UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric Head Lice: A Hairy Ordeal

Keywords: Pediatrics, head lice (PubMed Search)

Posted: 1/6/2014 by Danielle Devereaux, MD (Updated: 12/11/2023)
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Head lice infestation is a common problem in the United States with treatment costs estimated at 1 billion dollars and cases affecting millions of children each year.  Many of these children present to the ED for care...lucky us!  Traditional therapies containing permethrin and pyrethrins are having increased rates of treatment failure likely secondary to increasing resistance and medication noncompliance.  The typical first line agents require multiple doses.  There are safety concerns regarding therapies that contain malathion and lindane in children.  Is there another option?  Topical ivermectin 0.5% lotion applied to scalp in a single dose has been shown to be effective and safe for treatment of head lice infestation in children older than 6 months.  It was FDA approved at the end of 2012.  Considerations include cost. Sklice lotion is expensive!  

The NEJM article was considered an "editors pick"  by the AAP as one of the best articles of 2012-2013.


1. Pariser DM, Meinking TL, Bell M, et al. Topical 0.5% ivermectin lotion for treatment of head lice. N Eng J Med. 2012; 367(18):1687-1693

2. Wright, T. Topical Ivermectin: a new treatment for head lice. AAP Grand Rounds, Feb 2013, Vol 29(2)

3. Frankowski BL, et al. Head Lice. Pediatrics. 2010; 126:392-404

4. Meinking TL, et al. Head Lice. Pediatric Dermatology. 2010; 27(1):19-24