Treatment of human lice

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Treatment of human lice
Jan Siberechts "Cour de ferme" detail Scene d'epouillage.jpg
Mother hunting for headlice, detail of a painting by Jan Siberechts
Specialty Infectious disease

The treatment of human lice is the removal of head lice parasites from human hair. It has been debated and studied for centuries. However, the number of cases of human louse infestations (or pediculosis) has increased worldwide since the mid-1960s, reaching hundreds of millions annually. [1] There is no product or method that assures 100% destruction of the eggs and hatched lice after a single treatment. However, there are a number of treatment modalities that can be employed with varying degrees of success. These methods include chemical treatments, natural products, combs, shaving, hot air, and silicone-based lotions.

Contents

Treatment is recommended only after a clear diagnosis since all treatments have potential side effects. [2] Louse eggs hatch 6–9 days after oviposition. Therefore, a common recommendation is to repeat treatment with a pediculicide at least once after 10 days, when all lice have hatched. [3] Between the two treatments (Days 2–9) the person will still be infested with lice that hatch from eggs not killed by the anti-louse product. Between the treatments, it is advised to wet the hair and comb daily with a louse-comb to remove the hatching lice. If no living lice are found, the treatment was successful, even if nits (eggs) are visible on the hair. If living lice are still present, the treatment is repeated using an anti-louse product with a different active ingredient. This is kept in the hair for 2 hours and then rinsed out, with the head and hair cleaned before sleep. Prophylactic treatment with pediculicides is not recommended. [4]

Medications

Insecticides used for the treatment of head lice include lindane, malathion, carbaryl, pyrethrum, piperonyl butoxide, permethrin, phenothrin, bioallethrin, and spinosad.

Many of the pediculicides in the market are either not fully effective or are ineffective when they are used according to the instructions. [5] [6] [7] [8] Pediculicides may rapidly lose their efficacy because of the development of resistance. Resistance of head lice to insecticides such as lindane, malathion, phenothrin and permethrin has been reported. [9] [10] [11]

A 2021 systematic review and meta-analysis found that the mean frequency of pyrethroid resistance of lice was 77% globally, and even 100% in several countries (Australia, England, Israel, and Turkey). [12] It concluded that treatment with current insecticides may not be effective and is likely the cause of increased levels of infestations. [12]

Ivermectin by mouth has been shown to reduce levels of louse infestation. [13] [14] [15] Ivermectin is approved by the U.S. Food and Drug Administration (FDA) for pediculosis. [16]

Agents approved by the FDA for treatment of pediculosis include abametapir, [17] topical ivermectin lotion, lindane, malathion, permethrin, and piperonyl butoxide with pyrethrins. [18] [ needs update ]

Heated air

A heated air device designed by Larada Sciences to kill headlice by drying LouseBuster.JPG
A heated air device designed by Larada Sciences to kill headlice by drying

A standard home blow dryer will kill 96.7% of eggs with proper technique. [19] To be effective, the blow dryer must be used repeatedly (every 1 to 7 days since eggs hatch in 7 to 10 days) until the natural life cycle of the lice is over (about 4 weeks). [20]

A number of commercial head lice treatment companies across the country offer a heated air treatment.

Combing

The delousing by Adriaen Brouwer Adriaen Brouwer - The delousing.jpg
The delousing by Adriaen Brouwer

A special fine-toothed comb that can pick out lice is used. For a treatment with louse comb alone, it is recommended to comb the hair for an hour to an hour and a half (depending the length and type of the hair) daily or every second day for 14 days. Wetting the hair especially with water and shampoo or conditioner will facilitate the combing and the removal of lice, eggs and nits. [21] [22] [23] [24]

Electronic louse combs use a small electrical charge to kill lice. The metal teeth of the comb have alternating positively and negatively charged tines, which are powered by a small battery. When the comb is used on dry hair, lice make contact with multiple tines of the fine-toothed comb, thereby closing the circuit and receiving an electrical charge. A non-peer-reviewed letter has been published in a dermatology journal claiming effectiveness based on personal experience (total of 6 uses). [25]

Procedures

Shaving the head or cutting the hair extremely short can be used to control lice infestation. Short hair, baldness, or a shaven scalp are generally seen as a preventive measure against louse infestation. This will also eliminate – particularly if maintained for the length of the parasites' reproductive cycle – louse infestation.

Infestation with lice is not a serious disease and the medical symptoms are normally minimal. In any case, health providers and parents should try not to create emotional problems for children during examination and treatment. [26]

Shaving of the area above and behind the ears and the upper part of the neck while leaving the crown of the head with hair is commonly used to prevent lice among tribes in Africa, Asia, and America (in America – Mohawk style).[ citation needed ]

School treatment

Head louse nits on human hair Fig. 5. Louse nits.jpg
Head louse nits on human hair

Schools in the United States, Canada, and Australia commonly exclude infested students, and prevent return of those students until all lice, eggs, and nits are removed. [27] This is the basis of the "no-nit policy". Data from a primarily American study during 1998–1999 found that no-nit policies were present at 82% of the schools attended by children suspected of louse infestation. [28] A separate 1998 survey revealed that 60% of American school nurses felt that "forced absenteeism of any child who has any nits in their hair is a good idea." [29]

A number of health researchers and organizations object to the no-nit policy. [27] [30] [31] [32] Opponents to the no-nit policy mention that visible nits may only be empty egg casings which pose no concern as transmission can only occur via live lice or eggs. [27] This has led to the perception that the no-nit policy serves only to ease the workload of school nurses and punish the parents of infested children. [27]

Proponents of the no-nit policy counter that only a consistently nit-free child can be reliably shown to be infestation-free. [33] That is, the presence of nits serves as an indirect proxy for infestation status. Proponents argue that such a proxy is necessary because lice screening is prone to false negative conclusions (i.e., failure to find lice present on actively infested children). [30] [34] For example, a 1998 Israeli study found that 76% of live lice infestations were missed by visual inspection (as verified by subsequent combing methods). [35] [36] Although lice cannot fly or jump, they are fast and agile in their native environment (i.e., clinging to hairs near the warmth of the scalp), [30] and will try to avoid the light used during inspection. [37] [38] Louse colonies are also sparse (often fewer than 10 lice), which can contribute to difficulty in finding live specimens. [39] Further, lice populations consist predominantly of immature nymphs, [40] which are even smaller and harder to detect than adult lice. [35]

Alternative medicine

Tea tree oil has been promoted as a treatment for head lice; however, evidence of its effectiveness is weak. [41] [42] A 2012 review of head lice treatment recommended against the use of tea tree oil for children because it could cause skin irritation or allergic reactions, because of contraindications, and because of a lack of knowledge about the oil's safety and effectiveness. [43] Other home remedies such as putting vinegar, isopropyl alcohol, olive oil, mayonnaise, or melted butter in the hair have been partially disproven, [44] The use of plastic bags may be dangerous. [45] Similarly, the Centers for Disease Control and Prevention reports that swimming has no effect on treating lice, and can in fact harm the treatment by commercial products. [46] Ethanol (ethyl alcohol, common alcohol) is toxic to arthropods including lice and an external application of it is harmless to humans. [47] [48] [49]

Gasoline or kerosene

The use of kerosene or gasoline for prevention or treatment of lice is dangerous due to the inherent fire hazard. [4] [50] Since 1989, there have been at least nine cases of children being severely burned during such attempts. These cases apparently occurred because, contrary to popular belief, it is the fumes of the gasoline, rather than the liquid itself, that are flammable. These fumes can ignite due to the presence of even a small spark or open flame - such as those caused by electrical appliances, cigarette lighters, or pilot lights in stoves and water heaters. The use of gasoline to treat lice also carries a high risk of dermatitis (i.e. irritation of the scalp). [51]

Before gasoline (Petrol) was used as fuel, it was sold in small bottles as a treatment against lice and their eggs.[ citation needed ] At that time, the word Petrol was a trade name. [52]

Related Research Articles

<span class="mw-page-title-main">Scabies</span> Human disease

Scabies is a contagious human skin infestation by the tiny (0.2–0.45 mm) mite Sarcoptes scabiei, variety hominis. The word is from Latin: scabere, lit. 'to scratch'. The most common symptoms are severe itchiness and a pimple-like rash. Occasionally, tiny burrows may appear on the skin. In a first-ever infection, the infected person usually develops symptoms within two to six weeks. During a second infection, symptoms may begin within 24 hours. These symptoms can be present across most of the body or just certain areas such as the wrists, between fingers, or along the waistline. The head may be affected, but this is typically only in young children. The itch is often worse at night. Scratching may cause skin breakdown and an additional bacterial infection in the skin.

<span class="mw-page-title-main">Louse</span> Order of insects

Louse is the common name for any member of the clade Phthiraptera, which contains nearly 5,000 species of wingless parasitic insects. Phthiraptera has variously been recognized as an order, infraorder, or a parvorder, as a result of developments in phylogenetic research.

<span class="mw-page-title-main">Sucking louse</span> Suborder of insects

Sucking lice have around 500 species and represent the smaller of the two traditional superfamilies of lice. As opposed to the paraphyletic chewing lice, which are now divided among three suborders, the sucking lice are monophyletic.

<span class="mw-page-title-main">Crab louse</span> Species of insect

The crab louse or pubic louse is an insect that is an obligate ectoparasite of humans, feeding exclusively on blood. The crab louse usually is found in the person's pubic hair. Although the louse cannot jump, it can also live in other areas of the body that are covered with coarse hair, such as the perianal area, the entire body, and the eyelashes.

<span class="mw-page-title-main">Pediculosis</span> Medical condition

Pediculosis is an infestation of lice from the sub-order Anoplura, family Pediculidae. Accordingly, the infestation with head lice is named pediculosis capitis, while this with body lice, pediculosis corporis. Although pediculosis in humans may properly refer to lice infestation of any part of the body, the term is sometimes used loosely to refer to pediculosis capitis, the infestation of the human head with the specific head louse.

<span class="mw-page-title-main">Head louse</span> Insect parasite of humans

The head louse is an obligate ectoparasite of humans. Head lice are wingless insects that spend their entire lives on the human scalp and feed exclusively on human blood. Humans are the only known hosts of this specific parasite, while chimpanzees and bonobos host a closely related species, Pediculus schaeffi. Other species of lice infest most orders of mammals and all orders of birds.

<span class="mw-page-title-main">Permethrin</span> Medication and insecticide

Permethrin is a medication and an insecticide. As a medication, it is used to treat scabies and lice. It is applied to the skin as a cream or lotion. As an insecticide, it can be sprayed onto outer clothing or mosquito nets to kill the insects that touch them.

<span class="mw-page-title-main">Malathion</span> Chemical compound

Malathion is an organophosphate insecticide which acts as an acetylcholinesterase inhibitor. In the USSR, it was known as carbophos, in New Zealand and Australia as maldison and in South Africa as mercaptothion.

<span class="mw-page-title-main">Ivermectin</span> Medication for parasite infestations

Ivermectin is an antiparasitic drug. After its discovery in 1975, its first uses were in veterinary medicine to prevent and treat heartworm and acariasis. Approved for human use in 1987, it is used to treat infestations including head lice, scabies, river blindness (onchocerciasis), strongyloidiasis, trichuriasis, ascariasis and lymphatic filariasis. It works through many mechanisms to kill the targeted parasites, and can be taken by mouth, or applied to the skin for external infestations. It belongs to the avermectin family of medications.

<span class="mw-page-title-main">Sea louse</span> Family of copepods

Sea lice are copepods of the family Caligidae within the order Siphonostomatoida. They are marine ectoparasites that feed on the mucus, epidermal tissue, and blood of host fish. The roughly 559 species in 37 genera include around 162 Lepeophtheirus and 268 Caligus species.

<i>Cheyletiella</i> Genus of mites

Cheyletiella is a genus of mites that live on the skin surface of dogs, cats, and rabbits.

<span class="mw-page-title-main">Body louse</span> Subspecies of insect

The body louse or the cootie is a hematophagic ectoparasite louse that infests humans. It is one of three lice which infest humans, the other two being the head louse, and the crab louse or pubic louse.

An ectoparasiticide is an antiparasitic drug used in the treatment of ectoparasitic infestations. These drugs are used to kill the parasites that live on the body surface. Permethrin, sulfur, lindane, dicophane, benzyl benzoate, ivermectin and crotamiton are well known ectoparasiticides. Additionally, ectoparasiticides have been used to safely contaminate rhinoceros horns with hopes of it deterring the demand for these horns on the black market.

<span class="mw-page-title-main">Head lice infestation</span> Medical condition

Head lice infestation, also known as pediculosis capitis, is the infection of the head hair and scalp by the head louse. Itching from lice bites is common. During a person's first infection, the itch may not develop for up to six weeks. If a person is infected again, symptoms may begin much more quickly. The itch may cause problems with sleeping. Generally, however, it is not a serious condition. While head lice appear to spread some other diseases in Africa, they do not appear to do so in Europe or North America.

<span class="mw-page-title-main">Archaeoparasitology</span> Study of parasites in archaeological contexts

Archaeoparasitology, a multi-disciplinary field within paleopathology, is the study of parasites in archaeological contexts. It includes studies of the protozoan and metazoan parasites of humans in the past, as well as parasites which may have affected past human societies, such as those infesting domesticated animals.

<span class="mw-page-title-main">No nit policy</span> Public health policy

No nit policy is a public health policy implemented by some education authorities to prevent the transmission of head lice infestation. The "no nit" policy requires the sending home and barring of all children who have nits on their hair from controlled settings such as school, summer camp or day care facilities. The CDC, American Academy of Pediatrics (AAP) and the National Association of School Nurses (NASN) advocate that "no-nit" policies should be discontinued, due in part because nits, the eggs or empty egg shells, are not transmissible and the burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice. Proponents of the no-nit policy counter that only a consistently nit-free child can be reliably shown to be infestation-free. That is, the presence of nits serves as a proxy for infestation status. Proponents argue that such a proxy is necessary because lice screening is prone to false negative conclusions.

<span class="mw-page-title-main">Pediculosis corporis</span> Medical condition

Pediculosis corporis or Vagabond's disease is a cutaneous condition caused by body lice that lay their eggs on clothing and to a lesser extent on human hairs.

<span class="mw-page-title-main">Pediculosis pubis</span> Infestation by the pubic louse

Pediculosis pubis is an infestation by the pubic louse, Pthirus pubis, a wingless insect which feeds on blood and lays its eggs (nits) on mainly pubic hair. Less commonly, hair near the anus, armpit, beard, eyebrows, moustache, and eyelashes may be involved. It is usually acquired during sex, but can be spread via bedding, clothing and towels, and is more common in crowded conditions where there is close contact between people.

<i>Trichodectes canis</i> Species of louse

Trichodectes canis, also known as canine chewing louse, is a chewing louse found on domesticated dogs and wild canids throughout the world. T. canis is a well-known vector for the dog tapeworm, Dipylidium caninum. T. canis usually does not present any major problems to the host, however, can be very irritating in heavy infestations. In North America and most developed countries, T. canis infestation of domesticated dogs is very uncommon as long as they are properly cared for and healthy. Poorly taken care of dogs are more prone to getting a lice infestation.

<i>Haematopinus suis</i> Species of louse

Haematopinus suis, the hog louse, is one of the largest members of the louse suborder Anoplura, which consists of sucking lice that commonly afflict a number of mammals. H. suis is found almost solely on the skin surface of swine, and takes several blood meals a day from its host. H. suis has large claws that enable it to grasp a hog's hair and move around its body. It is easily seen without magnification, being 5–6 millimetres (0.20–0.24 in) long. H. suis has a long, narrow head and long mouthparts adapted for sucking blood. It is the only louse found on swine. H. suis infestation is relatively rare in the US; a 2004 study found that about 14% of German swine farms had H. suis infestations. Due to the frequency of feeding, infected swine become severely irritated, often rubbing themselves to the point of injuring their skin and displacing body hair. Particularly afflicted hogs may become almost completely bald and, in young hogs, the resulting stress can arrest growth, a cause of concern for farmers.

References

  1. ↑ Gratz, Norman G. (1998), Human lice, their prevalence and resistance to insecticides (PDF), Geneva: World Health Organization (WHO) , retrieved 20 April 2020
  2. ↑ Frankowski, Barbara L; Bocchini, Joseph A.; Council on School Health and Committee on Infectious Diseases (August 2010). "Head Lice". Pediatrics. 126 (2): 392–403. doi:10.1542/peds.2010-1308. PMID   20660553. S2CID   29226586.
  3. ↑ [ needs update ]Mumcuoglu, Kosta (1 May 2006). "Effective Treatment of Head Louse with Pediculicides". Journal of Drugs in Dermatology . 5 (5): 451–452. PMID   16703782.
  4. 1 2 [ needs update ]Mumcuoglu, Kosta Y.; Barker, CS; Burgess, IF; Combescot-Lang, C; Dagleish, RC; Larsen, KS; Miller, J; Roberts, RJ; Taylan-Ozkan, A. (2007). "International Guidelines for Effective Control of Head Louse Infestations". Journal of Drugs in Dermatology . 6 (4): 409–414. PMID   17668538.
  5. ↑ Roberts, RJ; Casey D; Morgan DA; Petrovic M (12 August 2000). "Comparison of Wet Combing With Malathion for Treatment of Head Lice in the UK: A Pragmatic Randomised Controlled Trial". The Lancet . 356 (9229). Amsterdam: Elsevier: 540–544. doi:10.1016/S0140-6736(00)02578-2. PMID   10950230. S2CID   9790264.
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  8. ↑ Meinking, Terri L.; Entzel, Pamela; Villar, Maria Elena; Vicaria, Maureen; Lemard, Glendene A; Porcelain, Sherri L. (March 2001). "Comparative Efficacy of Treatments for Pediculosis Capitis Infestations". Archives of Dermatology . 137 (3). Chicago: American Medical Association: 287–292. PMID   11255326 . Retrieved 2008-01-03.
  9. ↑ Pollack RJ, Kiszewski A, Armstrong P, Hahn C, Wolfe N, Rahman HA, Laserson K, Telford SR, Spielman A (September 1999). "Differential Permethrin Susceptibility of Head Lice Sampled in the United States and Borneo". Archives of Pediatrics & Adolescent Medicine . 153 (9). Chicago: American Medical Association: 969–973. doi:10.1001/archpedi.153.9.969. PMID   10482215.
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  12. 1 2 Mohammadi, Jalal; Azizi, Kourosh; Alipour, Hamzeh; Kalantari, Mohsen; Bagheri, Masoumeh; Shahriari-Namadi, Marzieh; Ebrahimi, Saeedeh; Moemenbellah-Fard, Mohammad D. (2021). "Frequency of pyrethroid resistance in human head louse treatment: systematic review and meta-analysis". Parasite. 28: 86. doi:10.1051/parasite/2021083. PMC   8693761 . PMID   34935614.
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  37. ↑ Bacot A (1917). "Contributions to the bionomics of Pediculus humanus (vestimenti) and Pediculus capitis". Parasitology. 9 (2): 228–258. doi:10.1017/S0031182000006065. S2CID   86846228.
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  39. ↑ Mumcuoglu KY, Miller J, Gofin R, et al. (September 1990). "Epidemiological studies on head lice infestation in Israel. I. Parasitological examination of children". International Journal of Dermatology. 29 (7): 502–6. doi:10.1111/j.1365-4362.1990.tb04845.x. PMID   2228380. S2CID   39798857.
  40. ↑ Buxton, Patrick A. (1947). "The biology of Pediculus humanus". The Louse; an account of the lice which infest man, their medical importance and control (2nd ed.). London: Edward Arnold. pp. 24–72. OCLC   1533520.
  41. ↑ Jacobi, Tillmann (22 September 2011). "The Basics – The management of head lice". GP: 38. All in all, the evidence for alternative treatments, such as tea tree oil and neem seed oil, remains weak.
  42. ↑ "Tea tree oil". National Center for Complementary and Integrative Health . Retrieved 8 February 2024.
  43. ↑ Eisenhower, Christine; Farrington, Elizabeth Anne (2012). "Advancements in the Treatment of Head Lice in Pediatrics". Journal of Pediatric Health Care. 26 (6): 451–61, quiz 462–4. doi:10.1016/j.pedhc.2012.05.004. PMID   23099312.
  44. ↑ Takano-Lee, Miwa; Edman, John D.; Mullens, Bradley A.; Clark, John M. (December 2004). "Elsevier". Journal of Pediatric Nursing: Nursing Care of Children and Families. 19 (6). Pediatricnursing.org: 393–398. doi:10.1016/j.pedn.2004.11.002. PMID   15637580 . Retrieved 2012-11-22.
  45. ↑ "Massachusetts toddler dies after lice treatment goes awry". Yahoo News/Reuters. 5 February 2015.
  46. ↑ "Healthy Water: Healthy Swimming: Lice, Pinworms, and MRSA". Cdc.gov. 16 May 2022. Retrieved 8 February 2024.
  47. ↑ Marriott, John F (2010). Pharmaceutical Compounding and Dispensing (2nd ed.). Pharmaceutical Press. p. 77. ISBN   9780853699125. OCLC   640077286. ALCOHOL. After water, this is probably the next most important solvent used pharmaceutically. Although ethanol (ethyl alcohol) is rarely used as a lone solvent for preparations for internal use, it is used in the manufacture of some of the galenicals used in pharmacy (e.g. tinctures, see Chapter 2). In extemporaneous dispensing it is normally used for the production of lotions for external application to unbroken skin. It is particularly useful if rapid evaporation is required (e.g. for insecticidal lotions applied to hair for the treatment of lice)...
  48. ↑ Szinwelski, N; Fialho, V. S.; Yotoko, K. S. C.; L. R., Seleme; C. F., Sperber (2012). "Ethanol fuel improves arthropod capture in pitfall traps and preserves DNA". ZooKeys (196): 11–22. Bibcode:2012ZooK..196...11S. doi: 10.3897/zookeys.196.3130 . PMC   3361084 . PMID   22679388. ...It has been shown that at concentrations higher than 95%, commercial alcohol preserves DNA (Nagy 2010), but the use of highly concentrated commercial alcohol as a killing solution may be prohibitively expensive when needed in large quantities, such as in large-scale biodiversity sampling. In Brazil, for example, it is illegal to carry large amounts of commercial alcohol on long journeys, which could hinder its use in extensive field expeditions. Here we propose the use of ethanol fuel as a cheaper and logistically feasible alternative...
  49. ↑ "Actualización en pediculosis capitis" (PDF). Sociedad Argentina de Pediatria (in Spanish). La cuasia amarga (palo amargo) se extrae de un arbusto que crece en el norte de la Argentina. El principio activo que se extrae de la madera es la cuasina y químicamente es un hidrocarburo soluble en alcohol. Popularmente se lo usa como repelente de piojos y como pediculicida. Es efectiva únicamente en solución alcohólica y no en solución acuosa. Así es tan efectiva como una solución pura de alcohol por lo cual se duda de su efecto pediculicida "per sé" y es irritativa
  50. ↑ "Indiana teenager burned trying to kill head lice with gasoline". The Mercury News. 26 February 2009.
  51. ↑ Mikkelson, Barbara (26 February 2009). "Is Gasoline a Recommended Treatment for Getting Rid of Lice?". Snopes.
  52. ↑ "History of Carless, Capel & Leonard". Vintage Garage. 2008. Archived from the original on 29 December 2014. Retrieved 2014-12-28.

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