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Treatment of Pediculosis Capitis: A Critical Appraisal of the Current Literature

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Abstract

Pediculosis capitis is the most common ectoparasitic disease in children in industrialized countries and extremely common in resource-poor communities of the developing world. The extensive use of pediculicides with a neurotoxic mode of action has led to the development and spread of resistant head lice populations all over the world. This triggered the development of compounds with other modes of action. The current literature on treatment approaches of head lice infestation was searched, and published randomized controlled trials were critically analyzed. The following compounds/family of compounds were identified: spinosad, a novel compound with a new neurotoxic mode of action, isopropyl myristate, 1,2-octanediol, ivermectin, plant-based products, and dimeticones. The efficacy and safety of these compounds are reviewed and recommendations for the treatment of pediculosis capitis in individuals as well as the interruption of ongoing epidemics are provided.

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References

  1. Jahnke C, Bauer E, Feldmeier H. Pediculosis capitis im Kindesalter: epidemiologische und sozialmedizinische Erkenntnisse einer Reihenuntersuchung von Schulanfängern. Gesundheitswesen. 2008;70(11):667–73.

    Article  PubMed  CAS  Google Scholar 

  2. Rukke BA, Birkemoe T, Soleng A, Heggen-Lindstedt H, Ottesen P. Head lice prevalence among households in Norway; importance of spatial variables and individual and household characteristics. Parasitology. 2011;138:1296–304.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Feldmeier H, Heukelbach J. Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues. Bull World Health Org. 2009;87(2):152–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Feldmeier H. Pediculosis capitis: new insights into epidemiology, diagnosis and treatment. Eur J Clin Microbiol Infect Dis. 2012;31:2105–10.

    Article  PubMed  CAS  Google Scholar 

  5. Lesshafft H, Baier A, Guerra H, Terashima A, Feldmeier H. Prevalence and risk factors associated with pediculosis capitis in an impoverished urban community in Lima, Peru. J Global Infect Dis. 2013;5(4):138–42.

    Article  Google Scholar 

  6. Falagas ME, Matthaiou DK, Rafailidis PI, Panos G, Pappas G. Worldwide prevalence of head lice. Emerg Infect Dis. 2008;14(9):1493–4.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Vassena CV, MougabureCueto GA, Alzogaray RA, Zerba EN, Picollo MI. Prevalence and levels of permethrin resistance in Pediculus humanus capitis De Geer (Anoplura: Pediculidae) from Buenos Aires, Argentina. J Med Entomol. 2003;40:447–50.

    Article  PubMed  CAS  Google Scholar 

  8. Kasai S, Ishii N, Natsuaki M, Fukutomi H, Komagata O, Kobayashi M, Tomita T. Prevalence of kdr-like mutations associated with pyrethroid resistance in human head louse populations in Japan. J Med Entomol. 2009;46(1):77–82.

    Article  PubMed  CAS  Google Scholar 

  9. Durand R, Millard B, Bouges-Michel C, Bruel C, Bouvresse S, Izri A. Detection of pyrethroid resistance gene in head lice in schoolchildren from Bobigny, France. J Med Entomol. 2007;44:796–7.

    Article  PubMed  CAS  Google Scholar 

  10. Kristensen M, Knorr M, Rasmussen AM, Jespersen JB. Survey of permethrin and malathion resistance in human head lice populations from Denmark. J Med Entomol. 2006;43:533–8.

    Article  PubMed  CAS  Google Scholar 

  11. Yoon KS, Gao JR, Lee SH, Clark JM, Brown L, Taplin D. Permethrin resistant human head lice, Pediculus capitis, and their treatment. Arch Dermatol. 2003;139:994–1000.

    Article  PubMed  CAS  Google Scholar 

  12. Barker SC, Burgess IF, Terri L, Meinking TL, Mumcuoglu KY. International guidelines for clinical trials with pediculocides. Int J Dermatol. 2012;51:853–8.

    Article  PubMed  Google Scholar 

  13. Feldmeier H, Jahnke C. Pediculosis capitis: epidemiologie, diagnose und therapie. Pädiatrische Praxis. 2010;76:359–70.

    Google Scholar 

  14. Jahnke C, Bauer E, Hengge U, Feldmeier H. Accuracy of diagnosis of pediculosis capitis: visual inspection versus wet combing. Arch Dermatol. 2009;145:309–13.

    Article  PubMed  Google Scholar 

  15. Pickett MM, Muszynski MA, Norton S. Of Lice and Men. JAMA Dermatol. 2014;150(3):250.

    Article  PubMed  Google Scholar 

  16. Veracx A, Raoult D. Biology and genetics of human head and body lice. Trends Parasitol. 2012;28:563–71.

    Article  PubMed  CAS  Google Scholar 

  17. Parola P, Fournier PE, Raoult D. Bartonella quintana, lice, and molecular tools. J Med Entomol. 2006;43:787.

    Article  PubMed  Google Scholar 

  18. Light JE, Allen JM, Long LM, Carter TE, Barrow L, Suren G, Raoult D, Reed DL. Geographic distributions and origins of human head lice (Pediculus humanus captitis) based on mitochondrial data. J Parasitol. 2008;94(6):1275–81.

    Article  PubMed  Google Scholar 

  19. Boutellis A, Medlannikov O, Bilcha KD, Ali J, Campelo D, Barker SC, Raoult D. Borrelia recurrentis in head lice, Ethiopia. Emerg Infect Dis. 2013;19:796–8.

    PubMed  PubMed Central  Google Scholar 

  20. Angelakis E, Diatta G, Abdissa A, Trape JF, Mediannikov O, Richet H, Raoult D. Altitude-dependent Bartonella quintana genotype C in head lice, Ethiopia. Emerg Infect Dis. 2011;17(12):2357–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Feldmeier H. Lice as vectors of pathogenic microorganisms. In: Heukelbach J, editor. Management and control of head lice infestation. Bremen: UNIMED; 2010. p. 132–5.

    Google Scholar 

  22. Do-Pham G, Le Cleach L, Giraudeau B, Maruani A, Chosidow O, Ravaud P. Designing randomized-controlled trials to improve head louse treatment: systematic review using a vignette-based method. J Investig Dermatol. 2014;134:628–34.

    Article  PubMed  CAS  Google Scholar 

  23. Sonnberg S, Oliveira FA, de Melo ILA, de Melo Soares MM, Becher H, Heukelbach J. Ex vivo development of eggs from head lice (Pediculus humanus capitis). Open Dermatol J. 2010;4:82–9.

    Google Scholar 

  24. Strycharz JP, Lao AR, Alves A, Clark JM. Ovicidal respone of NYDA formulations on the human head louse (Anoplura: PEdiculidae) using a hair tuft bioassay. Lanham: Entomological Society of America; 2012.

    Google Scholar 

  25. Elston DM. Drug-resistant lice. Arch Dermatol. 2003;139:1061–4.

    Article  PubMed  Google Scholar 

  26. Picollo MI, Vassena CV, Mougabure Cueto GA, Vernetti M, Zerba E. Resistance to insecticides and effect of synergesis on permethrin toxicity in Pediculus capitis (Anoplura: Pediculidae) from Buenos Aires. J Med Entomol. 2000;37:721–5.

    Article  PubMed  CAS  Google Scholar 

  27. Bailey AM, Provic P. Persistent head lice following multiple treatments: evidence for insecticide resistance in Pediculus humanus capitis. Australas J Dermatol. 2000;41:250–4.

    Article  PubMed  CAS  Google Scholar 

  28. Hunter JA, Barker SC. Susceptibility of head lice (Pediculus humanus capitis) to pediculicides in Australia. Parasitol Res. 2003;90:476–8.

    Article  PubMed  CAS  Google Scholar 

  29. Burgess IF, Kay K, Burgess NA, Brunton ER. Soya oil-based shampoo superior to 0.5 % permethrin lotion for head louse infestation. Med Devices Evid Res. 2011;4(4):35–42.

    Article  Google Scholar 

  30. Burgess IF, Lee PN, Brown CM. Randomised, controlled, parallel group clinical trials to evaluate the efficacy of isopropyl myristate/cyclomethicone solution against head lice. Pharm J. 2008;280:371–5.

    Google Scholar 

  31. Burgess IF, Brunton ER, Burgess NA. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43 % lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr. 2010;169:55–62.

    Article  PubMed  Google Scholar 

  32. Burgess IF, Brunton ER, Burgess NA. Single application of 4 % dimeticone liquid gel versus two applications of 1 % permethrin creme rinse for treatment of head louse infestation: a randomised controlled trial. BMC Dermatol. 2013;13:5. doi:10.1186/1471-5945-13-5.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  33. van der Stichele RHV, Dezeure EM, Bogaert MG. Systematic review of clinical efficacy of topical treatments for head lice. BMJ. 1998;311:604–8.

    Article  Google Scholar 

  34. Burgess IF, Brown CM, Lee PN. Treatment of head louse infestation with 4 % dimeticone lotion: randomised controlled equivalence trial. BMJ. 2005;330:1423–6.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  35. Plastow L, Luthra M, Powell R, Wright J, Russel D, Marshall MN. Head lice infestation: bug busting vs. traditional treatment. J Clin Nurs. 2001;10:775–83.

    Article  PubMed  CAS  Google Scholar 

  36. Willems S, Lapeere H, Haedens N, Pasteels I, Naeyaert JM, De Maeseneer J. The importance of socio-economic status and individual characteristics on the prevalence of head lice in schoolchildren. Eur J Dermatol. 2005;15(5):387–92.

    PubMed  Google Scholar 

  37. Tomalik-Scharte D, Lazar A, Meins J, Bastian B, Ihrig M, Wachall B, Jetter A, Tantcheva-Poor I, Mahrle G, Fuhr U. Dermal absorption of permethrin following topical administration. Eur J Clin Pharmacol. 2005;61(5–6):399–404.

    Article  PubMed  CAS  Google Scholar 

  38. Anonymous Topische Therapie bei Kopfläusen. Der Arzneimittelbrief. 2009;43:81–86.

  39. Menegaux F, Baruchel A, Bertrand Y, Lescoeur B, Leverger G, Nelken B, Sommelet D, Hémon D, Clavel C. Household exposure to pesticides and risk of childhood leukaemia. Occup Environ Med. 2006;63(2):131–4.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  40. Stough D, Shellabarger S, Quiring J, Gabrielsen AA Jr. Efficacy and safety of spinosad and permethrin creme rinses for Pediculosis capitis (head lice). Pediatrics. 2009;124(3):389–95.

    Article  Google Scholar 

  41. Heukelbach J, Canyon DV, Heukelbach-Oliveira F, Muller R, Spear RC. In vitro efficacy of over-the-counter botanical pediculicides against the head louse Pediculus humanus var capitis based on a stringent standard for mortality assessment. Med Vet Entomol. 2008;22:262–74.

    Article  Google Scholar 

  42. Heukelbach J, Canyon DV, Speare R. The effect of natural products on head lice: in vitro tests and clinical evidence. J Pediatr Infect Dis. 2007;2:67–76.

    Google Scholar 

  43. Strycharz JP, Yoon KS, Clark JM. A new ivermectin formulation topically kills permethrin-resistant human head lice (Anoplura: Pediculidae). J Med Entomol. 2008;45(1):75–81.

    Article  PubMed  CAS  Google Scholar 

  44. Barnett E, Palma KG, Clayton B, Ballard T. Effectiveness of isopropyl myristate cylcomethicone of removing cuticular hydrocarbons from human head lice. BMC Dermatol. 2012;12:15. doi:10.1186/1471-5945-12-15.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  45. Kaul N, Palma KG, Silagy SS, Goodman JJ, Toole J. North American efficacy and safety of a novel pediculicide rinse, isopropyl myristate 50 % (Resultz). J Cutan Med Surg. 2007;11(5):161–7.

    PubMed  CAS  Google Scholar 

  46. Burgess IF, Lee PN, Kay K, Jones R, Brunton ER. 1,2-Octanediol, a novel surfactant, for treating headlouse infestation: identification of activity, formulation, and randomised, controlled trials. PLoS One. 2012;7(4):e35419.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  47. Burgess IF, Brunton ER, French R, Burgess NA. Prevention of head louse infestation: a randomised, double-blind, cross-over study of a novel concept product, 1 % 1,2-octanediol spray versus placebo. BMJ Open. 2014;4(5):e004634.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Feldmeier H. Pediculosis capitis: Eine Herausforderung für das Apothekerteam. PTA-Forum. 2013;11:22–6.

    Google Scholar 

  49. Heukelbach J, Oliveira FA, Richter J, Häussinger D. Dimeticone-based pediculicides: a physical approach to eradicate head lice. Open Dermatol J. 2010;4:77–81.

    CAS  Google Scholar 

  50. Burgess IF. The mode of action of dimeticone 4 % lotion against head lice, Pediculus capitis. BMC Pharmacol. 2009;9:3. doi:10.1186/1471-2210-9-3.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Richling I, Böckeler W. Lethal effects of treatment with a special dimeticone formula on head lice and house crickets (Orthoptera, Ensifera: Acheta domestica and Anoplura, Phthiraptera: Pediculus humanus). Arzneim-Forsch/Drug Res. 2008;58:248–54.

    CAS  Google Scholar 

  52. Heukelbach J, Pilger D, Oliveira F, Khakban A, Ariza L, Feldmeier H. A highly efficacious pediculocide based on dimeticone: randomized observer blinded comparative trial. BMC Infect Dis. 2008;8:115. doi:10.1186/1471-2334-8-115.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Heukelbach J, Sonnberg S, Becher H, Melo I, Speare R, Oliveira FA. Ovicidal efficacy of high concentration dimeticone: a new era of head lice treatment. J Am Acad Dermatol. 2011;64(4):e61–2.

    Article  PubMed  Google Scholar 

  54. Nair B. Final report on the safety assessment of stearoxy dimethicone, dimethicone, methicone, amino bispropyl dimethicone, aminopropyl dimethicone, amodimethicone, amodimethicone hydroxystearate, behenoxy dimethicone, C24-28 alkyl methicone, C30-45 alkyl methicone, C30-45 alkyl dimethicone, cetearyl methicone, cetyl dimethicone, dimethoxysilyl ethylenediaminopropyl dimethicone, hexyl methicone, hydroxypropyldimethicone, stearamidopropyl dimethicone, stearyl dimethicone, stearyl methicone, and vinyldimethicone. Int J Toxicol. 2003;22:11–35.

    PubMed  Google Scholar 

  55. Lapeere H, Brochez L, Verhaeghe E, Vander-Stichele RH, Remon JP, Lambert J, Leybaert L. Efficacy of products to remove eggs of Pediculosis humanus capitis (Phthiraptera: Pediculidae) from the human hair. J Med Entomol. 2014;51(2):400–7.

    Article  PubMed  Google Scholar 

  56. Meinking TL, Mertz-Rivera K, Villar ME, Bell M. Assessment of the safety and efficacy of three concentrations of topical ivermectin lotion as a treatment for head lice infestation. Int J Dermatol. 2013;52:106–12.

    Article  PubMed  CAS  Google Scholar 

  57. Dornseiff M, Schwartz T. Randomisierte, Untersucher-verblindete kontrollierte, multizentrische Therapiestudie mit Dodecanol plus Demeticon (Dimet® 20*) versus Dimeticon-Mono bei Kopflausbefall—Integrierter Abschlussbericht. 2010. http://www.infectopharm.com/login?ref=/egi-bin/dl.pl/downloads/dimet20studie_2010.pdf. Assessed 21 July 2014.

  58. Deeks LS, Naunton M, Currie MJ, Bowden FJ. Topical ivermectin 0.5 % lotion for treatment of head lice. Ann Pharmacother. 2013;47(9):1161–7.

    Article  PubMed  Google Scholar 

  59. Burgess I. Head lice. Clin Evid (Online). 2011;05:pii:1703.

  60. Laguna MF, Risau-Gusman S. Of lice and math: using models to understand and control populations of head lice. Plos One. 2011;6(7):e21848. doi:10.1371/journal.pone.0021848.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  61. Greive KA, Lui AH, Barnes TM, Oppenheim VM. Safety and efficacy of a non-pesticide-based head lice treatment: results of a randomised comparative trial in children. Australas J Dermatol. 2012;53(4):255–63.

    Article  PubMed  Google Scholar 

  62. Mumcuoglu KY, Miller J, Zamir C, Zentner G, Helbin V, Ingber A. The in vivo pediculicidal efficacy of a natural remedy. IMAJ. 2002;4(10):790–2.

    PubMed  Google Scholar 

  63. Barker SC, Altman PM. A randomised, assessor blind, parallel group comparative efficacy trial of three products for the treatment of head lice in children-melaleuca oil and lavender oil, pyrethrins and piperonyl butoxide, and a “suffocation” product. BMC Dermatol. 2010;10:6. doi:10.1186/1471-5945-10-6.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Chosidow O, Giraudeau G, Cottrell J, Izri A, Hofmann R, Mann SG, Burgess IF. Oral ivermectin versus malathion lotion for difficult-to-treat head lice. N Engl J Med. 2010;362(10):896–905.

    Article  PubMed  CAS  Google Scholar 

  65. Pariser DM, Meinking TL, Bell M, Ryan WG. Topical 0.5 % ivermectin lotion for treatment of head lice. N Engl J Med. 2012;367(18):1687–93.

    Article  PubMed  CAS  Google Scholar 

  66. Nofal A. Orales ivermectin gegen Kopfläuse: ein Vergleich mi 0,5 % topischer Malathionlotion. JDDG. 2010;8(12):985–9.

    PubMed  Google Scholar 

  67. Pilger D, Heukelbach J, Khakban A, de Oliveiera FAS, Fengler G, Feldmeier H. Household-wide ivermectin treatment for head lice in an impoverished community: randomized observer-blinded controlled trial. Bull World Health Org. 2010;88:90–6. doi:10.2471/BLT.08.051656):90-96.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Burgess IF, Lee PN, Matlock G. Randomised, controlled, assessor blind trial comparing 4 % dimeticone lotion with 0.5 % malathion liquid for head lice infestation. PLoS One. 2007;11:e1127.

    Article  Google Scholar 

  69. Kurt O, Balcioglu C, Burgess IF, Limoncu ME, Girginkardesler N, Tabak T, Muslu H, Ermis O, Sahin MT, Bilac C, Kavur H, Ozbel Y. Treatment of head lice with dimeticone 4 % lotion: comparison of two formulations in a randomised controlled trial in rural Turkey. BMC Public Health. 2009;9:441.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The excellent secretarial assistance by U. Kolander is gratefully acknowledged.

Conflict of interest

Dr. Feldmeier reports receiving consulting and lecture fees from Pohl-Boskamp. No other potential conflict of interest relevant to this article is reported.

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  1. Institute of Microbiology and Hygiene, Charité University Medicine, Campus Benjamin Franklin, Hindenburgdamm 27, 12203, Berlin, Germany

    Hermann Feldmeier

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Feldmeier, H. Treatment of Pediculosis Capitis: A Critical Appraisal of the Current Literature. Am J Clin Dermatol 15, 401–412 (2014). https://doi.org/10.1007/s40257-014-0094-4

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