Understanding the Nix Treatment Protocol
Nix is an over-the-counter (OTC) medication containing permethrin, a synthetic insecticide that paralyzes and kills lice. While the first application is designed to kill all live lice, it is not 100% effective at killing all of the eggs, or nits. This is the key reason why a second treatment is often necessary. The second application is timed to kill any newly hatched lice (nymphs) before they can mature and lay more eggs, thus breaking the life cycle of the parasite.
The standard protocol for the Nix Creme Rinse, according to sources like Drugs.com and the Mayo Clinic, is a two-step process. The first application is done upon discovery of the infestation. After that, a second treatment is recommended 7 to 9 days later, but only if live lice are still visible. It is important to note that leaving the first treatment on for longer than the recommended time will not increase its effectiveness and may cause skin irritation. Using the product more than twice is not typically advised without consulting a healthcare provider, especially if it seems the treatment is not working.
The Step-by-Step Nix Application Guide
For the Nix Creme Rinse to be effective, proper application is crucial. Always read the specific instructions provided in the product's packaging, as different formulations (like Nix Ultra) may have different directions.
Before the first treatment
- Wash the hair properly: Use a standard shampoo, but avoid any products that contain a conditioner or are '2-in-1' formulas. Conditioner can coat the hair and reduce the effectiveness of the Nix treatment.
- Towel-dry the hair: The hair should be damp, not dripping wet, for optimal application.
- Shake the bottle well: Before pouring, shake the Nix bottle to ensure the permethrin is evenly distributed.
During the first treatment
- Protect the eyes: Use a washcloth or towel to shield the eyes from the product.
- Saturate thoroughly: Apply the Nix Creme Rinse to completely saturate the hair and scalp. Pay special attention to the areas behind the ears and at the base of the neck, as these are common spots for lice.
- Leave on for the directed time: Start a timer and leave the product on for the time specified in the instructions, which is typically 10 minutes. Do not leave it on for longer than directed.
- Rinse with warm water: After the specified time, rinse the hair thoroughly with warm water.
After treatment: Combing and rechecking
- Use the nit comb: Thoroughly comb the hair with the provided fine-toothed comb to remove dead lice and any remaining nits. Working in small sections (1-2 inches wide) and cleaning the comb after each pass is essential for success.
- Dispose of nits properly: Place removed lice and nits into a sealed plastic bag and throw it away immediately.
- Recheck daily: Continue to inspect the scalp daily for the next several days.
- Plan for the second application: Wait 7 to 9 days for the second application, if needed. This timing is important to catch any newly hatched nymphs.
Comparison of Permethrin Treatment and Alternative Options
While Nix is a common treatment, it's helpful to understand how it compares to other available options, especially given the rise of pesticide-resistant "superlice".
| Feature | Nix Creme Rinse (Permethrin) | Nix Ultra (Pesticide-free) | Wet-Combing with Conditioner |
|---|---|---|---|
| Active Ingredient | Permethrin (1%) | Dimethicone or other non-pesticide agents | None (mechanical removal) |
| How it Works | Kills lice by paralyzing their nervous system. | Suffocates and immobilizes lice and nits physically. | Removes lice and nits physically with a comb. |
| Initial Application | One treatment kills live lice. | One treatment kills lice and eggs. | Requires repeated combing over several weeks. |
| Retreatment Recommended | Yes, 7-9 days later if live lice remain. | Recommended if lice or nits are still present after 7 days. | Ongoing until all lice and nits are gone. |
| Potential for Resistance | Yes, "superlice" have developed resistance. | No, as it works physically, not chemically. | Not applicable. |
| Age Recommendation | 2 months and older. | 1 year and older for some products. | Safe for all ages. |
| Time Commitment | Application time as directed, plus combing. | Varies by product; often requires a specific application time plus combing. | Highly time-consuming, up to 2 hours per session. |
What to Do if Nix Doesn't Seem to Work
If you have used Nix correctly and performed the recommended second treatment, but still find live lice, there are a few possibilities.
Reasons for treatment failure:
- Incorrect application: Not leaving the product on long enough or using conditioner beforehand can reduce its effectiveness.
- Reinfestation: The individual may have been exposed to someone else with lice again.
- Resistant lice (Superlice): In some areas, lice have developed resistance to permethrin.
If you suspect resistant lice, you may need to try a different type of product or consult a healthcare provider for a prescription treatment. Products like Nix Ultra use different mechanisms to kill lice and eggs.
Preventing Reinfestation: An Essential Step
Successful lice treatment extends beyond the hair. Taking action on the home and personal items is crucial for preventing a recurrence.
Best practices for environmental cleaning:
- Wash all fabric: Machine wash and dry all bedding, clothes, and stuffed animals used by the infested person in the 24-48 hours before treatment. Use hot water (at least 130°F / 54.5°C) and high heat for the dryer.
- Seal non-washable items: Place items that cannot be washed or dry cleaned, like certain pillows or toys, in a sealed plastic bag for at least two weeks to kill any remaining lice.
- Vacuum surfaces: Thoroughly vacuum furniture, carpets, and car seats that may have been in contact with the infested person's head.
- Soak hair accessories: Combs, brushes, and other hair accessories should be soaked in hot water (above 130°F) for 5-10 minutes.
- Avoid sharing: Teach family members not to share hairbrushes, combs, hats, or other personal items.
Conclusion
For most people using Nix Creme Rinse, the treatment plan involves one application, followed by a recheck of the hair 7 to 9 days later. A second application should only be performed at that time if live lice are still observed. Consistency in following all steps, including the specified application time and thorough combing, is vital for success. Combining this approach with proper environmental cleaning maximizes the chance of eliminating head lice and preventing reinfestation. If live lice persist after two applications, resistance may be a factor, and consulting a healthcare professional is recommended.
