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