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Stevenson B, Tesfaye W, Christenson J, Mathew C, Abrha S, Peterson G, Samarawickrema I, Thomas J. Comparative efficacy and safety of interventions for treating head lice: a protocol for systematic review and network meta-analysis. BMJ Paediatr Open 2021; 5:e001129. [PMID: 34041368 PMCID: PMC8112437 DOI: 10.1136/bmjpo-2021-001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/07/2022] Open
Abstract
Background Head lice infestation is a major public health problem around the globe. Its treatment is challenging due to product failures resulting from rapidly emerging resistance to existing treatments, incorrect treatment applications and misdiagnosis. Various head lice treatments with different mechanism of action have been developed and explored over the years, with limited report on systematic assessments of their efficacy and safety. This work aims to present a robust evidence summarising the interventions used in head lice. Method This is a systematic review and network meta-analysis which will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for network meta-analyses. Selected databases, including PubMed, Embase, MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials will be systematically searched for randomised controlled trials exploring head lice treatments. Searches will be limited to trials published in English from database inception till 2021. Grey literature will be identified through Open Grey, AHRQ, Grey Literature Report, Grey Matters, ClinicalTrials.gov, WHO International Clinical Trials Registry and International Standard Randomised Controlled Trials Number registry. Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two independent reviewers, with disagreements resolved via a third reviewer. The primary outcome measure is the relative risk of cure at 7 and 14 days postinitial treatment. Secondary outcome measures may include adverse drug events, ovicidal activity, treatment compliance and acceptability, and reinfestation. Information from direct and indirect evidence will be used to generate the effect sizes (relative risk) to compare the efficacy and safety of individual head lice treatments against a common comparator (placebo and/or permethrin). Risk of bias assessment will be undertaken by two independent reviewers using the Cochrane Risk of Bias tool and the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations guideline for network meta-analysis. All quantitative analyses will be conducted using STATA V.16. Discussion The evidence generated from this systematic review and meta-analysis is intended for use in evidence-driven treatment of head lice infestations and will be instrumental in informing health professionals, public health practitioners and policy-makers. PROSPERO registration number CRD42017073375.
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Affiliation(s)
- Bill Stevenson
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Wubshet Tesfaye
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Julia Christenson
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Cynthia Mathew
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Solomon Abrha
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Gregory Peterson
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Pharmacy, University of Tasmania, Hobart, Tasmania, Australia
| | - Indira Samarawickrema
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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Huppertz HI, Iseke A, Heininger U, Grundhewer H, Knuf M, Korenke C, Müller A, von Both U. Evidenzbasierte Kontrolle der Pediculosis capitis und deren Sekundärprävention. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-00987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
CONTEXT: Infections are common in contact sports. This review aims to describe the epidemiology, presenting signs and symptoms, treatment guidelines, and regulations for several common infections seen in contact sport athletes. The conditions discussed include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, human immunodeficiency virus, hepatitis C virus, and vaccine-preventable illnesses. EVIDENCE ACQUISITION: Searches were performed across PubMed and MEDLINE research databases. In addition, general internet search engine results and reviews of reference lists of relevant papers were used to identify additional sources of evidence. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: The most common infections seen in contact sport athletes include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, and vaccine-preventable illnesses. Other infections, including human immunodeficiency virus and hepatitis C, are uncommon but potentially life threatening. CONCLUSION: Infections are common in contact sport athletes. The provider who cares for these athletes should be aware of the most common infections and their appropriate management. Early diagnosis and appropriate clinical management are important for treating the infected athlete, minimizing risk of transmission, minimizing time lost from competition, and preventing large outbreaks.
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Affiliation(s)
- Andrew R. Peterson
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Emma Nash
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - B.J. Anderson
- University of Minnesota, Minneapolis, Minnesota
- Boynton Health Service, Minneapolis, Minnesota
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Jahangiri F. Case report: a new method for treatment of permethrin - resistant head lice. Clin Case Rep 2017; 5:601-604. [PMID: 28469858 PMCID: PMC5412800 DOI: 10.1002/ccr3.899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/05/2016] [Accepted: 02/13/2017] [Indexed: 11/11/2022] Open
Abstract
Head lice (Pediculus humanus capitis) infestation is an important disease worldwide, especially in children under 11 years old. Permethrin is the most common insecticide for treatment of human pediculosis, but nowadays resistance to permethrin and other pyrethroids has caused many treatment failures. The second treatment of choice is malathion.
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Affiliation(s)
- Farhad Jahangiri
- Department of PathobiologySchool of Veterinary MedicineShiraz University1731Shiraz71345Iran
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Militão de Sousa F, Vasconcelos AW, de Nadon J, Duhot PY. Treatment of human head lice infestations in a single application with a new galenic lotion. Int J Cosmet Sci 2015; 32:369-75. [PMID: 20491994 DOI: 10.1111/j.1468-2494.2009.00558.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To evaluate the efficiency and safety of a new galenic meta-emulsion for the treatment of human head lice (Pediculus capitis) in a single application. A controlled clinical study was conducted comparing lice infestation and nit hatching observed before and after a treatment in a single application. Eighty-two of the 87 children included completed the study. An infestation control was performed on 36 and 46 children, 8 and 24 h respectively after application. Five days later, a meticulous hair examination was carried out to check that the lice infestation was completely cured. After a single application of the lotion being tested, an examination of the scalp with a head lice detection comb, as well as an examination of the rinsing water and the towel used for drying after washing, showed that out of the total 1285 lice, there were no live lice. The percentage of nits hatching before treatment was close to 70%. In comparison, after an 8-h treatment (t(+8)), the percentage of nits hatching was 2.1%, with only 0.35% of living nymphs. After a 24-h treatment (t(+24)), 1.9% hatched with 0.38% living nymphs. Nymphs were revealed to be non-viable. After 5 days (t(+120)), no living adult or immature lice were found on the subjects tested. Moreover, observation of tolerance levels to this treatment at days 1, 5 and 12 showed no side effects. The specific galenic lotion completely cured head lice infestation in the population studied in a single application. The lotion, a patented meta-emulsion, has a mechanical action that asphyxiates lice and nits. Considering the advantages of the single application, the possibility of complete concomitant therapeutics for a whole school population within only 1 day and the high level of tolerance to this treatment, this approach seems simple and promising.
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6
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Abstract
An endeavour to delineate the salient details of the treatment of head lice infestation has been made in the present article. Treatment modalities including over the counter permethrin and pyrethrin, and prescription medicines, including malathion, lindane, benzyl alcohol, spinosad are discussed. Salient features of alternative medicine and physical treatment modalities are outlined. The problem of resistance to treatment has also been taken cognizance of.
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Affiliation(s)
- Prashant Verma
- Department of Dermatology and STD, North DMC Medical College, Hindu Rao Hospital, New Delhi, India
| | - Chaitanya Namdeo
- Department of Dermatology and STD, S.S Medical College, Rewa, Madhya Pradesh, India
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7
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Abstract
CONTEXT Cutaneous infections are common in wrestlers. Although many are simply a nuisance in the everyday population, they can be problematic to wrestlers because such infections may result in disqualification from practice or competition. Prompt diagnosis and treatment are therefore important. EVIDENCE ACQUISITION Medline and PubMed databases, the Cochrane Database of Systematic Reviews, and UpToDate were searched through 2012 with the following keywords in various combinations: skin infections, cutaneous infections, wrestlers, athletes, methicillin-resistant Staphylococcus aureus, skin and soft tissue infections, tinea corporis, tinea capitis, herpes simplex, varicella zoster, molluscum contagiosum, verruca vulgaris, warts, scabies, and pediculosis. Relevant articles found in the primary search, and selected references from those articles were reviewed for pertinent clinical information. RESULTS The most commonly reported cutaneous infections in wrestlers are herpes simplex virus infections (herpes gladiatorum), bacterial skin and soft tissue infections, and dermatophyte infections (tinea gladiatorum). The clinical appearance of these infections can be different in wrestlers than in the community at large. CONCLUSION For most cutaneous infections, diagnosis and management options in wrestlers are similar to those in the community at large. With atypical presentations, testing methods are recommended to confirm the diagnosis of herpes gladiatorum and tinea gladiatorum. There is evidence to support the use of prophylactic medications to prevent recurrence of herpes simplex virus and reduce the incidence of dermatophyte infections in wrestlers.
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Affiliation(s)
| | - Kevin deWeber
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Barker SC, Burgess I, Meinking TL, Mumcuoglu KY. International guidelines for clinical trials with pediculicides. Int J Dermatol 2012; 51:853-8. [PMID: 22715834 DOI: 10.1111/j.1365-4632.2011.05446.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Pediculosis capitis, infestation with head lice, is common in all human societies. Chemical pediculicides are often used to control head louse infestations, particularly in wealthy communities. A significant number of different protocols have been used to test the efficacy and safety of pediculicides in clinical trials; this constrains scientific comparison of the evidence for efficacy of the different pediculicides. Here we recommend protocols for clinical trials of the efficacy and safety of single-, two-, and three-treatment interventions.
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Affiliation(s)
- Stephen C Barker
- Parasitology Section, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia.
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van der Wouden JC, Klootwijk T, Le Cleach L, Do G, Vander Stichele R, Knuistingh Neven A, Eekhof JAH. Interventions for treating head lice. Hippokratia 2011. [DOI: 10.1002/14651858.cd009321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Tim Klootwijk
- Erasmus Medical Center; Department of General Practice; PO Box 2040 Rotterdam Netherlands 3000 CA
| | - Laurence Le Cleach
- Hospital Henri Mondor; Department of Dermatologie; 51 avenue du Général de Lattre de Tassigny Créteil France 94010
| | - Giao Do
- Hospital Henri Mondor; Department of Dermatologie; 51 avenue du Général de Lattre de Tassigny Créteil France 94010
| | - Robert Vander Stichele
- Ghent University; Heymans Institute of Clinical Pharmacology; De Pintelaan 185 Ghent Belgium B-9000
| | - Arie Knuistingh Neven
- Leiden University Medical Center; Department of Public Health and Primary Care; PO Box 9600 Leiden Netherlands 2300 RC
| | - Just AH Eekhof
- Leiden University Medical Center; Department of Public Health and Primary Care; PO Box 9600 Leiden Netherlands 2300 RC
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10
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Barker SC, Altman PM. An ex vivo, assessor blind, randomised, parallel group, comparative efficacy trial of the ovicidal activity of three pediculicides after a single application--melaleuca oil and lavender oil, eucalyptus oil and lemon tea tree oil, and a "suffocation" pediculicide. BMC DERMATOLOGY 2011; 11:14. [PMID: 21864348 PMCID: PMC3182970 DOI: 10.1186/1471-5945-11-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 08/24/2011] [Indexed: 11/30/2022]
Abstract
Background There are two components to the clinical efficacy of pediculicides: (i) efficacy against the crawling-stages (lousicidal efficacy); and (ii) efficacy against the eggs (ovicidal efficacy). Lousicidal efficacy and ovicidal efficacy are confounded in clinical trials. Here we report on a trial that was specially designed to rank the clinical ovicidal efficacy of pediculicides. Eggs were collected, pre-treatment and post-treatment, from subjects with different types of hair, different coloured hair and hair of different length. Method Subjects with at least 20 live eggs of Pediculus capitis (head lice) were randomised to one of three treatment-groups: a melaleuca oil (commonly called tea tree oil) and lavender oil pediculicide (TTO/LO); a eucalyptus oil and lemon tea tree oil pediculicide (EO/LTTO); or a "suffocation" pediculicide. Pre-treatment: 10 to 22 live eggs were taken from the head by cutting the single hair with the live egg attached, before the treatment (total of 1,062 eggs). Treatment: The subjects then received a single treatment of one of the three pediculicides, according to the manufacturers' instructions. Post-treatment: 10 to 41 treated live eggs were taken from the head by cutting the single hair with the egg attached (total of 1,183 eggs). Eggs were incubated for 14 days. The proportion of eggs that had hatched after 14 days in the pre-treatment group was compared with the proportion of eggs that hatched in the post-treatment group. The primary outcome measure was % ovicidal efficacy for each of the three pediculicides. Results 722 subjects were examined for the presence of eggs of head lice. 92 of these subjects were recruited and randomly assigned to: the "suffocation" pediculicide (n = 31); the melaleuca oil and lavender oil pediculicide (n = 31); and the eucalyptus oil and lemon tea tree oil pediculicide (n = 30 subjects). The group treated with eucalyptus oil and lemon tea tree oil had an ovicidal efficacy of 3.3% (SD 16%) whereas the group treated with melaleuca oil and lavender oil had an ovicidal efficacy of 44.4% (SD 23%) and the group treated with the "suffocation" pediculicide had an ovicidal efficacy of 68.3% (SD 38%). Conclusion Ovicidal efficacy varied substantially among treatments, from 3.3% to 68.3%. The "suffocation" pediculicide and the melaleuca oil and lavender oil pediculicide (TTO/LO) were significantly more ovicidal than eucalyptus oil and lemon tea tree oil pediculicide (EO/LTTO) (P < 0.0001). Ranking: 1. "Suffocation" pediculicide (68.3% efficacy against eggs); 2. Melaleuca oil and lavender oil (44.4%) pediculicide; 3. Eucalyptus oil and lemon tea tree oil (3.3%) pediculicide. The "suffocation" pediculicide and TTO/LO are also highly efficacious against the crawling-stages. Thus, the "suffocation" pediculicide and TTO/LO should be recommended as first line treatments. Trial Registration The study was listed at the Australian/New Zealand Clinical Trial Registry (ANZCTR): reg. no. 12609000884202.
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Affiliation(s)
- Stephen C Barker
- Parasitology Section, School of Chemistry & Molecular Biosciences, and UniQuest Pty Ltd, University of Queensland, Brisbane, QLD, Australia.
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11
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Heukelbach J, Pilger D, Oliveira FA, Khakban A, Ariza L, Feldmeier H. A highly efficacious pediculicide based on dimeticone: randomized observer blinded comparative trial. BMC Infect Dis 2008; 8:115. [PMID: 18783606 PMCID: PMC2553415 DOI: 10.1186/1471-2334-8-115] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 09/10/2008] [Indexed: 11/16/2022] Open
Abstract
Background Infestation with the human head louse (Pediculus humanus capitis) occurs worldwide. Existing treatment options are limited, and reports of resistance to commonly used pediculicides have been increasing. In this trial we assessed the efficacy of a product containing a high (92%) concentration of the silicone oil dimeticone (identical in composition to NYDA®), as compared to a 1% permethrin lotion. Methods Randomized, controlled, observer blinded clinical trial. Participants were recruited from a poor urban neighbourhood in Brazil where pediculosis capitis was highly prevalent. To minimize reinfestation during the trial, participants (145 children aged 5–15 years with head lice infestations) were transferred to a holiday resort outside the endemic area for a period of 9 days. Two applications of dimeticone or 1% permethrin were done, seven days apart. Outcome measures were defined as cure (absence of vital head lice) after first application and before and after second applications, degree of itching, cosmetic acceptability, and clinical pathology. Results Overall cure rates were: day 2 – dimeticone 94.5% (95% CI: 86.6% – 98.5%) and permethrin 66.7% (95% CI: 54.6% – 77.3%; p < 0.0001); day 7 – dimeticone 64.4% (95% CI: 53.3% – 75.3%) and permethrin 59.7% (95% CI: 47.5% – 71.1%; p = 0.5); day 9 – dimeticone 97.2% (95% CI: 90.3% – 99.7%) and permethrin 67.6% (95% CI: 55.4%-78.2%); p < 0.0001). Itching was reduced similarly in both groups. Cosmetic acceptability was significantly better in the dimeticone group as compared to the permethrin group (p = 0.01). Two mild product-related incidents occurred in the dimeticone group. Conclusion The dimeticone product is a safe and highly efficacious pediculicide. Due to its physical mode of action (interruption of the lice's oxygen supply of the central nervous system), development of resistance is unlikely. Trial registration Current Controlled Trials ISRCTN15117709.
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Affiliation(s)
- Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
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Plastow L, Luthra M, Powell R, Wright J, Russell D, Marshall MN. Head lice infestation: bug busting vs. traditional treatment. J Clin Nurs 2008. [DOI: 10.1111/j.1365-2702.2001.00541.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Affiliation(s)
- Marc Tebruegge
- Department of Paediatric Infectious Diseases, St Mary's Hospital London, UK.
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Lee SW, Kasai S, Komagata O, Kobayashi M, Agui N, Kono Y, Tomita T. Molecular characterization of two acetylcholinesterase cDNAs in Pediculus human lice. JOURNAL OF MEDICAL ENTOMOLOGY 2007; 44:72-9. [PMID: 17294923 DOI: 10.1603/0022-2585(2007)44[72:mcotac]2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Two cDNA sequences encoding Drosophila Ace-orthologous and -paralogous acetylcholinesterase precursors (AO- and AP-AChE precursors, respectively), were identified from the body louse, Pediculus humanus humanus L. In vitro inhibition studies with an insecticide-susceptible body louse strain exhibited a simplex inhibitory response of AChE. The I50 values of fenitroxon and carbaryl were estimated to be 2.2 and 1.9 microM for the susceptible lice, respectively. The mRNA level of AP-AChE gene was 3.1- and 9.3-fold higher than that of AO-AChE gene in the abdomen and the combined parts of the head and thorax, respectively, suggesting, due to its abundance, the potential significance of the AP-AChE isoform in Pediculus human lice in association with the efficacy of AChE-targeting pediculicides.
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Affiliation(s)
- Si-Woo Lee
- Department of Medical Entomology, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640, Japan
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15
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Goates BM, Atkin JS, Wilding KG, Birch KG, Cottam MR, Bush SE, Clayton DH. An effective nonchemical treatment for head lice: a lot of hot air. Pediatrics 2006; 118:1962-70. [PMID: 17079567 DOI: 10.1542/peds.2005-1847] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Head lice (Pediculus humanus capitis) are a major irritant to children and their parents around the world. Each year millions of children are infested with head lice, a condition known as pediculosis, which is responsible for tens of millions of lost school days. Head lice have evolved resistance to many of the currently used pediculicides; therefore, an effective new treatment for head lice is needed. In this study we examined the effectiveness of several methods that use hot air to kill head lice and their eggs. METHODS We tested 6 different treatment methods on a total of 169 infested individuals. Each method delivers hot air to the scalp in a different way. We evaluated how well these methods kill lice and their eggs in situ. We also performed follow-up inspections to evaluate whether the sixth, most successful, method can cure head louse infestations. RESULTS All 6 methods resulted in high egg mortality (> or = 88%), but they showed more-variable success in killing hatched lice. The most successful method, which used a custom-built machine called the LouseBuster, resulted in nearly 100% mortality of eggs and 80% mortality of hatched lice. The LouseBuster was effective in killing lice and their eggs when operated at a comfortable temperature, slightly cooler than a standard blow-dryer. Virtually all subjects were cured of head lice when examined 1 week after treatment with the LouseBuster. There were no adverse effects of treatment. CONCLUSIONS Our findings demonstrate that one 30-minute application of hot air has the potential to eradicate head lice infestations. In summary, hot air is an effective, safe treatment and one to which lice are unlikely to evolve resistance.
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Affiliation(s)
- Brad M Goates
- Department of Biology, University of Utah, 257 S 1400 E, Salt Lake City, UT 84112, USA
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Hill N, Moor G, Cameron MM, Butlin A, Preston S, Williamson MS, Bass C. Single blind, randomised, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom. BMJ 2005; 331:384-7. [PMID: 16085658 PMCID: PMC1184251 DOI: 10.1136/bmj.38537.468623.e0] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effectiveness of the Bug Buster kit with a single treatment of over the counter pediculicides for eliminating head lice. DESIGN Single blind, multicentre, randomised, comparative clinical study. SETTING Four counties in England and one county in Scotland. PARTICIPANTS 133 young people aged 2-15 years with head louse infestation: 56 were allocated to the Bug Buster kit and 70 to pediculicide treatment. INTERVENTIONS Home use of proprietary pediculicides (organophosphate or pyrethroid) or the Bug Buster kit. MAIN OUTCOME MEASURE Presence of head lice 2-4 days after end of treatment: day 5 for the pediculicides and day 15 for the Bug Buster kit. RESULTS The cure rate using the Bug Buster kit was significantly greater than that for the pediculicides (57% v 13%; relative risk 4.4, 95% confidence interval 2.3 to 8.5). Number needed to treat for the Bug Buster kit compared with the pediculicides was 2.26. CONCLUSION The Bug Buster kit was the most effective over the counter treatment for head louse infestation in the community when compared with pediculicides.
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Affiliation(s)
- N Hill
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT.
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Affiliation(s)
- Michael J Sladden
- Department of Dermatology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, LE1 5WW.
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Mills C, Cleary BJ, Gilmer JF, Walsh JJ. Inhibition of acetylcholinesterase by Tea Tree oil. J Pharm Pharmacol 2004; 56:375-9. [PMID: 15025863 DOI: 10.1211/0022357022773] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Pediculosis is a widespread condition reported in schoolchildren. Treatment most commonly involves the physical removal of nits using fine-toothcombs and the chemical treatment of adult lice and eggs with topical preparations. The active constituents of these preparations frequently exert their effects through inhibition of acetylcholinesterase (AChE, EC 3.1.1.7). Increasing resistance to many preparations has led to the search for more effective treatments. Tea Tree oil, otherwise known as Melaleuca oil, has been added to several preparations as an alternative treatment of head lice infestations. In this study two major constituents of Tea Tree oil, 1,8-cineole and terpinen-4-ol, were shown to inhibit acetylcholinesterase at IC50 values (inhibitor concentrations required to give 50% inhibition) of 0.04 and 10.30 mM, respectively. Four samples of Tea Tree oil tested (Tisserand, Body Treats, Main Camp and Irish Health Culture Association Pure Undiluted) showed anticholinesterase activity at IC50 values of 0.05, 0.10, 0.08 and 0.11 microL mL(-1), respectively. The results supported the hypothesis that the insecticidal activity of Tea Tree oil was attributable, in part, to the anticholinesterase activity of Tea Tree oil.
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Affiliation(s)
- Clive Mills
- Department of Pharmacognosy, School of Pharmacy, Trinity College Dublin, College Street, Dublin 2, Ireland
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21
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Abstract
Head lice infestation is a common and growing problem that primarily affects school-aged children. Most cases of head lice are diagnosed and treated by nonphysicians. Misdiagnosis may lead to treatment when no lice are present. Treatment failure may lead to repeated use of and improperly applied pediculicides, potentially resulting in overexposure to pesticides. These treatment failures are primarily due to the emergence of treatment-resistant lice. In regions where resistant lice are common, patients may self-treat numerous times with over-the-counter pediculicides before seeking treatment from a physician. Resistance has decreased the efficacy of lindane, a prescription pediculicide that has been used for decades. In addition, the Food and Drug Administration recently warned of potentially serious adverse effects associated with lindane and recommended strict controls for its use. Malathion, recently reintroduced in the United States as a prescription pediculicide, has not been associated with treatment resistance or notable adverse effects, although it is flammable due to its alcohol base. Because of concerns about decreasing efficacy due to resistance and safety concerns about over-the-counter products and some prescription pediculicides, a reassessment of pediculicide safety is warranted. The safety and efficacy of commonly used over-the-counter and prescription pediculicide products are discussed, along with the safety and efficacy of other treatments, such as ivermectin, that are not indicated for the treatment of head lice but are being used increasingly.
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Affiliation(s)
- Craig G Burkhart
- Department of Internal Medicine, Medical College of Ohio at Toledo, 5600 Monroe St, No. 106-B, Sylvania, OH 43560, USA.
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Abstract
The 3 major lice that infest humans are Pediculus humanus capitis (head louse), Pthirus pubis (crab louse), and Pediculus humanus humanus (body louse). Patients with louse infestation present with scalp pruritus, excoriations, cervical lymphadenopathy, and conjunctivitis. A hypersensitivity rash, or pediculid, may mimic a viral exanthem. Head lice infestation crosses all economic and social boundaries, whereas body lice infestation preferentially affects the homeless and displaced. Body lice are major vectors of diseases such as typhus, trench fever, and relapsing fever. Pubic lice infestation often is acquired as a sexually transmitted disease and may be a marker to screen for other sexually transmitted diseases. Treatment of louse infestation can be challenging. Mechanical measures, such as combing, are helpful as adjunctive measures, but most studies suggest they are not as effective as chemical agents. Resistance to chemical agents is a growing problem. Major types of resistance include knock-down resistance, glutathione-S-transferase-based resistance, and monooxygenase-based resistance. Research is needed to identify new effective treatments.
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Affiliation(s)
- Christine J Ko
- Department of Dermatology, University of California at Irvine, USA
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Jones KN, English JC. Review of common therapeutic options in the United States for the treatment of pediculosis capitis. Clin Infect Dis 2003; 36:1355-61. [PMID: 12766828 DOI: 10.1086/374840] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2002] [Accepted: 12/24/2002] [Indexed: 11/03/2022] Open
Abstract
Numerous therapies are available in both over-the-counter and prescription formulations for the treatment of head lice infestation. We summarize treatment recommendations from published literature and from a recent meta-analysis from the Cochrane Database of Systematic Reviews that describe the efficacy, safety, and resistance patterns of monotherapies available in the United States. If treatment with pyrethrin or permethrin fails to eradicate the infestation, the treatment of choice is malathion. However, because of malathion's flammability, it should be a second-line therapy. Orally administered ivermectin has been reported to be efficacious, but it is not currently a US Food and Drug Administration-approved pediculicide. Alternative therapies are also discussed, in addition to indications for prophylaxis, resistance reporting, and the social impact of infestation.
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Affiliation(s)
- Kimberly N Jones
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA, 22908, USA
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Abstract
Epizoonoses such as scabies, lice and cimicosis are common, vexing disorders that occur worldwide. Historically, many treatment modalities have been employed in the management of these disorders, and most of the drugs described in this review are of historical interest and no longer recommended or in widespread use because of their wide spectrum of adverse effects. More recently, reports documenting resistance against various antiectoparasite drugs, complicated and severe courses of the diseases, and adverse effects of drug therapy have prompted the development of new treatment strategies and drugs for optimal disease management. Because the strategies currently recommended for the treatment of ectoparasites differ worldwide, this review proposes a rational approach to selecting the best therapeutic agent by comparing the pharmacokinetics, pharmacodynamics, drug efficacy and adverse effects. A literature search of the currently Internet accessible libraries PubMed, Medline and Ideal library, of citations of articles found there, and from communications with the Federal Institute for Drugs and Medical Devices, Germany, was conducted based on this approach. One major observation of this literature search is that permethrin is the treatment of choice for lice and scabies in the US and in Great Britain, whereas lindane is still recommended for scabies in most other European countries because of its longer-standing record of effectiveness. Although permethrin has not yet been proven to be more effective than lindane in treating infections with these ectoparasites, it currently appears to have the best efficacy versus safety profile of topical treatments for scabies and lice. Ivermectin is a newer oral drug for the treatment of ectoparasites, which has been used with great success in the treatment of onchocercosis and other endoparasites. Although ivermectin appears to be a promising drug, its role in the treatment of ectoparasitic infections will be clarified as more study data become available. Finally, it is important to emphasise the clinical aspects of ectoparasite therapy and that providing the patient with optimal instructions on the use of topical therapeutics is of great importance in avoiding adverse effects and assuring complete removal of the ectoparasite, thereby avoiding the development of drug-resistance.
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Affiliation(s)
- T C Roos
- Department of Dermatology, University Clinic of the Rheinisch Westfälischen Technischen Hochschule Aachen, Germany.
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25
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