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Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780


Permethrin is the most widely used pediculicide, but evidence of resistance from several countries and anecdotal reports from Germany suggest that permethrin lotion is now less effective. We designed a randomized, controlled, parallel group trial involving 100 participants with active head louse infestation to investigate the activity of a coconut and anise spray and to see whether permethrin lotion is still effective, using two applications of product 9 days apart. The spray was significantly more successful (41/50, 82.0%) cures compared with permethrin (21/50, 42.0%; p < 0.0001, difference 40.0%, 95% confidence interval of 22.5% to 57.5%). Per-protocol success was 83.3% and 44.7%, respectively. Thirty-three people reported irritant reactions following alcohol contact with excoriated skin. We concluded that, although permethrin lotion is still effective for some people, the coconut and anise spray can be a significantly more effective alternative treatment.

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This study was supported financially by Omega Pharma NV, Nazareth, Belgium, which played no active role in the design of the study, interpretation of the results, or the writing of the manuscript. We wish to thank Dr Marc Dams and Isabelle Dedeken for administrative support. Thanks also to Laurence Noiroux of S-Clinica, Brussels, Belgium for statistical analyses. Investigation team members who contributed to the study but were not named as authors were Ian Jones, Audrey Pepperman, and Christine Sullivan. Medical supervision for clinical queries was provided by Dr Paul Silverston.

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Correspondence to Ian F. Burgess.

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Burgess, I.F., Brunton, E.R. & Burgess, N.A. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr 169, 55 (2010).

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  • Head lice
  • Permethrin
  • Essential oils
  • Insecticide resistance
  • Coconut oil