Table 2.
Main Therapeutic options for pediculosis treatment.
| Pediculicide | Class | Mechanism of action | Adulticide/ovicidal activities | Documented adverse health effect | Documented resistance in lice | References |
|---|---|---|---|---|---|---|
| PEDICULICIDE WITH A NEUROTOXIC MODE OF ACTION | ||||||
| DDT, dichlorodiphenyltrichloroethane | Organochloride | Opening of sodium ion channels in neurons | Yes/yes | Toxic | Yes | Durand et al., 2012; Bonilla et al., 2013 |
| Lindane | Organochloride | Inhibition of c-aminobutyric acid- gated chloride channel | Yes/yes | Toxic | Yes | Durand et al., 2012; Bonilla et al., 2013 |
| Natural pyrethrins | Chrysanthemum extract | Delayed repolarization of voltage-gated | Yes/no | Minor | Yes | Bonilla et al., 2013 |
| Permethrin, synthetic pyrethrin | (+)-3-phenoxybenzyl 3-(2,2-dichlorovinyl)-2,2, dimethyl cyclopropan carboxylate | The same as natural pyrethrins | Yes/no | Minor | Yes | Durand et al., 2012; Bonilla et al., 2013; Clark et al., 2013 |
| Malathion | Organophosphate | Irreversible inhibition of acetylcholinesterase | Yes/no | Minor | Yes | Durand et al., 2012; Bonilla et al., 2013; Kwon et al., 2014 |
| Carbaryl | Carbamate | Irreversible inhibition of acetylcholinesterase | Yes/no | Moderate to very toxic | Yes | Durand et al., 2012; Bonilla et al., 2013 |
| Ivermectin* | Macrocyclic lactone | Binding to glutamate-gated chloride ion channels | Yes/no | None to minimal | Yes | Chosidow et al., 2010; Clark et al., 2013; Diatta et al., 2016 |
| Spinosad | Macrocyclic lactone | Overstimulates nerve cells by acting like acetylcholine | Yes/yes | Minor | No | Aditya and Rattan, 2012; Feldmeier, 2014 |
| PEDICULICIDE WITH PHYSICAL MODE OF ACTION | ||||||
| Dimeticone | Synthetic silicone oils | Work by occlusion | Yes/yes | Low | No | Durand et al., 2012; Burgess et al., 2013; Feldmeier, 2014 |
| Isopropyl myristate | Ester | Work by occlusion or by dissolving cuticle wax | Only head lice tested | Minimal | No | Feldmeier, 2014 |
| 1,2-octanediol | Detergent | Dehydration by reducing the ability of louse to prevent water loss through the cuticle | Yes/no | Minimal | No | Burgess et al., 2012; Feldmeier, 2014; Burgess and Silverston, 2015 |
| Benzyl alcohol | Aromatic alcohol | Asphyxiates lice by “stunning” the spiracles open | Yes/no | Minimal | No | Meinking et al., 2010 |
*
Ivermectin is the only pediculicide used on topical and oral administrations whereas the other pediculicides are only available through topical applications.