What's the Best Way to Get Rid of Drug Resistant Lice?

December 08, 2021

This article was reviewed by our Baystate Health team to ensure medical accuracy.

John R. O'Reilly, MD John R. O'Reilly, MD View Profile
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The Centers for Disease Control says 6 million to 12 million school-aged children get head lice in the United States each year.

But anyone can get lice.

Dr. John O’Reilly, chief of general pediatrics at Baystate General Pediatrics - Springfield - High Street, shares how to spot signs of head lice and safely get rid of them without harsh chemicals.

What are head lice?

Lice are a tiny insect about the size of a sesame seed. They go on human hair and feed on tiny amounts of blood from the scalp. They’re generally found on the head and neck and attach their eggs to the base of the hair shaft. They usually survive less than a day if not on a person’s scalp. Lice can only survive a day or two without a human host.

How do people get lice?

Lice have nothing to do with poor hygiene or an unclean home environment.

Lice stay close to the scalp because they require a certain body temperature to survive. Since they can’t jump, they are usually only spread by direct head to head contact.

Lice can only be spread through human to human contact. They cannot be transmitted from animals to human or vice versa.

As hat and scarf season sets in, children start spending more time indoors playing. This is when head lice can become more of a concern. While it’s more common for lice to be transmitted during the fall and winter months, they can occur at any time during the year.

Can lice live on pillows and sheets?

Lice can’t jump or fly onto pillows and sheets. But they could crawl off a person’s head as they sleep.

The CDC does not recommend sharing pillows and sheets or laying on a bed right after a person who has lice.

Make sure to either:

  • Wash the infected linens in hot water (130°F) and dry on the high heat drying cycle OR
  • Dry clean infected linens OR
  • Seal the linens in a plastic bag and store for 2 weeks

What are the symptoms of head lice?

The most common symptom of head lice is an itchy scalp, especially behind ears and at the nape of the neck.

The best way to check for lice is to part your child’s hair and look at the scalp.

You’ll want to look for nits (lice eggs), small white or yellow-brown specks that are firmly attached to the hair shafts.

It may be more difficult to spot adult lice because they are small and will move quickly away when exposed to light.

If you find lice on one family member, make sure to check everyone else in your household.

What are some effective prevention tips?

While it is uncommon for them to crawl from one person’s clothing to another, there are ways you can reduce your chances of getting lice:

  • Do not share hats, scarves, coats, sports uniforms, hair ribbons, or barrettes.
  • Do not share combs, brushes, or towels.
  • Keep hair relatively short or tied up to prevent hair-to-hair contact.

The American Academy of Pediatrics (AAP) does not recommend excessive cleaning, such as using home pesticides. However, washing pillowcases and treating natural bristle hair care items that may have been in contact with the hair of anyone found to have head lice are reasonable measures.

Learn about the CDC’s lice prevention recommendations.

How to treat lice at home?

The Cetaphil method has been proven to eliminate these resistant lice. Cetaphil skin cleanser is a gentle over the counter skin cleanser. A study from 2004 shows a 96 to 97% success rate at eliminating these mutant lice. This treatment works by suffocating the lice.

For best results, follow the steps below for a total of three treatments done one week apart:

  • First apply a liberal amount of Cetaphil cleaner to the dry scalp, until it is thoroughly saturated with the cleanser.
  • Blow dry the hair until completely dry.
  • Leave the treatment in the hair for 8 hours or more. Lice can go up to 8 hours without taking a breath.
  • Repeat once a week for three weeks.

“The key to lice treatment is to remember that you are treating the scalp, and not the hair. For kids with long thick hair parents have to take the time to make sure that they are applying the treatment to the scalp and not just using it like shampoo. Also remember to re treat in 7-10 days because that is when the nits hatch and can cause a re-infection. We normally recommend treating all the kids in the home if there is a history of reinfection,” Dr. O’Reilly said.

Using other home remedies to treat lice

Many people hoping to avoid using harsh chemicals often turn to home remedies to treat lice.

Not all options have proven effective. If you do end up trying other techniques, make sure you keep checking your hair. If the lice just won’t go away, contact your doctor.

“In general, I think you can say that there is science to back up the use of Cetaphil. All these other home remedies (olive oil, mayo, tea tree oil, etc.) are not proven and may be a waste of time and money,” Dr. O’Reilly said.

Can you treat head lice with…


Despite social media claims, Coca-Cola cannot get rid of lice.

Not only are the ingredients not toxic to the little bugs, Coca-Cola also doesn’t have ingredients that can detach the nits from your hair.

It’s important to do your research before using a natural remedy a stranger posts about.

Listerine? Other Mouthwashes?

Some people think the alcohol found in some mouthwashes can treat ticks. But it’s not a good treatment.

“Regular alcohol is not effective at killing lice. Benzyl alcohol lotion (5%) or the brand name product, Ulesfia lotion, is a prescription treatment that can be used in kids over 6 months old but it is not a first line treatment,” Dr. O’Reilly said.

Coconut oil?

Some studies have shown coconut oil can be an effective treatment against lice.

But coconut oil still isn’t a completely proven treatment.

While the adult lice will die, coconut oil won’t kill the nits attached to your hair. This means you may have to do a coconut oil treatment many times for it to work.

Some suggest using a combination of home remedy treatments.


People using this method often say the mayonnaise will smother the lice, killing them in the process.

While the technique may work for some people, there’s no proof mayo actually gets rid of lice. And mayo doesn’t hurt nits.

If you want a fast lice treatment solution, this is not the method for you. You’ll likely be cause in a continuous cycle of mayo treatments as nits keep hatching. On top of that, mayo is harder to get out of your hair.

Olive oil?

There are some olive oil brands and distributors who promote olive oils, but it’s not a reliable treatment method.

“I don’t think that you can depend on olive oil to kill lice and nits,” Dr. O’Reilly said.


While Vaseline is one of the more effective home remedies, it’s not foolproof.

One study found petroleum jelly stops all but 6% of nits from hatching and can kill a lot of lice – but it won’t stop the surviving lice from laying more eggs.

Tea Tree Oil?

Tea tree oil and other essential oils are also not proven to treat lice.

Some say the diluted essential oil, when combined with combing and shampooing, can get rid of lice.

Make sure you do a patch test first. Some people are allergic to essential oils, and they’re not proven to be safe for children.

Apple cider vinegar?

Researchers have found apple cider vinegar is one of the most ineffective lice treatments.

It doesn’t do a good job of killing lice and cannot remove nits from your hair.

Are there salons that treat head lice?

There are some salons that offer head lice treatment services.

But call ahead before you go to a traditional hair salon. Some salons turn away clients with lice.

Why are some over-the-counter treatments not working?

In 2015, there were reports of “mutant” head lice that have become resistant to the commonly used over the counter products and even some prescription drugs. Massachusetts is just one of the 25 states that have seen these mutant lice.

Now the effectiveness of some over-the-counter treatments for lice, such as shampoos and cream rinses, is being called into question.

Dr. Kyong Yoon of Southern Illinois University – a former UMass graduate student – and his team were the first to collect lice samples from many populations across the United States. 104 of the 109 lice populations they tested recently had high levels of gene mutations, which have been linked to resistance to pyrethroids.

A pyrethroid is an organic compound like the natural pyrethrins produced by the flower of pyrethrums and used in a variety of commercial household insecticides. They include permethrin, which is the active ingredient contained in most of the common lice treatments sold over the counter.

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.

You should also talk to your doctor if home remedies are not working for you.

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