Head lice? Don't panic—just treat them properly

Head lice are a nuisance, but they’re easy to treat. They occur in every family and aren’t a sign of poor hygiene. You can usually get rid of them by combing the hair thoroughly and, if necessary, using a treatment.

Where do head lice come from?

Head lice live only on humans. They seek out a warm scalp, hair to cling to, and blood for food. When they bite, their saliva enters the skin. This can cause itching. Not everyone experiences itching right away.

Lice do not come from pets and are not caused by poor hygiene. They mainly crawl from one head to another when hair comes into contact, for example while playing, hugging, or looking at a phone together. They cannot fly or jump. Transmission via personal items is likely rare. Therefore, extra cleaning or washing all sheets and stuffed animals is not necessary. [source 1,2]

How to recognize a louse or nit

An adult head louse is 2 to 4 millimeters long and gray-blue to reddish-brown. Nits are eggs measuring about 1 millimeter. Live nits are firmly attached to a hair, close to the scalp (up to about 4 millimeters from it). Dandruff comes off easily; a nit does not. After about a week, a young louse hatches. It can lay eggs on its own after 7 to 10 days. [sources 2,3]

Just looking isn’t enough. Wet the hair, apply conditioner, and comb with a fine-toothed comb from the scalp to the ends. Work section by section, especially behind the ears, at the nape of the neck, and under the bangs. Wipe the comb on a white piece of paper. A moving louse confirms the infestation.

What treatments are available?

Dutch clinical guidelines recommend careful daily combing for two weeks. This can be a complete treatment. If you also want to use an anti-head lice treatment, start it at the same time as combing and, according to the RIVM, choose dimeticone. Continue combing daily for two weeks even then. [sources 1–4]

Dimeticone: a physically acting agent

Dimeticone is a silicone oil. It seals the lice’s breathing holes and therefore does not act on the nervous system. Conventional insecticide resistance is therefore not expected. Its effectiveness has been well studied, but varies by product and treatment regimen. Therefore, always follow the package insert. [sources 5, 6]

Permethrin and malathion: older insecticides

Permethrin and malathion are older insecticides. Products containing these substances are no longer sold in the Netherlands for the treatment of head lice due to the risk of resistance. Therefore, when using a head lice treatment, opt for dimethicone. [source 4,7]

Plant-based and other alternatives

Tea tree, eucalyptus, and other plant-based remedies may sound mild, but “natural” does not automatically mean safe. Studies are small and vary widely. Skin irritation can occur. Never use pure essential oils, cleaning products, kerosene, or insect spray on a child’s head. [source 8]

Comparing treatments

The outcome depends on more than just the treatment. Using enough product, ensuring complete coverage of the hair and scalp, the correct application time, repeat treatments, and monitoring by household members are just as important.

Treatment	Effectiveness	Advantages	Disadvantages	Special Considerations
Dimethicone	Preferred in current Dutch guidelines; its efficacy has been well-studied. [5,6]	Acts physically; not a traditional insecticide. Resistance is not expected.	Must be applied thoroughly everywhere. May be greasy or irritate the scalp or eyes.	Exposure time varies by product. Often repeat after 7 days and continue combing daily. [3]
Permethrin	No longer sold in the Netherlands for the treatment of head lice due to the risk of resistance.[1]	Not applicable to current Dutch practice.	Resistance is the main reason this product is no longer sold for the treatment of head lice.	When using an anti-head lice treatment, choose dimethicone.
Malathion	No longer sold in the Netherlands for the treatment of head lice due to the risk of resistance. [1]	Not applicable to current Dutch practice.	Resistance is the main reason the product is no longer sold for the treatment of head lice.	When using a head lice treatment, choose one containing dimeticone.
Wet combing alone	May work if you comb very carefully every day for 14 days. Research shows varying success rates. [1,2,9]	No medication, no resistance, and no side effects from a treatment.	Takes time. It can be difficult or painful with long or curly hair.	In the Netherlands, it is a fully accepted first-line treatment. Also useful for monitoring and in combination with dimethicone.
Plant-based remedies	Evidence is uncertain due to small and highly varied studies. [8]	Some users find the scent or application pleasant.	Composition and mechanism of action vary. May cause skin irritation or allergies.	Not automatically safe for children. Not a proven method for preventing lice.

Practical step-by-step plan

Check first. Comb wet hair with conditioner. Check everyone in the household. Treat only those who have live lice or nits.
Choose a treatment method. Comb every day for 14 days. If you want to add dimeticone, start using it at the same time as combing and consult your pharmacist to choose the right product based on age, pregnancy, asthma, or a sensitive scalp.
Use dimeticone exactly as directed. Usually apply it to dry hair and cover both the hair and scalp completely. Don’t forget the nape of the neck and behind the ears. Let it air dry. The duration of action varies: some lotions last about 8 hours, while other gels last shorter. Always follow the package insert.
Repeat on time. Many dimethicone products are used on day 1 and day 8. Comb your hair on all the days in between and continue doing so for a total of 14 days. A second treatment targets young lice that hatch from nits later on. [source 3]
Check the results. If you still find live lice after two weeks, start over with two weeks of daily combing. Ask your pharmacist to check whether you used enough product, whether the treatment time was correct, and whether there might be a new infestation.

Frequently Asked Questions

Do I need to treat the whole family?

No. Check everyone, but only treat people on whom you find lice or nits. Otherwise, you’re using the treatment unnecessarily.

Can my child go to school?

Yes. Be sure to report the head lice to the school, daycare, and close contacts. That way, others can check themselves, and you’ll prevent reinfection.

Do I need to wash bedding, stuffed animals, and coats?

No. Lice spread mainly through direct hair-to-hair contact. Extra washing and vacuuming do not help with treatment. [source 1,2]

Do lice capes or preventive sprays work?

There is no solid evidence that a cape, hat, or spray prevents head lice. Regular checkups—for example, monthly and after school breaks—are more effective. [sources 1,2]

When should you seek advice?

Ask your pharmacist for advice if you’re unsure about the diagnosis, if combing isn’t working, for a child younger than 6 months, during pregnancy, if there are allergies or a damaged scalp, and if treatment hasn’t worked after two weeks. We can help you choose the right product, the correct amount, and how to use it. Call your family doctor if there is painful inflammation, pus, or a fever.

This article provides general information. Personal advice may vary depending on age, skin conditions, or the product chosen.

Read the step-by-step guide on head lice at Thuisarts.nl

Read how dimethicone is used on Apotheek.nl