An effective treatment for pediculosis pubis and capitis.
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The therapeutic efficacy and tolerance of a single application of 1% permethrin cream rinse, applied for ten minutes, and a single application of 1% lindane shampoo applied, as recommended by the manufacturer, for four minutes, against the head louse Pediculus humanus var capitis were compared in a single-blinded, randomized, controlled clinical trial. Of 573 patients enrolled at eight centers, 559 were assessable for tolerance and 508 for efficacy. Of the 257 patients treated with 1% permethrin cream rinse, 99% were lice free at 14 days; of the 251 patients treated with 1% lindane shampoo, 85% were lice free at 14 days. The difference is statistically significant. For both treatments, adverse experiences were infrequent, mild, and usually difficult to distinguish from the symptoms of head lice infestation. A single ten-minute application of 1% permethrin cream rinse was well tolerated, highly effective, and therapeutically superior to a single four-minute application of 1% lindane shampoo.
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Scabies and lice infestations are almost an everyday diagnosis in the dermatology clinics. Along with the unbearable itch, resistance to medication, secondary infection, and the high risk for spreading the parasite to their close contacts, the patients have also to battle with many myths, prejudice, and shames connected to those infestations.
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The 3 major lice that infest humans are Pediculus humanus capitis (head louse), Pthirus pubis (crab louse), and Pediculus humanus humanus (body louse). Patients with louse infestation present with scalp pruritus, excoriations, cervical lymphadenopathy, and conjunctivitis. A hypersensitivity rash, or pediculid, may mimic a viral exanthem. Head lice infestation crosses all economic and social boundaries, whereas body lice infestation preferentially affects the homeless and displaced. Body lice are major vectors of diseases such as typhus, trench fever, and relapsing fever. Pubic lice infestation often is acquired as a sexually transmitted disease and may be a marker to screen for other sexually transmitted diseases. Treatment of louse infestation can be challenging. Mechanical measures, such as combing, are helpful as adjunctive measures, but most studies suggest they are not as effective as chemical agents. Resistance to chemical agents is a growing problem. Major types of resistance include knock-down resistance, glutathione-S-transferase-based resistance, and monooxygenase-based resistance. Research is needed to identify new effective treatments.
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