NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is headlice.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

MHRA Drug Safety Update (March 2018): Head lice eradication products: risk of serious burns if treated hair is exposed to open flames or other sources of ignition, e.g. cigarettes

Parents, caregivers and the individual(s) with head lice, if appropriate, should be aware that some products for the eradication of head lice infestations are combustible/flammable when on the hair, and that it should be kept away from open flames or other sources of ignition, including in the morning after overnight application until hair is washed.

Dimeticone

• Lotion 4% (£10.00 = 150ml)

Indications

• Head lice

Dose

• Rub into dry hair and scalp, allow to dry naturally, shampoo after minimum 8 hours (or overnight); repeat application after 7 days

Malathion

• Aqueous liquid 0.5% (£14.31 = 150ml)

Indications

• Head lice
• Crab lice
• Scabies

Dose

• Head lice, rub 0.5% preparation into dry hair and scalp, allow to dry naturally, remove by washing after 12 hours (see also notes above); repeat application after 7 days
• Crab lice, apply 0.5% aqueous preparation over whole body, allow to dry naturally, wash off after 12 hours or overnight; repeat application after 7 days

Permethrin

• Cream 5% (£8.65 = 30g)

Indications

• Crab lice
• Scabies

Dose

• Crab lice, adult over 18 years, apply 5% cream over whole body, allow to dry naturally and wash off after 12 hours or after leaving on overnight; repeat application after 7 days

Notes

1. Permethrin is effective for scabies and crab lice. It is active against head lice but the formulation and licensed methods of application make them unsuitable for treatment.