Treatment of head louse infestation is primarily a family affair. However, until products became available for self medication it was fraught with difficulty. The introduction of neurotoxic insecticides was not a lasting solution as head lice rapidly developed resistance to one active substance after another. Additionally the evaluation of treatments was generally poor until quite recently, which allowed some products that were ineffective to be sold, with the increased risk that resistance would follow. A recently published evaluation of an oral treatment, ivermectin, showed high efficacy but use of this insecticide is likely to be restricted for regulatory reasons. It is now the case that conventional insecticide treatments are disappearing in favour of materials of natural origin and physically acting chemicals. The former are often difficult to characterise, and most are likely to suffer the same fate as insecticides. The latter are increasing in use and popularity but still require careful application, even if development of resistance is not likely to emerge as a problem.
There is also a renewed interest in combing for treatment, which suits some people but appears to be beyond the ability of others. Fundamental to all treatment is being able to diagnose an infestation at the earliest stages. Evidence shows that using appropriate diagnostic combs is the best method for this.
This review assesses the strengths and weaknesses of the available treatment options to guide health care professionals advising consumers on the self-care of head lice infestation.
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