I think my
child has head lice. What should I do?
Pearlman cannot tell you specifically what to do without examining
your child in his office. However, there is a general approach you
can follow. As with all medical conditions, you need an
accurate diagnosis and then an effective treatment. To evaluate
the child you may wish to use a Lice Identification Test (LIT). We
find this to be the best way of proving the presence or absence of
a lice problem. Then in most cases, we recommend the Nuvo®
method for treatment.
Should I do
a LIT for other family members?
There may be
others in the family who are infested but show no symptoms. You
may elect to screen everyone in the family now with a LIT, or you
may choose to wait until signs or symptoms of head lice appear.
wrong with just looking at my child's scalp to see if lice or nits
of nits (louse eggs) does not prove active infestation. These may
be inactive, dead nits from a prior infestation. Or the white
specks may not even be nits at all. The only way to prove active
infestation is to find actual crawling lice.
crawling-phase head lice by looking at the scalp is not easy. Dr.
R.J. Roberts, a noted British head lice researcher
writes “visual inspection of the hair and scalp is widely
practiced, but this approach may miss three quarters of
infestations.”A better method is the Lice Identification Test (see
above). In Dr. Pearlman’s experience,a properly performed LIT is
more than 99% reliable in proving or disproving the presence of a
ever wrongly diagnosed as having head lice? Could the parent on
“lice patrol,” the nurse, or even the doctor be wrong?
there are several situations which are mistakenly diagnosed as
head lice even though no head lice are present.
1) The child
has so-called fake or pseudo nits rather than real nits. There are
two types of commonly found fake or pseudo nits. In one type, the
child has dandruff scales which stick together in lumps that can
resemble real nits. In the other type, the child has an
abnormality in which the adjacent normal skin adheres to the hair
shaft, creating a white lump that mimics the appearance of a nit.
2) The child
has real nits but they are from a prior infestation. The only way
to diagnose an active problem is to find crawling lice. The best
way to find lice is to do an LIT.
3) The child
has an itchy scalp from dandruff and the scaling is mistaken for
lice or nits.
The absence of
real nits and especially a negative LIT clarifies this situation.
for head lice treatment
The Nuvo method is the nontoxic treatment for head lice described
in Dr. Dale Pearlman’s
study published in the September 2004 issue of the journal
Pediatrics. In this study, the Nuvo method was 96% effective and
involved only minimal household cleanup.
apply the Cetaphil Cleanser to the hair and scalp, and use a comb
to distribute the lotion evenly and to remove excess lotion. You
then use a hair drier to dry the lotion in place, which "shrink
wraps" the lice, cutting off their source of oxygen. You leave
the dried lotion on the hair for at least eight hours. It can
then be washed out with a regular shampoo. For detailed
instructions on how to use the Nuvo method with Cetaphil Cleanser,
The lotion Dr. Dale
Pearlman used in his head lice study was
Cetaphil Gentle Skin Cleanser, a widely sold, soap-less
cleanser for people with sensitive skin. It is sold in pharmacies
in the U.S. and abroad. For full instructions on how to use the
Nuvo method with Cetaphil Cleanser,
Cleanser an FDA approved remedy for head lice?
The Nuvo method using Cetaphil Cleanser for treating and
diagnosing head lice has not been evaluated or approved by the
U.S. Food and Drug Administration. Cetaphil® is a
trademark of Galderma Laboratories, L.P. United States, which has
not reviewed or endorsed the material on this web site.
our knowledge, the Nuvo Method using Cetaphil Cleanser is the most
successful non-toxic-based therapy to have been proven to work in
a peer-reviewed, published, scientific study.
I bought Cetaphil Moisturizer instead. Can I use it
for the Nuvo method?
Our research only studied
the Cetaphil Gentle Skin Cleanser, so we do not know about the
usefulness of the moisturizing lotion. We advise people who want
to try the Nuvo method to only use the cleanser.
Why do you
leave it on the hair for eight hours?
Lice can hold their breath for a very long time. A louse needs to
be submerged or coated with lotion for at least eight hours to
die. That is why other wet suffocation treatments like olive oil
or mayonnaise are unreliable. The wet treatment can be wiped off
too soon if the child lies down on a pillow, changes a shirt, or
just rubs the hair. The child cannot wipe off the dried-on lotion.
With the Nuvo method, patients usually leave the dried lotion in
their hair until the next day and shampoo it out at bath time with
the child's usual shampoo. The dried lotion is invisible in the
hair, so the children are not embarrassed to have it in their hair
during the day.
Nuvo method kill nits (louse eggs)?
No, the Nuvo method kills only crawling lice.
If the Nuvo
method does not kill the nits, how can it work?
The Nuvo method cures head lice infestations by disrupting the
life cycle of the lice. The lice are all killed before they can
lay any more eggs. The Nuvo method is used in three
applications. The first application kills the crawling lice. The
second application, one week later, kills the lice that have
hatched in the interim. Because it takes a louse about 10 days to
become sexually mature, the newly hatched lice cannot lay more
eggs. A third application kills any remaining lice that might
have hatched after the second application.
saying that newly hatched lice may still be on my child's head
during the treatment. Does that mean my child will be
Although baby lice or instars will hatch on your child's head,
these instars do not migrate on their own to a new host. Only
older "teenage" or adult head lice migrate. The serial
applications of Cetaphil will kill them before they are mature
enough to migrate. It is still a good precaution not to let your
child share combs that may transfer instars.
The families in the research study did only minimal household
cleanup. They laundered their clothes, and put their bedding in
the drier for 10 minutes. In addition they sanitized their combs
and hair brushes by running them through the dishwasher. Patients
in the study had a 96% cure rate using this cleanup regimen.
I don’t see
how your recommendations for minimal household cleanup could be
reasonable. Why don’t we need to clean up carpets and couches and
chairs? Couldn’t nits fall off our child onto these surfaces, and
hatch there? Then couldn’t the louse climb onto someone else? What
about children’s stuffed, plush toys. Couldn’t a louse lay eggs
there that would hatch and infect other people?
louse egg contains the embryo of a living creature. It requires
specific temperature and humidity requirements in order to
develop. These conditions are found on the human scalp but not on
the floor, a chair, or a couch. So the nit will not hatch when off
the human head. Thus we are not concerned with nits that fall on
A good way to
think about lice eggs is to compare them to chicken eggs. The egg
must either be under the hen or in a special incubator in order to
hatch. It will not hatch on the floor.
There is no support for the
standard recommendation to vacuum floors as part of curing head
lice. There is no report in the research literature of lice being
found on the carpets of the home or school. An Australian
researcher, Rick Speare,
evaluated the floors of 118 schools where 20% of the students
had head lice. There were no lice found on the carpets.
that a louse would lay eggs on a plush toy is not valid. Female
lice lay eggs on human hairs as close as possible to the scalp as
possible for good reasons. First such a location assures the
conditions described above to allow the eggs to develop. Second,
such proximity to the scalp means the newly hatched baby lice will
easily find a place for its first meal nearby. A plush toy’s
“hairs” do not offer either of the above required conditions.
While one often hears about the need to remove all the stuffed,
plush toys from a child’s environment, actually there are no
published reports showing lice eggs on plush toys.
Do head lice migrate to household dogs and
cats? If so, do they need to be treated as well?
Head lice only live on people. There is no need to evaluate or
treat dogs, cats or other pets.
the advantages of the Nuvo method of treatment? Why chose it over
the other treatments?
is now major problem in treating head lice because they have
become resistant to the usual treatments. This means that
permethrin, pyrethrin, malathion, and other chemical pediculicides
you buy in the pharmacy may fail to cure your child.
method is a highly reliable head lice treatment. In our research,
96% of patients were cured by a three-week course of treatment. It
is effective even in cases resistant to those standard treatments.
More than 70% of patients in Dr. Pearlman’s original research
report had been resistant to such usual treatments.
conventional treatments, Cetaphil cleanser, the lotion used in the
Nuvo method, contains no neurotoxins.
method is simple. No nit removal or extensive household cleanup
method produced long term cure. 94% of patients cured with the
Nuvo method were still lice-free more than 6 months after
You say the
treatment is 96% effective. What does that mean?
Answer: In Dr.
Pearlman’s research study, 96% of patients had no more head lice
after three treatments. The remaining 4% of patients were cured by
one more application of lotion.
usual products fail, why is it that Nuvo treatment still works?
usual products, such as Nix® and Rid®, are
chemical neurotoxins which rely on attacking a specific
biochemical target in the louse. Over time, many lice have mutated
so that this target has changed and is no longer vulnerable to the
chemical. Nuvo treatment does not rely on such a specific target.
It works by coating the entire louse with a layer of dried on
lotion which plugs up their breathing holes. They can’t breathe so
they die. Lice can’t mutate their way out of the need to breathe.
circumstances is the Nuvo method not a good choice for a patient?
Answer: If the
patient or the parent are not able to carry out the steps of
treatment correctly, then Nuvo is not a good choice. Sometimes
parents are unwilling to devote the time to properly apply the
lotion, and then comb, and dry the patient’s hair. Sometimes the
child is not willing or able to allow the treatment. The child
might be too fidgety, too impatient, or not able to be diverted
with videos or reading or television.
I live in Germany. Where can I find
We have been advised that the manufacturer,
Galderma German pharmaceutical company medical unit says the
"Cetaphil gentle facial cleanser" is available on the German
market only in pharmacies. It is sold under the name "Cetaphil
I used the
Nuvo method for three consecutive weeks and my child still has
head lice. What gives?
through the following checklist.
1) Did your
child ever actually have head lice? Read the FAQs above on
diagnosis and evaluate the accuracy of the diagnosis.
2) Was a Lice
Identification Test (LIT) done before and after treatment that
still shows lice present? See the FAQs above about Lice
Identification Tests and proper evaluation.
3) If your
child had an LIT showing active infestation before treatment, and
after treatment also had an LIT showing active infestation, we
must ask if the treatment was done correctly. While the treatment
is relatively easy to do, you must follow the directions
carefully. Read through our common errors list, and make sure
that you are not making one of these common mistakes.
Four Common errors in Nuvo method treatment
skimp on amount of Cetaphil Cleanser used.
You must use
precisely the amount recommended in the detailed instructions or
will fail to
coat all the lice with lotion. An uncoated louse will survive the
treatment and may go on to reproduce. This is especially
important for children with shoulder length or longer hair. You
must remember to add an extra half bottle because of the long
apply the lotion incorrectly to the scalp.
parents just squirt it on top of the hair and try to massage it
in. This is NOT the way we explain in the instructions. You must
achieve a uniform coverage of the entire scalp to be effective. It
is critical to be touching the scalp with the nozzle the entire
time you apply the lotion. The “criss cross” pattern of
application assures even, complete coverage.
do not completely dry the lotion on the scalp.
completely dry the scalp so that it is totally dry. The lotion
works by drying onto the louse and plugging up the breathing
holes. If you leave it partly wet then the lotion can be
accidentally rubbed off when your child changes his shirt, lies
down on his pillow, rubs his hair, or lies on the carpet or couch.
By thoroughly drying the lotion in the scalp, the lotion adheres
to the lice and kills them.
timing between the applications is wrong.
You must use
the treatment in three applications done at one-week intervals.
The dried lotion kills lice and disrupts their life cycle. If you
wait too long for the next application, then baby lice can grow
into adults and lay eggs and continue on the cycle.
If you did the
treatment incorrectly, then you must start over again from the
I bought Cetaphil Moisturizer instead. Can I use it for the
Our research only studied the Cetaphil Gentle Skin Cleanser, so
we do not know about the usefulness of the moisturizing lotion. We
advise people who want to try the Nuvo method to only use
Cetaphil Gentle Skin Cleanser.
I bought Cetaphil Facial Cleanser instead. Can I use it for
the Nuvo method?
Our research only studied the Cetaphil Gentle Skin Cleanser, so
we do not know about the usefulness of the Facial Cleanser.
We advise people who want to try the Nuvo method to only
use Cetaphil Gentle Skin Cleanser.
Where can I
find out more about head lice?
A great source of information about head lice is this
web site by Dr. Rick Speare. We also recommend the Harvard
School of Public Health
We regret that
we cannot answer individual e-mail questions from parents.
However, if you feel at your question has not been answered on our
web site, please send an e-mail to
Mail@Nuvoforheadlice.com. From time to time, we will
be posting the answers to additional FAQs.