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Background: Scabies and head lice are ubiquitous ectoparasitic infestations that are common across the Pacific Islands. Ivermectin is an effective treatment for both conditions, although the doses used vary. At a community level, mass drug administration (MDA) with ivermectin is an effective strategy to decrease prevalence of scabies. To what extent MDA with ivermectin will also reduce prevalence of head lice is unknown. Methodology: Head lice prevalence was assessed before and after MDA with oral ivermectin (at a dose of 200 micrograms per kilogram of body weight) administered on day 1 and day 8. The primary outcome was the change in prevalence of head louse infestation at two weeks compared to baseline. Longer term efficacy was assessed three months after MDA. Results: 118 participants were enrolled. Baseline prevalence of active head louse infestation was 25.4% (95% CI 18.4–34.0). At three-month follow-up, prevalence was 7.5% (95% CI 2.7–12.3), a relative reduction of 70.6% (95% CI 72.7%-91.4%, p <0.001). Head louse infestation was associated with younger age (age ≤10 years: prevalence 46.7%; adjusted odds ratio compared to adults of 7.2, 95%CI 2.0–25.9) and with having at least one other member of the household with active head louse infestation (adjusted odds ratio 4.3, 95%CI 1.7–11.1). Conclusions: Head louse infestation is common in the Solomon Islands. This proof of principle study shows that oral ivermectin at a dose of 200 micrograms per kilogram can reduce the burden of active head louse infestation, offering an additional collateral benefit of MDA with ivermectin for scabies control. Trial registration: ClinicalTrials.gov . [ABSTRACT FROM AUTHOR]

The article evaluates several drugs for treatment of head lice including Spinosad, Linicin lotion, and Dimeticon Hedrin gel and of scabies including Malathion, Ivermectin, and Crotamiton cream Eurax.

The article discusses Ivermectin 0.5% Topical Lotion, which is indicated for the topical treatment of head lice infestation in patients 6 months or older. The topical lotion exhibits pediculicidal activity and is not directly ovicidal. The various pediculicidal and scabicidal agents approved by the U.S. Food and Drug Administration (FDA) are included. Studies evaluating the comparative efficacy of Ivermectin are described. The contraindications, warnings and precautions to be taken are included.

Lindane is an organochloride pesticide, first introduced as a scabicide for human use in the 1950s (1). Because of its low cost and efficacy, it quickly became a first-line treatment for scabies and head lice, but not long after its use became widespread, its safety was called into question, primarily regarding its neurotoxic effects. We intend to show through review of the literature and databases that lindane has been associated with numerous severe and fatal adverse reactions. This review will summarize 67 cases of adverse reactions and deaths associated with the medical use of lindane. Many of the most serious events and fatalities occurred in pediatric and geriatric populations. We concede that toxicity frequently arises from misuse, but labeled usage of lindane caused 43% of the serious adverse reactions of this review. Moreover, the numerous instances of lindane misuse elucidate the importance of clear labeling and instructions, especially with a product with a narrow therapeutic index. Therefore, this report attempts to elucidate the dangers of lindane as a medical treatment for scabies and head lice by providing a comprehensive review of all documented adverse drug reactions since its introduction. [ABSTRACT FROM AUTHOR]

A great pitfall for scabies and pediculosis therapeutic studies to date is that primary and secondary study outcomes are indirectly assessed (presence or absence of live parasites, including eggs, determined by gross clinical inspection) and data time points are non-standardized (highly variable) relative to the time of therapeutic application. Videodermatoscopy (VD) is a non-invasive technique that allows a rapid and magnified in vivo observation of the skin up to ××1000 with the visualization of morphologic features invisible to the naked eye. Utilization of VD in establishing highly definitive and precise quantitative data products used in the treatment of scabies and pediculosis provides enormous advantages in the quest to establish reproducible quantitative methodology for efficacy studies in these parasitoses. VD enhances the monitoring of clinical response to treatment in scabies and pediculosis and allows determination of the optimal timing of drug application both in vivo and ex vivo. This may be particularly important in minimizing risk of overtreatment, reducing the potential for side effects, and enhancing patient compliance. [ABSTRACT FROM AUTHOR]

Abstract: Unlike many other skin diseases, success or failure of therapy of ectoparasitic infestation depends much more on how to use the topical preparation and whom we treat than on which scabicide or pediculicides to use. The diagnosis of scabies should no longer rely on the rather uncommon and unpractical sign of finding a burrow or the number of parasites per infected patient. Most infested individuals have been shown to have several-fold more acari than the oft-quoted average of 12 adult acari per infected patient that appears in most of our textbooks (stemming from Mellanby''s work). Contrary to what Mellanby taught us, we know that indirect transmission (ie, without personal contact) does occur. As to which agent to use, the winner remains undeclared at present. Although indirect contact transmission of hair lice has been clarified after thousands of years of infestation, there are still numerous questions, uncertainties, disagreements, and controversies on the subject; for example, we know that lice survive immersion in water but are probably not transmitted in swimming pools. There is no consensus on the best or most correct way to diagnose lice, nor is the problem of resistance resolved. We do not recommend a “no-nit” policy. [Copyright &y& Elsevier]

Objective: The objective of this study was to assess pesticide exposures in children being treated for head lice with either lindane or permethrin (exposed group) and children who did not have a lice infestation and thus were not being treated with chemicals for head lice or scabies (unexposed group). Methods: In 2001, we enrolled 78 children aged 6–10 years old and collected baseline urine samples and demographic information from all the children. We subsequently collected post-exposure urine samples and questionnaire information about lice treatment from the 29 (37%) children (exposed children) who had been diagnosed and were being treated for head lice. Metabolites of the pesticides lindane and permethrin were measured in the samples. Results: The mean age of exposed and unexposed children in the study population was 9.3 years and 8.5 years, respectively. Fourteen of the 29 exposed children used prescription lice treatments (i.e., lindane or malathion); 25 of the 29 exposed children used at least one over-the-counte permethrin treatment, either alone or in addition to prescription treatments. Exposed children in both counties had higher urinary pyrethroid metabolite levels in their post-exposure samples compared with their baseline samples. However this difference was only significant in Forsyth County children. Conclusions: The significantly increased post-exposure pyrethroid metabolite levels in the urine of Forsyth County children suggest that the children are exposed to pyrethroid insecticides through the use of lice shampoos. [Copyright &y& Elsevier]

The ectoparasites scabies and pediculosis pubis are common causes of skin rash and pruritus worldwide. They are transmitted primarily by person-to-person spread and are generally associated with low morbidity. The preferred treatment for scabies has generally been topical agents such as lindane and permethrin. Recently, ivermectin has demonstrated good efficacy in the treatment of scabies, and it may be of particular use in institutional outbreaks and in communities in which scabies is endemic. Combination treatment with topical agents and oral ivermectin may be necessary for crusted scabies. Treatment of pediculosis pubis is best accomplished with topical permethrin, lindane, or pyrethrins with piperonyl butoxide. Although resistance to these topical agents has been reported in head lice, decreased efficacy in the treatment of pediculosis pubis has not been reported. [ABSTRACT FROM AUTHOR]

Epizoonoses such as scabies, lice and cimicosis are common, vexing disorders that occur worldwide. Historically, many treatment modalities have been employed in the management of these disorders, and most of the drugs described in this review are of historical interest and no longer recommended or in widespread use because of their wide spectrum of adverse effects. More recently, reports documenting resistance against various antiectoparasite drugs, complicated and severe courses of the diseases, and adverse effects of drug therapy have prompted the development of new treatment strategies and drugs for optimal disease management. Because the strategies currently recommended for the treatment of ectoparasites differ worldwide, this review proposes a rational approach to selecting the best therapeutic agent by comparing the pharmacokinetics, pharmacodynamics, drug efficacy and adverse effects. A literature search of the currently Internet accessible libraries PubMed, Medline and Ideal library, of citations of articles found there, and from communications with the Federal Institute for Drugs and Medical Devices, Germany, was conducted based on this approach. One major observation of this literature search is that permethrin is the treatment of choice for lice and scabies in the US and in Great Britain, whereas lindane is still recommended for scabies in most other European countries because of its longer-standing record of effectiveness. Although permethrin has not yet been proven to be more effective than lindane in treating infections with these ectoparasites, it currently appears to have the best efficacy versus safety profile of topical treatments for scabies and lice. Ivermectin is a newer oral drug for the treatment of ectoparasites, which has been used with great success in the treatment of onchocercosis and other endoparasites. Although ivermectin appears to be a promising drug, its role in the treatment of ectoparasitic infections will be clarified as more study data become available. Finally, it is important to emphasise the clinical aspects of ectoparasite therapy and that providing the patient with optimal instructions on the use of topical therapeutics is of great importance in avoiding adverse effects and assuring complete removal of the ectoparasite, thereby avoiding the development of drug-resistance. [ABSTRACT FROM AUTHOR]

The article presents the study on the economic burden of pediculosis pubis and scabies infections in the U.S. It aims to estimate the direct medical cost per case of pediculosis pubis and scabies medicated on an outpatient basis and the rates at which medical care is examined using insurance claims data. Moreover, the study shows that estimates help to quantify the health and economic burden of infections and maybe useful in economic evaluations of medical interventions to avert these infections.

An introduction is presented in which the editor discusses various reports within the issue on topics including the pathogenesis, epidemiology, and treatment of scabies and pediculosis, the use of ivermectin to control scabies, and insectide resistance in head lice.

A letter to the editor is presented in response to the article "Pediculosis and Scabies: A Treatment Update" on the September 15, 2012 issue.

Examines the etiology and clinical manifestations of scabies and several types of pediculosis. Confirmation of drug reactions in patients with cutaneous disease; Administration of ivermectin tablet; Treatment for the diseases.

Reports on an article by Fischer published in the November 1994 issue of `Annals of Emergency Medicine,' describing the neurologic effects of toxicity to lindane, a topical treatment for scabies and pediculosis, involving a young adult.