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August 1, 2007

BehindTheMedspeak: The price of lice


An informative piece on lice in the July 17, 2007 Wall Street Journal by Joseph De Avila noted that just like bacteria, lice have been developing resistance to drugs that formerly obliterated them.

The photo up top shows a louse crawling out of hair onto a comb.

Here's De Avila's story.

    A Head Scratcher: How to Get Rid Of a Pesky Parasite

    Lice are getting tougher.

    In recent years in the U.S., head lice have been developing resistance to the insecticides in over-the-counter treatments such as Nix and RID. And while the most common prescription treatment, Ovide, remains effective in the U.S., medical studies in the United Kingdom show that bugs there have developed a resistance to the insecticide malathion, an active ingredient in Ovide.

    A number of new treatments are in the pipeline, but are still a ways off from approval by the U.S. Food and Drug Administration. In the meantime, many people are searching for new ways to kill these pests — which affect six million to 12 million people each year in the U.S., occurring in all areas of the country and across socioeconomic strata.

    Resistant and susceptible lice are indistinguishable to the eye. But even in areas where resistant lice have been found, many experts say that over-the-counter treatments are good first options. They are inexpensive, at usually under $10 a package, and don't require a trip to the physician.

    Bayer HealthCare, the maker of RID, says its product is effective when used as directed — including combing out the hair between two applications of the shampoo. The company says it believes any problems with efficacy and reinfestation are linked to incorrect application.

    So-called nit-picking services, where someone manually combs out the lice and their eggs, are another alternative that has been growing in popularity. New salon-style providers have been popping up around the country — and some make house calls. But such services can be expensive, costing hundreds of dollars. Hair Fairies, with salons in Los Angeles, San Francisco and New York, charges $300 a person, according to Maria Botham, Hair Fairies founder. Other such services include Lousey Nitpickers, which operates in Southern California and charges $100 and hour, and Lice Fighters, which makes trips throughout New York, New Jersey and Pennsylvania, for $200 a head.

    It is difficult to say how widespread resistant lice have become, say public-health experts, but reports began appearing in medical journals in the late 1990s. Bugs that are resistant to permethrin and pyrethrins — the agents in over-the-counter treatments — have been found in many places, including parts of Florida, Massachusetts, Texas and California, according to John Clark, a professor of environmental toxicology and chemistry at the department of Veterinary and Animal Sciences at the University of Massachusetts, Amherst.

    The development isn't surprising, since all insects exposed to pesticides will develop resistance over time. For example, mosquitoes developed a resistance to the pesticide DDT after years of sprayings. Richard Pollack, a research associate at the department of immunology and infectious diseases at Harvard University's School of Public Health, says that some lice have a natural ability to eliminate toxins from their bodies, which they pass on to a new generation.

    Besides over-the-counter treatments and combing services, you can purchase a special lice-and-egg-removal comb at most drugstores and try combing out the pests at home. But experts warn that any combing treatment can be time-consuming. It can entail several hours of daily combing for about two weeks, says Craig Burkhart, a clinical professor of dermatology at the University of Toledo's College of Medicine, in Ohio.

    A physician could also prescribe Ovide lotion, which contains malathion and costs about $100-$140. Health insurance may cover part of the costs. The other prescription option is the insecticide Lindane, though it remains controversial. Lindane shampoo and lotion, distributed by Alliant Pharmaceuticals, isn't available in California and carries a so-called black-box warning on its label regarding possible links to rare seizures and deaths.

    There are also herbal remedies on the market with ingredients like tea tree oil, rosemary and lavender. But "there's a real absence of data showing that they work," says William Brogdon, a research entomologist with the Centers for Disease Control and Prevention. And "If they are not effective, you are wasting your money."


Am I the only one here who's suddenly developed an itch?

Didn't think so.

August 1, 2007 at 04:01 PM | Permalink


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In my family there were 3 girls with long hair, one of which was a lice magnet. Obviously head shaving was not a solution so I had to find something to use other than chemicals. I came up with a solution using hair conditioner. I even found it to be less labor intensive than the "nit picking" involved after chemical treatments and WAY cheaper!!!

Posted by: L. Lewis | Aug 26, 2007 10:34:40 AM

An Effective Nonchemical Treatment for Head Lice: A Lot of Hot Air
Brad M. Goates, MS, Joseph S. Atkin, BA, Kevin G. Wilding, BS, Kurtis G. Birch, BS, Michael R. Cottam, MS, Sarah E. Bush, PhD and Dale H. Clayton, MS, PhD
Department of Biology, University of Utah, Salt Lake City, Utah
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 ( 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.

Key Words: Pediculus humanus capitis • control • heat • desiccation • pediculosis • LouseBuster • nits
Abbreviations: CI—confidence interval

Posted by: commonsense | Aug 5, 2007 5:16:58 PM

There is a safe and effective treatment available over the counter that does not contain pesticides. The product is Licefreee!. It uses gelled salt to dehydrate and kill lice and their nits, and its very effective. Visit www.licefreee.com for more info.

Posted by: Tec Labs | Aug 2, 2007 12:27:59 PM

The kids have had lice from time to time - I've not had a lot of luck with chemicals, but a bright light and a nit comb have shifted them. The other thing that works is a hair-dryer. Get the hair hot enough for the owner to start complaining and the nits are toast.

Posted by: Skipweasel | Aug 2, 2007 12:26:23 PM

1. this was in the late 1970's in Missouri.
2. Even if I had photos of the patient her privacy is still hers to waive.

Posted by: 6.02*10^23 | Aug 1, 2007 11:58:10 PM

Damn, I was hoping for pictures of the chick...

Posted by: ScienceChic | Aug 1, 2007 10:30:42 PM

OK, I think I have the best story and cure, all in one!

A number of years ago and one career back - we had a gal show up in the ER. She had lice and had tried a "home remedy" - a kerosene shampoo. Apparently, she was standing too close to the wood stove in her home while "shampooing" and - yep, flash fire.

In the ER, the patient was placed on a gurney and the kerosene-soaked, partially burned hair was alive with departing Pediculus humanus. Of course her pCO2 and carboxyhemoglobin were fairly high....

Pretty pictures!



Posted by: 6.02*10^23 | Aug 1, 2007 10:01:57 PM

Well, one can always shave one's head can't one? No hair, no lice. Wash right off!

Posted by: ScienceChic | Aug 1, 2007 9:02:34 PM

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