Common in children, head lice are not thought to transmit any infectious diseases the way that body lice can. But infestations of the tiny, wingless parasites often cause dermatitis of the scalp, characterized by a red scaly rash and itching — or just itching, says Dr. Markus Boos, a dermatologist at Seattle Children’s Hospital and assistant professor of pediatrics at the University of Washington School of Medicine.
Along with the annoyance, there’s stigma attached to having lice. “There are definitely social ramifications,” Boos says, noting kids may be teased or viewed as unclean. However, clinicians point out, head-to-head contact with a person who has lice is the main means of transmission, not personal or household cleanliness. “This is something that is just very contagious,” says Dr. Katya Harfmann, a pediatric dermatologist at Nationwide Children’s Hospital and an assistant professor of pediatric dermatology at Ohio State University–Columbus.
Though experts say it may still be worth trying over-the-counter treatments as a first line of defense, the growing prevalence of so-called super lice — or lice that’s resistant to OTC treatments — has led clinicians to recommend parents also carefully consider other options, including prescription treatment, if a child’s lice persists. Research has found that as lice resistance to frequently used OTC treatments has grown widespread in the U.S., after first beginning to emerge in the 1990s, the effectiveness of OTC treatments has declined steadily. A study published earlier this year in the Journal of Medical Entomology found almost all lice collected and tested from 138 sites in 48 states (no lice were analyzed in Alaska or West Virginia) had mutations responsible for resistance to active ingredients in widely used OTC treatments, including Rid and Nix. The pharmaceutical firm Sanofi, which owned Sklice (ivermectin) lotion, a newer generation prescription treatment for lice, provided funding for the research.
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In addition, a review of head lice treatments published online this month in the journal Pediatric Dermatology noted a marked decline in the effectiveness of widely used OTC treatments, which are more frequently applied than prescription treatments. Published data “support that the emergence of resistance has caused this decline,” researchers wrote. The review also found home remedies, such as applying mayonnaise, petroleum jelly or olive oil in an attempt to smother lice, don’t work. The therapies may temporarily suppress the bugs’ metabolic activity, “giving the impression of death, only to have them awaken shortly thereafter — the so-called ‘resurrection effect,'” researchers wrote. Conversely, the review found treatment with several topical prescription products were safe and effective with just one application; those include using ivermectin, malathion and spinosad, while benzyl alcohol required two applications. These were among the same prescriptions Harfmann and Boos recommended to treat lice in children.
Harfmann notes ivermectin (Sklice) is approved by the Food and Drug Administration for children 6 months old and up, spinosad (Natroba) is approved for kids 4 years and up and malothion is approved for children 6 and up. Boos adds that the prescription Ulesfia — for which the active ingredient is benzyl alcohol — is also a good option to effectively kill lice in young kids, since it’s approved for children 6 months and older.
In the face of much hullabaloo over lice treatment resistance, Harfmann and Boos say it’s still important to make sure parents follow the direction for any treatment used on children and take other steps to prevent reinfestation of lice. “We have to distinguish whether it’s the treatment — the actual medication that’s not effective — or whether it’s everything that goes into treating lice that maybe wasn’t done properly or completely,” Harfmann says. She recommends the whole family get treated at the same time for lice to prevent the parasites from being passed back and forth. “We can only do so much to treat the child. But then if they get reinfested from somebody else, it’s hard to get that child clear,” she says.
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For most, the main side effect from OTC and prescription topical treatments is skin irritation, Harfmann says. “None of these are soothing lotions to the skin — they’re all a little bit irritating. But for most of them, since they’re being rinsed off so quickly — within 10 minutes — that’s usually not that significant,” she says. Most notably, Harfmann says, malathion is a flammable lotion. “So you wouldn’t want to put it on and use a hairdryer or a curling iron or something that had heat near the hair,” she says.
Apart from medication, Boos notes that the FDA-approved device AirAllé, formerly the LouseBuster, which blows hot air to destroy lice and their eggs, has also been shown to be safe and effective at treating lice — and would be an option for a person who lives near a lice treatment center that provides that treatment. Salt Lake City-based Larada Sciences, which owns AirAllé, says on its website that no adverse events have been reported and no one has been hurt as a result of the treatment. However, since the device delivers heated air, the company notes there’s a slight possibility of a scalp burn if it’s not used incorrectly.
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In addition to treatment, additional steps can be taken to help with the removal of lice, including vacuuming carpet and furniture in kids’ play areas, Harfmann says. Bedding, clothing and headgear like hats worn by kids with lice should be washed in hot water. “Lice cannot tolerate very high temperatures — so washing those in hot water and drying on high heat is recommended at the same time you do the treatment,” she says. But stopping the spread of lice — super or not — is a difficult chore, and there’s no foolproof way to go about preventing exposures. Experts say that makes finding the right treatment to effectively kill lice all the more crucial to stay ahead of the bugs.
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What’s the Best Treatment for Super Lice? originally appeared on usnews.com
