Lice checks were a dreaded part of my childhood — I remember anxiously waiting for the nurse to call my name for a checkup, hoping a call home wouldn’t follow (sometimes, I wasn’t so lucky). Head lice are most common in children between the ages of 3 and 11 years old, often due to close contact in school, on the playground and during sleepovers. On top of being a pain to treat, they can also infest adults and other children in the house. Important to note: Lice are not an indication of poor hygiene, according to experts.
I spoke with dermatologists and hair specialists about how to best control a head lice infestation and eliminate them for good. Read on for our experts’ advice as well as their product recommendations for treatment and prevention.
How I picked the best lice treatments
Here are the key factors I kept in mind to pull together this list, as recommended by my experts:
- Treatment type: There are two main types of lice treatments: chemical insecticides and suffocating agents. Insecticides include over-the-counter treatments like permethrin (commonly found in popular brand Nix) and pyrethrins (found in brands like Rid and R&C), as well as prescription-based treatments like spinosad and ivermectin (more on these treatments below). Suffocating agents, on the other hand, are insecticide-free and include oils like dimethicone to suffocate and kill lice and their eggs. The most effective treatments are prescription-based, so you should talk to your doctor if you have a hard-to-treat infestation, according to my experts.
- Physical methods: All of the experts I spoke to recommend using a metal nit comb to remove lice eggs and kill them before they hatch. You should use a nit comb in conjunction with a primary treatment to fully get rid of lice and eggs, experts say.
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Best lice treatments in 2025
Best overall
This treatment is a favorite of Dr. Carmen Castilla, a board-certified dermatologist at the New York Dermatology Group in Manhattan, because it comes in a two-pack (which is great for treating multiple family members), includes a fine tooth comb to remove nits and it’s safe for kids ages two months and up. It prevents lice reinfestation for up to 14 days after an initial application, according to the brand.
Best nit comb
All of my experts recommend using a fine-toothed metal nit comb in conjunction with a primary treatment because it makes finding and getting rid of nits easier (which a primary treatment may not fully kill). This Nit Free metal comb comes recommended by Dr. Svetlana Danovich, a cosmetic surgeon and founder of SD Medical Arts — and it’s one that my mom used on me as a child. It has rounded teeth that won’t cause painful scratches on the scalp, and has an anti-slip handle to ensure a secure grip. In addition to a good metal lice comb, use a bright light and a magnifier to spot tiny eggs, says Danovich.
Best fast-acting
When NBC Select editorial operations associate Jem Alabi got head lice last year, she used this all-in-one spray to treat it. “My case was so bad, I almost shaved my head,” says Alabi. “I tried everything to get rid of them, but the thing that finally saved me was this $15 spray from Amazon.” Alabi sprayed this treatment on her braids and noticed it worked without needing to comb the product through the hair. “Plus, you only need to leave it on for 20 minutes before washing out. I used a bonnet after applying the spray and was able to pick out/wash all the dead lice/eggs that same day,” she says. The spray kills lice and their eggs using dimethicone, an active ingredient that suffocates them, experts say. It’s also safe for sensitive skin, according to the brand, and comes with a fine tooth comb.
Best pesticide-free
This kit includes a lice treatment solution and a lice shampoo and conditioner, all of which are pesticide-free and made from suffocating agents (like oils) for “super lice” that are resistant to common insecticides like permethrin (more on these types of treatments below). The brand recommends using the treatment solution twice, two weeks apart, and the shampoo and conditioner daily until lice is fully gone. The kit comes with a nit comb to remove lice eggs, too. Rid also has a kit to treat lice in both hair and home.
If you want to avoid head lice altogether, consider this Lice Shield shampoo and conditioner combo, which repels lice using suffocating agents like citronella, rosemary, lemongrass, cedar and geraniol. It’s gentle enough to use on your child’s sensitive skin and leaves hair soft and clean, according to the brand.
How to treat head lice
Typically, you can treat head lice using topical treatments and/or physical methods of removal to rid of the nits, says Dr. Kristin Lo Sicco, a board-certified dermatologist and hair specialist at NYU Langone Health. “You need to ensure that you kill both the adult lice, nymphs (or “baby lice”) and nits (lice eggs), says Castilla.
There are two main types of lice treatments:
- Chemical insecticides: These are the traditional treatments for head lice, which you can get as a prescription or over the counter. Common insecticides include permethrin, spinosad and ivermectin (more on these treatments below). Look for treatments that come as lotions, solutions or creams, which are easier to apply, says Lo Sicco. Keep in mind that some lice may have developed a resistance to over-the-counter treatments (called “super lice), though this isn’t common, says Castilla.
- Suffocating agents: An alternative for those who are concerned about chemicals or resistance, these are non-insecticide products that physically disable the lice and may have less resistance and higher cure rates after proper application, says Lo Sicco. Suffocating agents usually have a silicone oil known as dimethicone, which kills head lice and their eggs by coating them in a thick layer of oil to suffocate them.
Over-the-counter treatments
OTC head lice treatments are considered the first-line treatment by the American Academy of Pediatrics. Here are a few to consider:
- Permethrin is an OTC ingredient that kills live lice by paralyzing their nervous system, says Castilla. You’ll need to use this treatment again after nine days to kill any newly hatched lice before they can produce new eggs. However, permethrin is not very effective on nits and requires a nit comb to manually remove the eggs (see below), says Castilla. Permethrin is approved for ages two months and up, she says.
- Pyrethrins, which derive from the chrysanthemum flower, kill live lice, not unhatched eggs (nits). Like permethrin, you’ll need to use treatments with this ingredient twice (nine to 10 days after the first treatment) to kill any newly hatched lice before they can produce new eggs. It’s approved for use on children two years of age and older, according to the CDC.
You should also use a physical method of lice and nit removal in combination with topical therapies, says Lo Sicco. “This takes patience as it takes about 30 minutes and may be required daily for several weeks,” she says. Using a nit comb (a metal fine-toothed comb long) on wet hair is usually the most effective physical method because it removes lice and their eggs from hair, experts say. “Start at the top of the hair shaft, closest to the scalp, then comb away from the scalp,” says Lo Sicco. “You really have to be methodical about manual removal, break the hair up into quadrants and be extremely thorough,” says Castilla. To make the process easier and avoid snagging hair with a nit comb, apply conditioner, says Lo Sicco.
Prescription treatments
Here are a few prescription head lice treatments to keep in mind, according to Castilla:
- Malathion (0.5%): Kills lice and some eggs, and it’s usually used when other treatment options have failed, says Castilla. It’s approved for ages six and older.
- Spinosad (0.9%): Kills both adult lice and eggs. It’s highly effective and does not require nit combing or a second treatment, says Castilla
- Ivermectin (topical or oral): Kills lice by paralyzing them and may reduce egg-laying.
- Benzyl alcohol lotion (5%): Suffocates lice but does not kill eggs, so a second treatment is necessary, says Castilla.
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Meet our experts
At NBC Select, we work with experts who have specialized knowledge and authority based on relevant training and/or experience. We also take steps to ensure all expert advice and recommendations are made independently and without undisclosed financial conflicts of interest.
- Dr. Svetlana Danovich is a cosmetic surgeon and founder of SD Medical Arts based in the New York City and Great Neck area.
- Dr. Carmen Castilla is a board-certified dermatologist in New York City who specializes in both cosmetic and medical dermatology.
- Dr. Kristin Lo Sicco is a board-certified dermatologist and hair specialist in the department of dermatology at NYU Langone Health.
Why trust NBC Select?
I’m an updates editor at NBC Select who has written about skin care, hair care and wellness since 2021. For this article, I spoke to three dermatologists and hair specialists to find the best head lice treatments and how to get rid of them for good.
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