This is a follow up post to my recent post on treating head lice. It’s all just a major inconvenience. And worse than having lice is having lice again and again. And even worse than your child getting re-infested may be treating lice with an ineffective therapy. Enter…..”super lice.” Ewwwww. Although please know that their name exceeds their actual scariness. These lice are only different (aka “super”) in that some lice may have developed gene mutations that indicate they are developing resistance to a common class of over-the-counter (OTC) treatments (permethrin).

A 2016 study in The Journal of Entomology that got a bunch of media coverage found resistant lice all over the United States. Lice were sampled from 48 states at well over 100 different centers to evaluate their patterns of mutations that may render them resistant to OTC medications. Do note that the study was funded in part by the pharmaceutical company that makes one of the prescriptions, but nonetheless did find that lice are becoming harder to treat, coast to coast.

Do you have a super lice? It may be hard to know. If you’ve treated your child several times exactly according to directions and aren’t having success, you should explore prescription medications that may work better. But REMEMBER though, that sometimes you child is just getting re-infested from someone at school.  It is sometimes hard to decipher if the OTC medication is ineffective, or if your child has been re-exposed. Working with your school and with others where your child may have been exposed is always a part of this when a child continues to have lice after a treatment. There are some medicines (see section below) that may help if the OTC meds are not working. The chart below shows where the resistant bugs were detected (red is fully resistant, orange shows intermediate resistance, and green showed no resistance to OTC meds).

Image c/o Journal of Entomology

A Few Prescription Lice Medications

There are 4 main medicines registered for use in the United States that can treat these “super” lice by prescription: Ulesfia (Benyzl Alcohol — suffocates lice but doesn’t kill eggs so you have to re-apply… but the medicine is not a neurotoxin), Natroba (Spinosad — kills lice and eggs), and Sklice (Ivermectin — kills lice and eggs) and Ovide (Malathion — kills lice and eggs). These meds are easy to use but not entirely cheap and may or may not be covered by your insurance. Ask your pediatrician what they think about giving you a prescription (ask: are they seeing lots of resistant cases in your neighborhood?) if you’re having trouble getting rid of lice. If your pediatrician is seeing many cases of difficult to treat lice they may be more apt to prescribe and you may want to start with a prescription. Not a lot of data out there that one of these medicines is far better than the other but I will say that like many of the OTC treatments, the prescription meds are pretty easy (one treatment and you’re done)!

PRO TIP: A nice chart comparing medicines and other tips for getting rid of lice here on Healthy Children from The American Academy of Pediatrics.