Head lice infestation is a very common community-wide problem, affecting millions of young people in industrialised countries. In the UK, 58% of 7–8 year-olds were found to be infested.1 Trans-mission occurs from person to person between infested individuals and indirectly through hats, clothes, or pillowcases.2 Persistent infection leads to a variety of problems including secondary impetigo, pruritis, sleep disturbance and difficulty in concentration at school.
Pediculicides are the mainstay of head lice management. Most agents currently used rely on neurotoxicity. Permethrin is a synthetic pyrethroid, which interferes with sodium transport of the arthropod with subsequent depolarisation of neuromembranes and resultant respiratory paralysis. Pyrethrin has the same mode of action as permethrin. Malathion is a weak, organophosphate cholinesterase inhibitor; lindane is an organochloride — both of these two treatments cause respiratory paralysis in arthropods.
All these agents are rather unpleasant to apply, especially for children, and all can cause unpleasant side effects, such as allergic and irritant dermatitis. Lindane also has the potential to cause seizures, and malathion, respiratory depression.
In addition, head lice are becoming increasingly resistant to standard treatments, and resistant head lice infestations are probably more common than generally realised.3 There is a need for a safe cosmetically acceptable agent that will effectively occlude respiratory openings of lice so that it kills lice without relying on neurotoxicity.
We recently treated eight patients from two families with head lice infestation that was persistent despite multiple separate treatments with malathion, permethrin, and additional fine combing. All eight people applied Dove® conditioner thickly from the root to the tip of the hair using approximately 100ml per treatment. The conditioner was left in place for at least 2 hours and then washed off. The treatment was repeated at one week to kill any newly hatched lice. All eight patients were cured by this very simple, safe and cheap method, with complete cessation of scratching and no evidence of lice on examination of their heads.
Although this is a small group of patients, we thought that it was useful to highlight this simple remedy for such a common problem that has become increasingly difficult to treat.
References
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