Management of Head Louse Infestations in the United States-A Literature Review.
Head lice are a source of scalp irritation, social disruption, and loss of school time. Health care providers need authoritative information to help avoid the costs and risks of ineffective treatment. A review was completed to provide relevant information on infestation treatments available in the United States. Three major biomedical databases were searched from 1985, when current products were first available, to 2014, focusing on U.S.


METHODS
A total of 579 references remained after duplicates were removed. A search of the U.S. Food and Drug Administration website and labels of approved products were reviewed. A marked decline in the effectiveness of permethrin and synergized pyrethrins was found, probably because of resistance arising from widespread and indiscriminate use, and the emergence of knockdown resistance mutations. The potential toxicity of lindane in the setting of readily available, safer, and more effective alternatives, should limit its use. Prescription products shown to be safe and effective with a single application, without nit combing, are topical ivermectin, malathion, and spinosad, whereas benzyl alcohol requires two applications. Home remedies such as mayonnaise, and essential oils, have not been demonstrated to be safe or effective, and may carry potential for severe adverse events. The high risk of failure of over-the-counter treatments in eliminating head louse infestations drives a need for health care provider recognition of the limitations of current treatments and for judicious use of treatments that remain effective.
Division of Pediatric Dermatology, Johns Hopkins Medicine, Baltimore, Maryland.
Ellen
E
Koch
Department of Veterinary and Animal Sciences, University of Massachusetts, Amherst, Massachusetts.
John Marshall
JM
Clark
Division of Pediatric Dermatology, Johns Hopkins Medicine, Baltimore, Maryland.
Bernard
B
Cohen
Global Health Association of Miami, Miami, Florida.
Terri L
TL
Meinking
Ryan Mitchell Associates LLC, Westfield, New Jersey. wgr@ryanmitch.com.
William G
WG
Ryan
Salt Lake Valley Health Department, Salt Lake City, Utah.
Audrey
A
Stevenson
University of Texas-Houston Medical School, Houston, Texas.
Robert
R
Yetman
Department of Biological Sciences and Environmental Sciences Program, Southern Illinois University-Edwardsville, Edwardsville, Illinois.
Kyong Sup
KS
Yoon
D000287:Administration, Topical; D000818:Animals; D016208:Databases, Factual; D004338:Drug Combinations; D005260:Female; D001556:Hexachlorocyclohexane / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007306:Insecticides / Q000494:pharmacology / Q000627:therapeutic use*; D007559:Ivermectin / Q000627:therapeutic use; D010373:Lice Infestations / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D010374:Pediculus / Q000187:drug effects*; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration
D004338:Drug Combinations; D007306:Insecticides; D018942:Macrolides; D001556:Hexachlorocyclohexane; D007559:Ivermectin; C415329:spinosad