Healthcare providers have a number of prescription medications to choose from for treating a case of head lice. Know your head lice prescriptions and don’t take for granted that all prescriptions are safe or effective.

In Part 1 of Know Your Head Lice Prescriptions, we examine three prescription products with potential side effects, some of which are quite frankly, not worth the risk of using:

  • Pyrethrin/Permethrin
  • Malathion
  • Lindane

Pyrethrin/Permethrin

Pyrethrin is an insecticide derived from the chrysanthemum flower.  It is the active ingredient found in Rid, an over-the-counter lice treatment product. Permethrin is a synthetically derived product that is chemically produced to act like pyrethrin in its insecticidal properties. It is the active ingredient in over-the-counter Nix “Lice Killing Cream Rinse” and various generic products.

When these products were first introduced to the market, they were in stronger dosages than what is available today. When concern first appeared over possible resistance, the manufacturers decreased the over-the-counter solutions and created prescription strengths. Today, over-the-counter solutions are comprised of 1% permethrin.  Prescriptions come in a 5% concentration.

How It’s Supposed To Work:

Pyrethrin and permethrin products are neurotoxins that attack the louse’s nervous system and can result in death.

Problem:

5% is no more effective than the 1% dosage. While 20 years ago these products were almost 100% effective at killing lice, today the bugs have mutated such that head lice are now almost 100% resistant to these neurotoxins (1). The term “super lice” has become popular these days to describe this increased resistance to these products.

Hazards:

Permethrin has been linked to potential neurodevelopmental deficits, or abnormal behavior in children such as being anxious and withdrawn, or defiant and aggressive (2). Neurotoxicity in not only the bugs, but also the humans that these products are used on, can happen. This means that our central and/or peripheral nervous systems can be compromised when using these toxic products. Symptoms can include fatigue, pain, depression, memory loss, lung/sinus conditions, etc. From personal experience, this writer had to be prescribed an inhaler due to the breathing issues experienced after using this chemical as a form of lice treatment on the head as well as spraying in the environment.

Recommendation:

These products are no longer effective at killing lice and nits. Combine this fact with the potential harmful side effects, they are not worth your time and money.

Buyer Beware:

At the time of writing this article, one could purchase 5% permethrin cream on eBay from a source in India that offers worldwide shipping. Take heed of their warning: “NOTE: Any sort of custom duties OR charges will be bared by buyers.” Since 5% is a prescription strength medication in the US, your shipment may never arrive here!

Malathion (Ovide)

Malathion is a chemically derived insecticide that is classified as an organophosphate.  It is used in our environment on farms, golf courses, home gardens, as a form of mosquito and Mediterranean fruit fly control, used to treat fleas on pets, etc.  It can also be prescribed to treat a case of head lice.  The brand name for malathion is called Ovide in the US, or Prioderm in Ireland.

How It’s Suppose To Work:

Malathion, and other organophosphates, work to disrupt neurotransmitters in a louse’s brain and enzymes in its nervous system, which can ultimately result in death.  Like pyrethrin and permethrin, malathion is classified as a neurotoxin.

Problem:

As a neurotoxin, head lice are increasingly resistant to malathion.  No data could be found on a percentage, but the products are losing efficacy.  More importantly, the potential side effects or hazards, are alarming.

Hazards:

According to the Illinois Department of Public Health regarding organophosphates:

“The chemicals in this class kill insects by disrupting their brains and nervous systems.  Unfortunately, these chemicals also can harm the brains and nervous systems of animals and humans.  These chemicals stop a key enzyme in the nervous system called cholinesterase from working, and this can make people ill.” (3)

As stated above, malathion is already used as an insecticide in our environment.  Children are at higher risk of potential exposure from these environmental conditions.  They play outside more, in the dirt, put their hands in their mouths more often, and may not wash their fruit before eating it.  Malathion is already present in our bodies.

Now add one, two or three prescription head lice treatments, where you apply the prescription and leave it on the head, as directed, for 8-12 hours (!).  According to the Toxicological Profile For Malathion published by the U.S. Department of Health and Human Service, those that have been overexposed to Malathion have experienced “difficulty breathing, chest tightness, vomiting, cramps, diarrhea, watery eyes, salivation, sweating, headaches, dizziness, and loss of consciousness, and some died.” (4)

On top of the risk of neurotoxicity, malathion is extremely flammable. The CDC has the following warning: “Malathion is flammable; keep medication and wet hair away from heat sources such as hair dryers, electric curlers, cigarettes, or open flames.” (5)

A 10 year old girl in Ireland suffered severe burns to her face when the malathion head lice shampoo that she used caught fire.  Read story here.

We commonly hear from clients that have used malathion (Ovide), that it burns the scalp on application, and the fumes from the product are too overpowering.  Many cannot keep the product on their head for the recommended time.

Recommendation:

Know your head lice prescriptions and say NO to malathion!

Lindane

Lindane is another neurotoxin that is designed to kill bugs, but poses the most serious threat to humans of all prescription head lice medications on the market.  It has been banned in 52 countries worldwide, and further restricted in 33 countries.  In the US, lindane has been banned by the Environmental Protection Agency for all uses under its jurisdiction.  The Federal Food & Drug Administration, however, allows for the use in treating head lice and scabies.  While lindane cannot be sprayed on our food supply or used on any part of an animal due to its severe/fatal toxicity, it can be applied to human’s heads as a prescription head lice treatment medication under the brand name, Kwell.

The FDA cautions when using lindane shampoo and lotions even “when used as directed”, the extremely serious side effects can be severe and even fatal for young children, people weighing under 110 lbs, pregnant or nursing women, and the elderly [source: FDA website].  It can only be used once in a human’s lifetime.

Recommendation:

Because lindane is severely toxic, NEVER use this product.  Even if it was 100% effective at killing lice and nits, which it is not (lice are increasingly resistant), our recommendation would not change.

How To Treat

So, all three of the products have a recommendation of do not use.  What should one do to treat a case of head lice?  Bottom line, there is no magical product on the market that kills lice or nits 100%.  A successful treatment means to remove every last bit of evidence from the hair.  If you leave behind two nits, one female and one male, the infestation begins again in a few weeks when those nits hatch and mature to become reproducing adults.  Toxic products are never needed in the removal process.

Call your closest Shepherd Certified lice treatment business.  They are trained professionals that are certified in all things lice.  They offer a full range of treatment services plus safe products that should you choose to treat at home, you can be successful.

About Us

Lice Spies are professionally trained and certified through the Shepherd Institute.   We provide safe, non-toxic, natural head lice checks, treatment services, DIY & preventative products at our Edmonds’ clinic. Located on the corner of Edmonds Way/SR 104 and 236th St SW in Edmonds, WA, appointments can be booked online, anytime of day or night at www.licespies.com.  Follow us on Facebook.

 

Sources:

We’d like to acknowledge the researcher extraordinaire, Meredith Riley, founder and owner of Dandy Strands Head Lice Removal Service in Oklahoma, head lice industry consultant and research contributor to www.letslearnaboutlice.com.

  1. https://www.webmd.com/skin-problems-and-treatments/news/20150818/head-lice-now-resistant-to-common-meds-in-25-states#1
  2. https://www.hawkesburygazette.com.au/story/4503259/head-lice-killer-linked-to-abnormal-behaviour-in-children/
  3. http://www.idph.state.il.us/Bioterrorism/factsheets/organophosphate.htm
  4. https://www.atsdr.cdc.gov/toxprofiles/tp154.pdf
  5. https://www.cdc.gov/parasites/lice/head/gen_info/faqs_malathion.html

 

Picture: Jessica Flemming (owner of The Lice Lounge in MN) and Cathy Baran (owner of Lice Spies in WA)

Head lice recheck appointments are important!  Can you treat a case of head lice in one shot, 100% of the time?  Some companies claim to do so.  Can it be so?

Let’s deconstruct the process a bit, to understand how these critters work.  Twenty years ago, lice were just lice.  They did not don their “super” capes.  They were not yet ordained “super lice.”  Over the counter pesticides were great at treating a case of head lice.  There was a fast, easy potion to rid oneself from these annoying critters.

Over the years, lice started to build a resistance to the pesticides that were once a reliable treatment option.  A few years ago, scientists researched and concluded that head lice resistance to permethrin and pyrethroids were such that the bugs were almost 100% resistance to these products1.  Thus the term, “super lice” came on the scene.

In response to these failing products, new products and methods emerged.  And some of these come with claims of being “one and done.”

Prescription Medications

Doctors today, have a number of prescription medications to choose from for treating a case of head lice.  Is any one of these products 100% effective at killing live lice and eggs (nits)?  No.

 

Rx Product & Efficacy

Permethrin/  Pyrethroids

  • Lice almost 100% resistant1
  • Linked to abnormal behavior in children, neurotoxin

 

Malathion (Ovide)

  • Can kill some bugs, but does not kill eggs, increased resistance
  • Extremely flammable2 around common household devices, burns, neurotoxin

 

Lindane

  • Can kill some bugs, but does not kill eggs, increased resistance
  • Lindane has been banned in 52 countries worldwide due to toxicity3, but Doctors can still prescribe for head lice and scabies.  Can only be used once in human lifetime.  Extremely toxic, neurotoxin.

 

Ivermectin (Sklice®)

  • 74% on day 154
  • $$ May not be covered by insurance

 

Benzyl Alcohol (Ulesfia®)

  • 75.0-76.2% on day 145
  • $$ May not be covered by insurance

 

Spinosad (Natroba™)

  • 85% after 14 days4
  • $$ May not be covered by insurance

 

75-85% isn’t bad though, right?  In a case of head lice, yes it is.  Check out our blog article: 6 month head lice battle OTC prescription pesticides to see the results of one of our client’s struggle.

If you do not get out every last 2 eggs in the hair, where one is male and one is female, then the whole cycle starts all over again.  A female louse only needs to be impregnated once in her lifetime to lay 5-10 eggs per day.  That’s every day of her adult life.  This translates into each impregnated female louse has the ability to lay upwards of 200 eggs in her lifetime.  In the span of those 14 days that you are waiting to see if these products worked, that represents up to 140 eggs that one female left behind could lay.

One has to consider the risks and cost of multiple applications of using these prescription medications knowing that products are not “one and done”.  If you choose to treat with one of these products, know that multiple applications will be needed and constant rechecking to make sure the infestation is truly gone.

 

Heated Air Devices

The most popular heated air device on the market today is the professional AirAlle® device found at salons/clinics, and the new DIY One Cure Lice Treatment Home Kit, both owned by Lice Clinics of America (parent company: Larada Sciences, Inc).  Prior to being branded AirAlle®, the device was known as the LouseBuster.

During clinical trials, the LouseBuster was 94.8% effective at dehydrating, thus killing, bugs and nits when an experienced person was operating the device.6  This is an impressive result.  However, in the case where someone has let’s say, 100 nits, 5 of those nits left behind could be viable.  Leaving behind one female and one male egg will result in the whole cycle starting again. 

It is worth noting that these devices cannot be used on children under the age of 4, or older people that cannot sense heat.

What is key to using this device is the process to remove every last bit of viable evidence in the hair after using the device.  Using the device alone, is not sufficient.  If removal (usually done by a comb out process) is not done, you run the risk of “getting lice back” in two-three weeks, when in fact, you didn’t complete the full treatment the first go around.

Even with the heated air device lice removal option, one should always follow up with a recheck appointment to verify that the treatment was successful.

 

Head Lice Removal Specialists

Armed with good lice combs and safe, non-toxic products, professional removal specialists rely on complete elimination of all nits and bugs on the head.  The gold standard in the industry is to be trained and certified from the Shepherd Institute7.  This certification is the most rigorous and intensive training that is on the market today.

For us here at Lice Spies, our goal is to achieve 100% eradication with one full treatment.  Most of the time, we meet that goal.  But “we are all humans with human eyeballs”, as Jessica Flemming, owner of The Lice Lounge in White Bear and Duluth, MN often says.

Can we miss something?  Absolutely.  How often do we miss something?  Not often, but the point is, it does happen just like any other option on the market.  No product, tool, device or human is perfect!

 

Conclusion

What is common to all the products, devices and methods listed above, is the fact that removing every last viable female and male egg from the head is key to a successful treatment.  Some products can help get you to an effective treatment quicker than others, and they are safe for all to use.  Other products come with the risk of some serious side effects that in our opinion, are just not worth it.

No product, tool, device or human has a 100% efficacy rate.  For this reason, we strongly believe in including at least one free follow-up recheck appointment after each full treatment.

Equally as important as checking one’s own work, is to make sure that the client does not get reinfested.  Most people do not know the exact source of who they got lice from, or who they might have shared it with while they had it.  And most of us have to re-enter into the same environment where we contracted lice in the first place.  Chances of reinfestation are very real.  Whatever your choice for treatment, demand a recheck!

 

Lice Spies are professionally trained and certified through the Shepherd Institute.   We provide safe, non-toxic, natural head lice checks, treatment services, DIY & preventive products at our Edmonds’ clinic. Located on the corner of Edmonds Way/SR 104 and 236th St SW in Edmonds, WA, appointments can be booked online, anytime of day or night at www.licespies.com.  Follow us on Facebook.

 

Sources:

[1] Expansion of the Knockdown Resistance Frequency Map for Human Head Lice (Phthiraptera: Pediculidae) in the United States Using Quantitative Sequencing, by Kyle J. Gellatly, Sarah Krim, Daniel J. Palenchar, Katie Shepherd, Kyong Sup Yoon, Christopher J. Rhodes, Si Hyeock Lee, and J. Marshall Clark; Journal of Medical Entomology, 53(3), 2016, 653–659

[2] https://www.cdc.gov/parasites/lice/head/gen_info/faqs_malathion.html

[3] http://www.panna.org/press-release/global-chemical-treaty-adds-lindane-ban-list

[4] https://www.forbes.com/sites/melaniehaiken/2012/11/28/finally-a-new-head-lice-treatment-that-really-works/#5bf579e511c0

[5] https://www.researchgate.net/publication/267911183_The_Clinical_Trials_Supporting_a_Novel_Non-Toxic_Lotion_Benzyl_Alcohol_5_for_the_Treatment_of_Head_Lice

[6] https://bioone.org/journals/journal-of-medical-entomology/volume-48/issue-1/ME10122/Efficacy-of-the-LouseBuster-a-New-Medical-Device-for-Treating/10.1603/ME10122.short

[7] http://www.shepherdinstitute.com/

Lice Spies be a friend and tell a friend

Be a friend and tell a friend!

Telling your friends, family and other social network that you have lice is a difficult thing to do.  Unfortunately, the stigma of head lice is real.  People are surely going to be mad and blame you, probably think you’re dirty (lice myth!), and potentially ostracize you and your loved ones.  Right?  It’s so much easier to just quietly deal with it to save yourself from humiliation and ridicule.

While it might appear to be easier, you risk the chances of reinfestation, not once, but multiple times if you are forced to enter into the same environment where you got lice in the first place.  Continually dealing with a lice infestation is far worse than just telling folks from the get go, and ensuring your environment is lice-free.

Julia…

Let’s look at the case of Julia (name and details have been altered for this example).  Julia is 15 years old, attends high school and participates on her school’s swim team.  Julia and her team traveled out of town for a weekend swim meet where they spent two nights together in a hotel.  The following Wednesday, Julia was in math class and scratched her head.  She was mortified to see a bug drop from her head onto her desk!  She quickly flicked the bug away and prayed that nobody noticed.  The following day, Julia and her mom were treated for lice at our clinic.  She definitely had lice long enough so that she was contagious during her swim team weekend away.

As much as Julia and her mom were embarrassed to notify her team, friends, family and school, they did so.  And thankfully they did, as 10 out of 12 other team members were also positive for lice.  Over half the cases were caught early before a large infestation ensued.  The girls on the team and families, were wonderfully supportive.  They even booked appointments with each other so that they could enjoy some time at the lice spa together!

Jonathan…

Now let’s look at Jonathan.  Jonathan is 8 years old and has about 4 inches of hair.  He’d been growing out his hair for a while and absolutely did not want to shave it off.  Jonathan likes to hang out with his friends at school and at after school care.  When Jonathan came to us for treatment, he had a moderate to severe infestation.  He was one of the 50% of people that don’t have an allergic reaction to the louse’s saliva, and thus did not itch.  We treated not only Jonathan, but also his mother and father.

Jonathan’s parents felt embarrassed and guilty about having lice, so they chose not to communicate with anyone.  A month after clearing the family of head lice, Jonathan was reinfested.  Everyone’s frustration level was through the roof.  Lice PTSD had set in.

Communication is key to prevention

Once you communicate, you’ll be surprised to find out how many people have either gone through a lice infestation before, or are currently dealing with one.  If someone has recently had lice or are currently treating, always ask how have they been treated.  If they are treating at home with either over-the-counter products or home remedies, don’t let your lice guard down!  See our other blog posts about why these methods might not work:

Wouldn’t you have appreciated a call from your friend giving you an early warning to check your heads for lice?  Be a friend and tell a friend.  And when you do get that call, thank your friend!

Lice Spies are professionally trained and certified through the Shepherd Institute.   We provide safe, non-toxic, natural head lice checks, treatment services, DIY & preventive products at our Edmonds clinic. Located on the corner of Edmonds Way and 236th Street Southwest in Edmonds, WA, appointments can be booked online, anytime of day or night at www.licespies.com.