Today, insecticides used for the treatment of head lice include organochlorines (lindane), organophosphates (malathion), carbamates (carbaryl), pyrethrins (pyrethrum), and pyrethroids (permethrin, phenothrin, bio-allethrin).
Pediculicides may rapidly lose their efficacy because of the development of resistance. Resistance of head lice to insecticides such as lindane, malathion, phenothrin and permethrin has been reported.
Ivermectin (which can be given orally) has been shown to reduce levels of louse infestation. Originally approved for onchocerciasis and strongyloidiasis, Ivermectin is now approved by the FDA for pediculosis.
Certain proteases can have insecticidal effects. This process works through using naturally occurring enzymes similar to those within the insects themselves. These proteolytic enzymes cause the insect to hatch and molt prematurely, destroying the creature's exoskeleton. These enzymes are similar to those found in meat tenderizers and digestive aids. The benefits of this type of treatment is that the lice do not develop resistance and these products are less toxic.
Dimethicone is a silicone oil, which coats and smothers the lice causing their death either by suffocation or dehydration. Most dimethicone lotions do not kill nits because the nits have only one breathing orifice, the operculum, so the dimethicone has less access there.
Therefore, most treatments should be repeated after 7–10 days to kill any lice that hatch from the eggs or to treat reinfection by family members or classmates . Combination lotions and foams exist (Silcap, manufactured by Oystershell NV) that have an immediate effect on nits (15 min, 96% mortality) by combining the rather viscous dimethicone with penetrating excipients that increase the delivery through the abdominal spiracles of adults and the operculum of the nits. However, "Silcap is not yet available in the US. Import and distribution is still waiting for final FDA approval."
The use of kerosene or gasoline for prevention or treatment of lice is dangerous due to the inherent fire hazard. Since 1989, there have been at least nine cases of children being severely burned during such attempts. These cases apparently occurred because, contrary to popular belief, it is the fumes of the gasoline, rather than the liquid itself, that are flammable. These fumes can ignite due to the presence of even a small spark or open flame - such as those caused by electrical appliances, cigarette lighters, or pilot lights in stoves and water heaters. The use of gasoline to treat lice also carries a high risk of dermatitis (i.e. irritation of the scalp).
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