Head lice infestation is still a public health problem worldwide, with an intracountry and intercountry prevalence variation of 0.7 to 59 %. There is a large variety of over-the-counter anti-louse products, but their efficacy is not always well assessed. Our objective was to test the pediculicidal and ovicidal efficacy of 21 over-the-counter head louse products, available in France during the period of 2008 to 2012. We tested children living in Tours City in central France and visiting preschools, primary schools, kindergarten, camps, and child care facilities, as well as children in their family houses, and were examined for the presence of lice. The products were collected from randomly selected pharmacies by covert investigators and then tested in the laboratory on an ex vivo sample of head lice and their eggs, collected from the hair of infested children. Living lice and unharmed eggs were collected from the scalps of 3–12 years old. The laboratory conditions for ex vivo testing mimicked the manufacturers’ instructions for exposure time and application method. In 21 runs, 3919 living lice and 4321 undamaged living eggs were collected from the scalp of over 400 children. The 21 products were classified in three groups: 6 products in a group of potentially 100 % pediculicidal activity and potentially 100 % ovicidal activity, 8 products in a group of potentially 100 % pediculicidal activity but insufficient ovicidal activity (including 2 products with claims of single application treatment), and 7 products in a group of insufficient pediculicidal activity and ovicidal activity. The pharmaceutical market for head lice products in France is swamped with poorly tested and ineffective products. Rigorous efficacy testing preregistration and periodic screening and testing of effectiveness in the post-registration period should be endorsed by the health authorities.
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[WHO] World Health Organization (1970) Insecticide resistance and vector control. Seventeenth Report of WHO Expert Committee on insecticides .Technical report series no 443 - Geneva
[WHO] World Health Organization (1975) Instruction for determining the susceptibility or resistance of body lice and head lice to insecticides. WHO/VBC/75.585 - Geneva
[WHO] World Health Organization (1976) Resistance of vectors and reservoirs of disease to pesticides. 22nd Report of the WHO Expert Committee on Insecticides. Technical Report Series no 585 - Geneva
[WHO] World Health Organization (1981) Instruction for determining the susceptibility or resistance of body lice and head lice to insecticides. WHO/VBC/81.808 - Geneva
Abdel-Ghaffar F, Semmler M, Al-Rasheid K, Klimpel S, Mehlhorn H (2010) Comparative in-vitro test on the efficacy and safety of 13 anti-head-lice products. Parasitol Res 106:423–429
Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS) - Procédure nationale: note explicative concernant les produits pédiculicides pour application locale soumis à autorisation selon l’art. L658-11 du code de la Santé publique. Commission d’Autorisation de Mise en Marché (AMM) du 07 juillet 1999
Asenov A, Oliviera FA, Speare R, Liesenfeld O, Hengge U, Heukelbach J (2010) Efficacy of chemicals and botanical over-the-counter pediculicides available in Brazil, and off-label treatments, against lice ex vivo. Int J Dermatol 49:324–330
Aydemir EH, Unal G, KutlarM ON (1993) Pediculosis in Istanbul. Int J Dermatol 32:30–32
Barker SC, Burgess IF, Meinking TL, Mumcuoglu KY (2012) International guidelines for clinical trtials with pediculicides. Int J Dermatol 51:853–858
Bouvresse S, Berdjane Z, Durand R, Bouscaillou J, Izri A, Chosidow O (2012) Permethrin and malathion resistance in head lice: results of ex vivo and molecular assays. J Am Acad Dermatol 67:1143–1150
Bulletin Organisation Mondiale de la Santé (BOMS) (1988 oct. 29th) Recommandations concernant les études biocliniques des préparations anti poux. AVIS du 8 septembre 1988.
Burgess IF (2004) Human lice and their control. Annu Rev Entomol 49:457–81
Burgess IF, Burgess NA (2011) Dimeticone 4% liquid gel found to kill all lice and eggs with a single 15 minute application. BMC Res Notes 4:15
Burgess IF, Brown CM, Lee PN (2005) Treatment of head louse infestation with 4% dimeticone lotion: randomised controlled equivalence trial. BMJ 330(7505):1423
Burgess IF, Lee PN, Matlock G (2007) Randomised, controlled, assessor blind trial Comparing 4% dimeticone lotion with 0.5% malathion liquid for head louse infestation. PLoS One 2(11):e1127
Burkhart CG (2004) Relationship of treatment-resistant head lice to the safety and efficacy of pediculicides. Clin Proc 79:661–666
Burkhart CG, Burkhart CN (2001) Recommendation to standardize pediculicidal and ovicidal testing for head lice (Anoplura: Pediculicidae). J Med Entomol 38:127–129
Burkhart CG, Burkhart CN (2006) Safety and efficacy of pediculicides for head lice. Expert Opin Drug Saf 5:169–179
Chosidow O, Chastang C, Btue C, Bouvet E, Mohand I, Monteny N, Bastuji-Garin S, Rousset J-J, Revuz J (1994) Controlled study of malathion and d-phenothrin lotions for Pediculus humanus var capitis-infested schoolchildren. Lancet 344:1724–1727
Combescot C (1990) Current epidemiology of Pediculosis capitis. Bull Acad Natl Med 174:231–236
Combescot C, Combescot-Lang C, de Nadon J, Remy-Kristensen A, Richard-Lenoble D (1996) Interest and limits of tests to evaluate pediculicides efficacy. Bull Acad Natl Med 180:1315–1324
Combescot-Lang C, Fournon M, Pioux R, Delemos-Ribeiro A, Combescot C (1986) Enquête épidémiologique sur la pédiculose dans la région de Fortaleza (Brésil-Nordeste). Bull Soc Parasitol 4:113–117
Counahan M, Andrews R, Bütner P, Bymes G, Speare R (2004) Head lice prevalence in primary school in Victoria, Australia. J Paediatr Child Health 40:616–619
Cour de cassation, chambre criminelle (10 mai 1924) Pourvoi en Cassation contre un arrêt de la cour d’appel de Rouen du 18 fev 1924; Delaneau law no 78 699, 6 july 1978; Code de la Santé publique Art. L.5136-1 Ord no 2000-548, 15 juin 2000; Art. L5136-1 Abrogé par Ordonnance no 2007-613 du 26 avril 2007- art. 28 JORF (27 Avril 2007).
Coz J, Combescot-Lang C, Verdier V (1993) Resistance of head lice Pediculus capitis L. 1758 to pyrethroïds: d-phenothrin and permethrin in France. Bull Soc Fr Parasitol 11:245–452
de Maeseneer J, Blokland I, Willems S, Vander Stichele R, Meersschaut F (2000) Wet combing versus traditional scalp inspection to detect head lice in schoolchildren: observational study. BMJ 321:1187–1188
Dodd CS (2000) Interventions for treating headlice. Cochrane Database Syst Rev 2001 (3): CD001165 update in Cochrane Database Syst Rev 2006; (4):CD001165, Withdrawn in 2007
Downs AMR, Stafford KA, Harvey I, Coles GC (1999) Evidence for double resistance to permethrin and malathion in head lice. Br J Dermatol 141:508–511
Falagas ME, Matthaiou DK, Rafailidis PI, Panos G, Pappas G (2008) Worldwide prevalence of head lice. Emerg Infect Dis 14:1493–1494
Feldmeier H (2012) Pediculosis capitis: new insights into epidemiology, diagnosis and treatment. Eur J Clin Microbiol Infect Dis 3:2105–2110
Filer J (1996) Egyptian bookshelf diseases. University of Texas Press, Austin, TX
Gallardo A, Mongabure-Cueto G, Vassena C, Piccollo MI, Toloza AC (2012) Comparative efficacy of new commercial pediculicides against adult and eggs of Pediculus humanus capitis (head lice). Parasitol Res 110:1601–1606
Gratz NG (1997) Human lice, their prevalence, control and resistance to insecticides. Geneva WHO/CTD/WHOPES 957(8):3–28
Hemingway J, Miller J, Mumcuoglu KY (1999) Pyrethroid resistance mechanisms in the head louse Pediculus capitis from Israel: implications for control. Med Vet Entomol 13:89–96
Heukelbach J, Canyon DV, Oliveira FA, Muller R, Speare R (2008a) In vitro efficacy of over-the-counter botanical pediculicides against the head louse Pediculuss humanus var capitis based on a stringent standard for mortality assessment. Med Vet Entomol 22:264–272
Heukelbach J, Pilger D, Oliveira FA et al (2008b) A highly efficacious pediculicide based on dimeticone: randomized observer blinded comparative trial. BMC Infect Dis 8:115
Heukenbach J, Asenov A, Liesenfeld O, Mirmohammadsadegh A, Oliveira FA (2009) A new two-phase dimeticone pediculicide shows high efficacy in a comparative bioassay. BMC Dermatol 9:12
Hill N, Moor G, Cameron M, Butlin A, Williamson M, Bass C (2005) Single blind randomized, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom. BMJ 331:384–387
Ibarra J, Fry F, Clarice W, Olsen A, Vander Stichele RH, Lapeere H, Maryan J, Franks A, Smith JL (2007) Overcoming health inequalities by using the Bug Busting ‘whole-school approach’ to eradicate head lice. J Clin Nurs 16:1955–1965
Jahnke C, Bauer E, Hengge UR, Feldmeier H (2009) Accuracy of diagnosis of pediculosis capitis: visual inspection vs. wet combing. Arch Dermatol 145:309–313
Kurt O, Balcioglu IC, Burgess IF et al (2009) Treatment of head lice with dimeticone 4% lotion: comparison of two formulations in a randomised controlled trial in rural Turkey. BMC Public Health 9:441
Loi 78 699 dite Delaneau (du 6 juillet 1978), portant sur l’autorisation de mise sur le marché des insecticides et acaricides et modifiant certaines dispositions du code de la santé publique (Art. L. 658-11)
Mathias RG, Huggins DR, Leroux SJ, Proctor EM (1984) Comparative trial of treatment with Prioderm lotion and Kwellada shampoo in children with head lice. Can Med Assoc J 130:407–409
Maunder JW (1971) Resistance to organochlorine insecticides in head lice, and trials using alternative compounds. Med Officer 125:27–29
Meinking TL, Taplin D, Kalter DC, Eberle MW (1986) Comparative efficacy of treatments for Ovide lotion (0.5% malathion) compared to Nix creme rinse (1% permethrin) for the treatment pediculosis capitis Infestation. Arch Dermatol 122:267–271
Meinking TL, Entzel P, Villar ME, Vicaria M, Lemard G, Porcelain C (2001) Comparative efficacy of treatments for pediculosis infestations. Arch Dermatol 137:287–292
Meinking TL, Serrano L, Hard B, Entzel P, Lemard G, Rivera E, Villar ME (2002) Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States. Arch Dermatol 138:220–224
Meinking TL, Vicaria M, Eyerdam DH et al (2004) Efficacy of a reduced application time of head lice. Pediatr Dermatol 21:670–674
Meinking TL, Vicaria M, Eyerdam DH et al (2007) A randomized, investigator-blinded, time-ranging study of the comparative efficacy of 0.5% malathion gel versus Ovide Lotion (0.5% malathion) or Nix Crème Rinse (1% permethrin) used as labeled, for the treatment of head lice. Pediatr Dermatol 24:405–411
Militao de Sousa F, Vasconcelos AW, de Nadon J, Duhot PY (2009) Treatment of human head lice infestations in a single application with a new galenic lotion. Int J Cosmet Sci 17:1–7
Mumcuoglu KY (2006) Effective treatment of head louse with pediculicides. J Drugs Dermatol 5:451–452
Mumcuoglu KY, Miller J (1991) The efficacy of pediculicides in Israel. Isr Med Sci 27:562–565
Mumcuoglu KY, Zias J (1989) How the ancients de-loused themselves. Biblic Archaeol Rev 15:66–69
Mumcuoglu KY, Miller J, Galun R (1990) Susceptibility of human head and body louse, Pediculus humanus (Anoplura: Pediculidae) to insecticides. Insect Sci Applic 11:223–226
Mumcuoglu KY, Hemingway J, Miller J, Ioffe-Uspensky I, Klaus S, Ben-Ishai F, Galum R (1995) Permethrin resistance in the head louse Pediculus capitis from Israel. Med Vet Entomol 9:427–432
Mumcuoglu KY, Miller J, Zamir C, Zentner G, Helbin V, Ingber A (2002) The in vivo pediculicidal efficacy of a natural remedy. Isr Med Assoc J 4:790–793
Mumcuoglu KY, Barker SC, Burgess IE, Combescot-Lang C, Dalgleish RC, Larsen KS, Miller J, Roberts RJ, Taylan-Oskan A (2007) International guideline for effective control of head louse infestations. J Drugs Dermatol 6:409–414
Nuttall GHF (1917) The biology of Pediculus humanus. Parasitology 10:80–185
Ozkan O, Sikar-Aktürk A, Mert K, Bilen N, Mumcuoglu KY (2012) Difficulties experienced by families following unsuccessful treatment of pediculosis capitis: the mothers’ perspective. Turk Parazitol Derg 36:82–86
Picollo MI, Casadio AA, Massimo J, Zerba EN (1998) Laboratory studies of susceptibility and resistance to insecticides in Pediculus capitis (Anoplura; Pediculidae). J Med Entomol 35:814–817
Portenart M, Combescot-Lang C (1984) La pédiculose a Pediculus humanus capitis en Touraine. Ouest Med 37:321–325
Rao R (1958) Seminars on susceptibility of insect to insecticide. Resistance test for lice. Panama City, Republic of Panama, 23-28 June. PASB/WHO report
Refaat GAE, Tosson AM, Mamdouh MIN, Samy AAK (2000) Evaluation of four pediculicides against the head lice Pediculus humanus capitis. J Egypt Soc Parasitol 30:51–58
Rukke BA, Birkemoe T, Soleng A, Linstedt HH, Ottesen P (2011) Head lice prevalence among households in Norway: importance of spatial variables and individual and household characteristics. Parasitology 138:1296–1304
Vander Stichele RH, Dezeure EM, Bogaert MG (1995) Systematic review of clinical efficacy of topical treatments for head lice. BMJ 311:604–608
Vander Stichele RH, Gyssels L, Bracke C, Meersschaut F, Blokland I, Wittouck E, Willems S, De Maeseneer J (2002) Wet combing for head lice: feasibility in mass screening, treatment preference and outcome. J R Soc Med 95:348–352
Vander Wouden JC, Klootwijk T, Le Cleach L, Do G, Vander Stichele R, Neven K, Eekhof JAH. Intervention for treating head lice. 2011 Protocol Cochrane Systematic Review. http://onlinelibrary.wiley.com/cochranelibrary/ : last accessed on Febr 20, 2014.
Vassena CV, Mougabure Cueto G, González Audino P et al (2003) Prevalence and levels of permethrin resistance in Pediculus humanus capitis De Geer (Anoplura: Pediculidae) from Buenos Aires, Argentina. J Med Entomol 40:447–450
Willems S, Lapeere H, Haedens N, Pasteels I, Naeyaert J-M, De Maeseneer J (2005) The importance of socio-economic status and individual characteristics on the prevalence of head lice in schoolchildren. Eur J Dermatol 15:387–392
Wright JW (1957) Brown AWA (1957) Global survey of the susceptibility of body louse to insecticides, based on the standard kit developed and distributed by [WHO] in 1953. Bull Wld Hlth Org 16:9–31
Yoon KS, Gao JR, Lee SH, Coles GC, Meinking TL, Taplin D, Edman JD, Takano L, Clark JM (2004) Resistance and cross-resistance to insecticide in human head lice from Florida and California. Pestic Biochem Physiol 80:192–201
Zeichner BC (1999) Baseline susceptibility of a laboratory strain of Pediculus humanus humanus (Anoplura Pediculidae) using a modified world health organization testing protocol. J Med Entomol 36:903–905
We thank Jean-Pierre Cheneveau, head of Community Health Services in the city of Tours, for his ongoing support for this study, Sudarshan K Malhotra, PhD, and Jacqueline Miller, PhD, for their editorial suggestions and linguistic advice in writing the manuscript, Cecile Enguehard-Gueiffier, PhD, for her help with the chemical classification of active ingredients of head lice products, and last but not least, the school masters, nurses, kindergarden staff, social assistants, managers, and executives of camps and child care facilities as well as the media, pharmacists, physicians, and parents, who helped us to accomplish this study.
Conflict of interest
Combescot-Lang C. and Toubate B performed as university experts tests for the evaluation of numerous products, including products in this study. However, for this study, all tests were performed independently, with products bought by the researchers in pharmacies.
Mumcuoglu K.Y. has participated in the development of Paranix®.
Vander Stichele RH and Veirron E have no potential conflicts of interest to declare.
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Combescot-Lang, C., Vander Stichele, R.H., Toubate, B. et al. Ex vivo effectiveness of French over-the-counter products against head lice (Pediculus humanus capitis De Geer, 1778). Parasitol Res 114, 1779–1792 (2015). https://doi.org/10.1007/s00436-015-4363-9