# Head Lice (pediculosis capitis) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAP Clinical Report: Head Lice 2022 for the indication, with the product from Egyptian National Drug Formulary - Antimicrobial 2023, Permethrin monograph (printed page 414): "Head lice: Topical: Cream rinse/lotion 1%: Prior to application, wash hair with conditioner-free shampoo; rinse with water and towel dry. Apply a sufficient amount of lotion or cream rinse to saturate the hair and scalp ... Leave on hair for 10 minutes (but no longer), then rinse off with warm water; remove remaining nits with a nit comb. A single application is generally sufficient; however, may repeat 7 days after first treatment if lice or nits are still present." The formulary's head lice strength is 1% against the 2.5% given here, and it puts 5% at scabies. · AAP Clinical Report: Head Lice 2022 · CDC Parasites: Lice: Head Lice Treatment 2020 · Ovide (malathion) Lotion 0.5% US prescribing information (DailyMed, Taro) - Verified date: 2026-08 ## Verified against - AAP Clinical Report: Head Lice 2022 for the indication, with the product from Egyptian National Drug Formulary - Antimicrobial 2023, Permethrin monograph (printed page 414): "Head lice: Topical: Cream rinse/lotion 1%: Prior to application, wash hair with conditioner-free shampoo; rinse with water and towel dry. Apply a sufficient amount of lotion or cream rinse to saturate the hair and scalp ... Leave on hair for 10 minutes (but no longer), then rinse off with warm water; remove remaining nits with a nit comb. A single application is generally sufficient; however, may repeat 7 days after first treatment if lice or nits are still present." The formulary's head lice strength is 1% against the 2.5% given here, and it puts 5% at scabies. - AAP Clinical Report: Head Lice 2022 - Ovide (malathion) Lotion 0.5% US prescribing information (DailyMed, Taro) ## Treatment metadata - Permethrin — topical - Malathion — topical ## Complete treatment card ```text HEAD LICE (PEDICULOSIS CAPITIS) Sources: AAP Clinical Report: Head Lice 2022 for the indication, with the product from Egyptian National Drug Formulary - Antimicrobial 2023, Permethrin monograph (printed page 414): "Head lice: Topical: Cream rinse/lotion 1%: Prior to application, wash hair with conditioner-free shampoo; rinse with water and towel dry. Apply a sufficient amount of lotion or cream rinse to saturate the hair and scalp ... Leave on hair for 10 minutes (but no longer), then rinse off with warm water; remove remaining nits with a nit comb. A single application is generally sufficient; however, may repeat 7 days after first treatment if lice or nits are still present." The formulary's head lice strength is 1% against the 2.5% given here, and it puts 5% at scabies. · AAP Clinical Report: Head Lice 2022 · CDC Parasites: Lice: Head Lice Treatment 2020 · Ovide (malathion) Lotion 0.5% US prescribing information (DailyMed, Taro) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Itching is the main presenting complaint of a lice infestation [itching] - Itching in someone living in crowded or unhygienic conditions raises suspicion for body lice [itching] SIGNS - what you find (4) - Diagnosis is confirmed by seeing at least one live louse on examination - Nits alone do not confirm active infestation, since they can persist on hair for months after treatment - Dandruff, hairspray residue, and dirt can look like nits and cause false positives - Pubic lice are diagnosed by finding lice in the pubic hair itself TESTS (4) - Sticky tape can collect adult lice from the scalp for microscopic examination - Nits look oval and are firmly attached to the hair shaft - A Wood lamp makes nits fluoresce greenish-yellow - Skin scrapings can rule out a fungal infection when the diagnosis is uncertain IF NOT THIS - what else fits (6) - Scalp lice must be differentiated from dandruff - Scalp lice must be differentiated from seborrhea - Scalp lice must be differentiated from superficial fungal infection - Scalp lice must be differentiated from eczema - Scalp lice must be differentiated from folliculitis - Scalp lice must be differentiated from scabies Source StatPearls "Pediculosis" - disease-level clinical article Status traced to the source above 1. PERMETHRIN [1st line] Adult Apply 2.5% lotion or cream to clean, towel-dried hair and scalp, leave on for 10 minutes, then rinse thoroughly with warm water. Repeat application in 7-10 days. x 2 applications 7-10 days apart Peds Suitable for infants and children >=2 months old. Apply to scalp/hair, leave on for 10 minutes, rinse. Repeat in 7-10 days. Source AAP Clinical Report: Head Lice 2022 for the indication, with the product from Egyptian National Drug Formulary - Antimicrobial 2023, Permethrin monograph (printed page 414): "Head lice: Topical: Cream rinse/lotion 1%: Prior to application, wash hair with conditioner-free shampoo; rinse with water and towel dry. Apply a sufficient amount of lotion or cream rinse to saturate the hair and scalp ... Leave on hair for 10 minutes (but no longer), then rinse off with warm water; remove remaining nits with a nit comb. A single application is generally sufficient; however, may repeat 7 days after first treatment if lice or nits are still present." The formulary's head lice strength is 1% against the 2.5% given here, and it puts 5% at scabies. Why AAP/CDC guidelines specify 1% permethrin baseline; Ectomethrin 2.5% lotion/cream is the registered formulation available in Egyptian retail pharmacies. Caution Avoid contact with eyes and mucous membranes; rinse thoroughly with water if contact occurs. Re-treatment on day 7-10 is essential to kill newly hatched nits, as topical pediculicides are not completely ovicidal. Examine and treat all household members with active infestation simultaneously to prevent re-infestation. Egypt ECTOMETHRIN 2.5 % CREAM 20 GM MISR > APC (A... 12.00 EGP ECTOMETHRIN 5 % CREAM. 20 GM MISR > APC (A... 21.00 EGP ECTOMETHRIN 5% OINT. 20 GM MISR > APC (A... 21.00 EGP NEWCID 1% 60ML SHAMPOO CID 9.00 EGP NEWCID 1% 80ML SHAMPOO CID 11.00 EGP 2. MALATHION [2nd line] Adult Apply 0.5% lotion to dry hair and scalp, allow to air dry naturally, leave on for 8-12 hours (or overnight), then wash out with shampoo. Repeat in 7-9 days if live lice persist. x 1-2 applications 7-9 days apart Peds Approved for children >=6 months (BNFC 2024) or >=6 years (CDC 2020 / FDA). Apply to dry hair, leave for 8-12 hours, then shampoo out. Repeat in 7-9 days. Source Ovide (malathion) Lotion 0.5% US prescribing information (DailyMed, Taro) Why Second-line organophosphate pediculicide registered in Egypt (Prioderm / Lice Clean 0.5% lotion) used when permethrin treatment failure or resistance occurs Caution Flammable due to isopropyl alcohol base; keep away from open flames, heat sources, and electric hair dryers while applied. Do not use in infants under 6 months of age without specialist advice. May cause temporary scalp irritation or stinging. Leave the hair uncovered while it dries, and comb it through with a fine nit comb after rinsing - the lotion kills, the comb removes. It is an organophosphate. If a child swallows any, that is an immediate hospital trip, not a wait. Egypt PRIODERM 0.5 % LOTION 60 ML PHARCO > MUND... 8.00 EGP -> ? different route - not topical LICE CLEAN 0.5GM/100ML TOPICAL LOTION WESTERN PHARMACEUTICALS INDUSTRIES... 8.00 EGP -> ? different route - not topical Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)