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Are teenagers spreading lice when they put their heads together to take a perfect selfie? This is a hot topic trending lately online. I’ve received emails and texts from parents who are fighting head lice in their homes and are wondering if this is possible.

I was skeptical at first about the risk of transmitting lice during a selfie session. Lying on the same pillow or sharing hairbrushes or headbands seemed more likely culprits. But however it happens, what should you do if your teenager has head lice?

Start with an over-the-counter product that contains permethrin or pyrethrin and follow directions. Know that using a hair conditioner before applying an OTC product can diminish its effectiveness. Many such products recommend not washing the hair for several days after finishing the application. Re-apply carefully in order to treat hatching lice and lice not killed by the first application.

Read the OTC package insert carefully. Even when you follow the directions to a “T,” though, lice can continue to thrive. This may be due to the fact that the pests have become resistant to the products. Different geographic regions do seem to have different rates of resistant head lice.

Four prescription products have been approved by the U.S. Food and Drug Administration for use when OTC treatments fail, including Sklice, Natroba, Ovide and Ulesfia. Each contains a different ingredient that’s proven to work against the human louse. These products do differ by application time, FDA labeled age guidelines, precautions for use and cost. There is no one product that’s the best to use.

One study looked at oral Ivermectin as a therapy for head lice in children over the age of 2. The drug is not FDA labeled for this use, however. There are guidelines for its use when both OTC and prescription topical agents fail to zap lice.

There’s no need to try all the crazy remedies you may have heard about – like applying mayonnaise to your teen’s head, or blow-drying concentrated moisturizers into the hair shaft. In several areas of the country, there are even businesses that will “nitpick” your child’s head, but one of my patients spent $500 (really!) on this but continued to have problems with lice.

If lice simply refuse to budge, call your doctor before resorting to alternative, unproven therapies. And don’t forget to smile in your next selfie!

Dr. Sue Hubbard is a pediatrician, medical editor and media host. Submit questions at kidsdr.com.