Comparative efficacy of two nit combs in removing head lice (Pediculus humanus var. capitis) and their eggs

Head Lice

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among caregivers of school-aged children and adolescents. Since the 2015 clinical report on head lice was published by the American Academy of Pediatrics, new medications have been approved, and an algorithm for management of affected patients is included. This revised clinical report clarifies current diagnosis and treatment protocols.

A Cosmetically Acceptable Dye Product to Improve Detection of Head Louse Eggs and Nits

Removing head louse eggshells and nits after a successful pediculicide treatment is often made more difficult because it is not easy to see them all amongst the hairs. Therefore, a treatment that makes louse eggs more visible potentially makes the task of removal easier and reduces the risk that children would be sent home from school or over-treated. This project involved the development of a hair treatment gel concept that was easy to apply, wash out, and that stained louse eggs and nits but without staining the hair and skin. A series of food-grade dyes were evaluated for their ability to stain the eggshells, and various copolymer-based rheology modifiers were tested for dye compatibility and stability. Several dyes were rejected because either they failed to stain louse eggshells or else stained skin too easily. Two dyes, Patent Blue and Ponceau 4R, were eventually selected for different product developments, one specifically for post-treatment nit removal and the other for pre-treatment diagnosis. In clinical field studies, both were found to make the treated eggshells contrast sufficiently with the hair to enable identification of persistent nits. Use of a nit stain product can enable easier detection of louse eggs and nits, thus facilitating the removal process and reducing the risk that persistent eggshells could be mistaken for signs of a continuing infestation.

Deterministic approaches for head lice infestations and treatments

Pediculus humanus capitis are human ectoparasites which cause infestations, mostly in children, worldwide. Understanding the life cycle of head lice is an important step in knowing how to treat lice infestations, as the parasite behavior depends considerably on its age and gender. In this work we propose a mathematical model for head lice population dynamics in hosts who could be or not quarantined and treated. Considering a lice population structured by age and gender we formulate the model as a system of hyperbolic PDEs, which can be reduced to compartmental systems of delay or ordinary differential equations. Besides studying fundamental properties of the model, such as existence, uniqueness and nonnegativity of solutions, we show the existence of (in certain cases multiple) equilibria at which the infestation persists on the host’s head. Aiming to assess the performance of treatments against head lice infestations, by mean of computer experiments and numerical simulations we investigate four possible treatment strategies. Our main results can be summarized as follows: (i) early detection is crucial for quick and efficient eradication of lice infestations; (ii) dimeticone-based products applied every 4 days effectively remove lice in at most three applications even in case of severe infestations and (iii) minimization of the reinfection risk, e.g. by mean of synchronized treatments in families/classrooms is recommended.

Head Lice

BACKGROUND

Conflicting information about the proper treatment of head lice has given rise to uncertainty among patients and treating personnel. For example, the reported efficacy of permethrin fell from 97% in the 1990s to 30% in 2010.

METHODS

Review of the literature based on a selective search of PubMed.

RESULTS

In Germany, outbreaks of head lice mainly occur among 5- to 13-year-olds returning to school after the summer vacation. Nymphs hatch from eggs after an average of 8 days and become sexually mature lice over the ensuing 9 days. The main route of transmission is direct head-to-head contact; transmission via inanimate objects is of no relevance. Symptoms arise 4-6 weeks after an initial infestation; many affected persons have no symptoms at all. Wet combing is the most sensitive method of establishing the diagnosis and monitoring treatment. Resistance to neurotoxic pediculocidal drugs is increasing around the world. Dimethicones are the treatment of choice, with 97% efficacy. Outbreaks must be managed with the synchronous treatment of all infested persons to break the chain of infestation. If the agent used is not ovicidal, the treatment must be repeated in 8-10 days and sometimes in a further 7 days as well.

CONCLUSION

Outbreaks of head lice can be successfully terminated by synchronous treatment with ovicidal dimethicones.

Head lice

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2010 clinical report on head lice was published by the American Academy of Pediatrics, newer medications have been approved for the treatment of head lice. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting.

How long do louse eggs take to hatch? A possible answer to an age-old riddle

There are no rigorous data on how long eggs of the head louse, Pediculus capitis (Phthiraptera: Pediculidae), take to hatch. Pediculicide users often report reinfestations after apparently successful treatments in the absence of infective contacts. This study aimed to resolve the question of whether some louse eggs hatch after the completion of treatment, thereby giving rise to a new infestation. Data were extracted from the records of lice collected after treatments in 20 clinical intervention trials. All datasets were eliminated except those in which only newly hatched louse nymphs were found prior to the final assessment. This excluded the possibility that new eggs were laid after the first treatment and thus any young lice found must have originated from eggs laid before the start of treatment. This identified 23 of 1895 (1.2%) records with evidence of louse nymphs emerging at 13 days or more after the first treatment, 3–6 days longer than previous estimates. Current treatment regimens for pediculicides of two applications 7–10 days apart appear inadequate, which may explain continuing infestation in the community. Therefore, it is suggested that a revised approach using three treatments applied at intervals of 1 week should prevent the survival of any nymphs and their development into a new generation of adults.

Comparative efficacy of commercial combs in removing head lice (Pediculus humanus capitis) (Phthiraptera: Pediculidae)

The use of a fine comb for removing lice from the head of the human host is a relevant tool both in the diagnosis of infestations and as part of an integrated control strategy of head lice. The effectiveness of a fine comb depends, in part, on the design and material they are built. The aim of this study was to compare in vivo the efficacy of metal and plastic combs that are currently used in the removal of head lice and eggs worldwide. The space between comb teeth and the length was 0.23 and 13 mm in KSL® plastic, 0.3 and 10.7 mm in NOPUCID® plastic, 0.15 and 31 mm in KSL® metal and 0.09 and 37 mm in ASSY® metal. The assays were performed comparing the combs in pairs: (a) KSL® vs. NOPUCID® plastic combs, (b) KSL® vs. ASSY® metal combs and (c) KSL® plastic comb vs. ASSY® metal comb. The most effective plastic comb was KSL®, removing a higher number of individuals of all stages. The most effective metal comb was ASSY®, removing more insects of all stages (except adults). The comparative test between KSL® plastic and ASSY® metal showed that ASSY® was the most effective in removing head lice and their eggs.

[Metal microchanelled fine-toothed comb use in the diagnosis of pediculosis]

BACKGROUND

Methods for the diagnosis of Pediculus humanus var. capitis are controversial and most studies are based on direct visual exam.

OBJECTIVE

The objective of this study was to compare the diagnosis efficacy of both direct visual exam and the use of a metal microchanelled fine-toothed comb.

METHODS

946 children and teenagers 4 to 19 years of age were examined. Each individual's hair was examined twice to determine whether there was infestation by lice or nits, through direct visual exam and the use of a metal microchanelled fine-toothed comb.

RESULTS

The visual diagnosis detected infestation in 30.7% of the cases, while the metal comb detected infestation in 51.5%. Females were the most affected. The forms of parasites detected through direct visual exam were: only lice (adults and/or nymphs) 1.4%, only live nits 64.8% and live nits and lice, 33.8%; with the metal comb the percentages were 6.4%, 23.6% and 70%, respectively. The average time to find a louse was 57 seconds with the fine-toothed comb and 116.4 seconds through the direct visual exam.

CONCLUSIONS

Diagnosis with the microchanelled fine-toothed comb is twice as fast and 3.6 times more efficient than through direct visual exam.The direct visual exam detects non-active, past infestations, and underestimates active ones.

Do nit removal formulations and other treatments loosen head louse eggs and nits from hair?

Eggs of the head louse, Pediculus capitis De Geer (Phthiraptera: Pediculidae), are difficult to remove because the female louse fixes them to hairs using a proteinaceous secretion that hardens within seconds. The persistent eggshells are harmless but unsightly and are often mistaken for an active infestation. Combing with a fine comb (nit comb) does not readily remove the eggs or empty eggshells because of the resilience of the fixative and both folk remedies and medical products have claimed to facilitate their removal. Measurement of the force required to initiate sliding of the egg fixative using a slip-peel tester was unable to detect evidence that any of three products which claimed to have egg-loosening properties (Step 2 Nit Removal System, Clear Lice Egg Remover, RID Lice Egg Loosener Gel) had any activity or exerted any effect on the egg fixative beyond the lubricating effects conveyed by water or conventional hair conditioner.