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A four-month-old infant with severe impetigo who had prolonged daily applications of lindane presented with two seizure episodes. His blood lindane level was 1.27 ppm. Caution should be exercised when using lindane in infants and children. Proper instruction and close supervision are essential.

Numerous toxic exposures have been implicated in causing aplastic anemia. Thirteen cases of aplastic anemia and 5 cases of other blood dyscrasias, eg, red blood cell aplasia and thrombocytopenia, associated with lindane, have been reported in the literature. However, aplastic anemia secondary to the scabicidal product (lindane [Kwell]) has not been documented, to our knowledge. We present the case of a 21-year-old man with a diagnosis of aplastic anemia, known prolonged exposure to lindane, and documented elevated serum lindane levels. His clinical course is described as well as various defects are explored for the aplasia.

Burst-promoting activity (BPA) was measured in the sera from 31 children with aplastic anaemia (AA). BPA levels were elevated in most of the children with AA (65.2%), the mean value (137.7 +/- 18.4%) being significantly higher than that in normal children (69.6 +/- 9.4%), in children in the recovery period and in children with non-aplastic anaemia. There was a negative relationship between the BPA level in children with AA and the peripheral haemoglobin concentration. The BPA level was higher in those whose duration of illness was shorter than 1 year. In three cases of AA caused by chloramphenicol and benzene hexachloride and one case of congenital pure red cell AA, the BPA level was not elevated. Eleven patients received fetal liver cell suspensions intravenously (FLI). After FLI the BPA level in their sera was significantly reduced. According to these results, it appears that the elevation of BPA level is a special phenomenon of AA. The measurement of BPA in serum is helpful for differentiation between AA and other kinds of anaemia. The elevation of the BPA level in serum is a biological compensation for the haematopoietic disorder, and the measurement of BPA in the serum of patients with AA may be helpful in evaluating the haematopoietic condition.

Twelve workers were monitored for exposure to 18.75% lindane dust formulation during manual wheat seed treatment. The mean total actual exposure rate was 32.89 mg/hr. Potential respiratory exposure averaged 0.0057 mg/hr (less than 1% of the total), with seven workers receiving no measurable respiratory exposures. Mean hand exposure was 1.84 mg/hr (5.6%). Dermal exposure to the head and neck averaged 4.28 mg/hr (13%). Exposure measured beneath the workshirt and workpants averaged 26.8 mg/hr (81.4%). The workshirt and workpants provided 3.4-fold and 11.5-fold protection factors, respectively. Forearm exposure measured beneath the workshirt represented more than 40% of total actual exposure. The small contribution of hand exposure to total dermal exposure was consistent with the use of chemical-resistant gloves by all workers. Total dermal exposure could be reduced substantially by wearing coveralls over regular work clothing, and by the use of guantlet-type gloves. It is recommended that worker education concerning personal hygiene and the appropriate use of protection clothing be made essential components of exposure reduction programs.

The efficacy and safety of permethrin 1% creme rinse and lindane shampoo were compared for the treatment of head lice (Pediculus humanus var. capitis). A total of 1040 patients in the Nezahualcoyotl community of Mexico City representing 296 family groups were enrolled and randomized to treatment, with one patient in each family designated as the index patient. Among index patients 98% treated with permethrin and 76% treated with lindane were louse-free 2 weeks after treatment (P less than 0.001). Comparable results were found with nonindex patients as well. Mild dermal reactions, such as pruritus or erythema, occurred in 1.2% of permethrin-treated patients and 2.6% of lindane-treated patients. There were no reports of central nervous system adverse effects or conjunctivitis.

The accumulation of hexachlorocyclohexane, one of the most commonly used chlorinated insecticides, was studied in a high-risk group of people who are exposed during its manufacturing process. The serum HCH concentration was estimated by quantitating its alpha, beta, gamma and delta-isomers with the help of GLC analysis. Exposed workers involved in maintenance work were found to have 3 times higher HCH residues than the controls, while in the plant operators and supervisors the levels were 5 times higher. The most severely exposed were the handlers who are in direct contact with the insecticide. The level of serum HCH residues in them was found to be about 12 times higher than those in the controls. The percentage composition of the insecticide, with respect to the different isomers, varied up to 20% for the gamma-isomer, up to 30% for alpha-isomer and had between 60%-100% of the beta-isomer in the samples. The serum levels of the insecticides were clearly related to the workers' job-related close contact, intensity, frequency, and the duration of their exposure. The total of HCH residues in the sera studied were in the range of 0.143-1.152 ppm. The importance of these findings and the relevant protective measures are discussed.

In 36 workers occupationally exposed to polychlorinated pesticides (Gammexane, DDT) and in a control group, cytochemical investigations of lactate and succinate dehydrogenases (LDH and SDH, respectively) in peripheral blood leukocytes were performed. In comparison with the control group, in workers exposed to pesticides, reduction of colour intensity in neutrophiles for SDH and in lymphocytes both for SDH and LDH was observed. In discussion, an attempt was made to interpret the obtained investigation results which seem to indicate disturbances in pyruvate metabolism in peripheral blood lymphocytes.

Risks and benefits involved in the use of lindane preparations for the treatment of scabies and head louse infestations are evaluated. Although lindane per si is moderately toxic, capable of inducing neurotoxic and hemotoxic effects, there is little evidence that the preparations used in the treatment of scabies and pediculosis give rise to toxic symptoms when applied according to directions. Current evidence does not support the view that lindane is intrinsically carcinogenic, although very high doses have induced hepatomas in mice. It is concluded that the benefits obtained in the use of lindane as a scabicide and pediculicide outweigh risks involved in its use for these purposes. Comparison with other preparations available for the control of scabies and pediculosis indicate that lindane is probably the most effective scabicide, although it also shows the greatest toxic potential. Malathion and pyrethrin preparations seem equally effective against head lice. Suggestions for even safer use of lindane are discussed.

The human clinical use of 1% lindane formulations has become somewhat controversial during the past five years. This review is an in-depth report of the efficacy and safety of 1% lindane compared with the agents that have been preferred as alternative. Almost all of the suspected adverse drug reactions (ADR) from 1% lindane have involved substantial misuse. The number of suspected ADRs remains small, especially when compared with the magnitude of human clinical use of 1% lindane preparations in the United States (50 million ounces during the past five years). One percent lindane should continue to remain the preparation of choice for nearly all patients with scabies and lice, but dermatologists should appreciate that these views are not necessarily shared by all health professionals. Consequently, it is most appropriate to explain the possible side effects from misuse of lindane to each patient. This brief period of patient education is time well spent--it will help maintain proper compliance and allay the upset that many of your patients may have if they encounter negative opinions about lindane in the lay and medical press or from other health professionals.

In the years 1980-1981 we treated 112 cases of scabies with 20% sulphur ointment, or 1% lindane. In 18% irritative contact dermatitis occurred after the treatment.

This open clinical study was designed to evaluate and compare the efficacy and side effects of lindane (1% and 0.3%), benzyl benzoate (20% and 10%) and permethrin (5% and 2.5%) after two, three, and one application at bedtime, in the treatment of scabies in 114 adults and 80 children aged between 0 and 5 years. Treatment failures were registered after lindane in 3 adults and 2 children, whereas benzyl benzoate and permethrin cured all patients as assessed after a 3-week follow-up. The number of irritations and post-scabious eczematous reactions was increased after benzyl benzoate treatment. Permethrin proved to be very reliable and exhibited few side effects when applied once at bedtime. Because of the percutaneous absorption and neurotoxicity of lindane, the application of permethrin can be recommended as a useful alternative in premature infants and small children, patients with seizures and neurological complications, in cases of therapeutic failure with lindane the treatment needs to be repeated, in scabies crustosa, as well as in children, pregnant women and nursing mothers.

A 3-year-old boy with nonbullous congenital ichthyosiform erythroderma with a four-month history of scabies was treated with a single dose of lindane cream. In a 48-hour period, he developed nausea and vomiting and also suffered from an epileptiform convulsion and muscular spasms. Seventy-two hours after application of the cream, his blood lindane level was 54 ng/mL. Caution should be exercised when using lindane in patients with compromised epidermal barrier function.

Plasma gamma-hexachlorocyclohexane (gamma-HCH) and three urinary trichlorophenols were measured in forestry workers who were engaged in planting seedlings treated with gamma-HCH. These two procedures were assessed as potential biological monitoring methods and the data were compared with reported clinical symptoms. The measurement of plasma gamma-HCH was considered to be a feasible and valid monitoring method for use in routine practice and is a useful indicator of gamma-HCH absorption. The data were used to illustrate the need to be vigilant about personal hygiene and the efficacy of protective clothing. Plasma gamma-HCH concentrations above 70 nmol/l were measured in two workers which coincided with persistent non-specific clinical symptoms. Trichlorophenols were identified in urine but the extensive and variable metabolism of gamma-HCH makes this approach less suitable for biological monitoring.

Treatment for scabies is usually initiated by general practitioners; most consider lindane (gamma benzene hexachloride) the treatment of choice. Lindane is also widely used as an agricultural and industrial pesticide, and as a result the toxic profile of this insecticide is well understood. Evidence is accumulating that lindane can be toxic to the central nervous system and may be associated with aplastic anaemia. Preparations containing lindane continue to be sold over the counter and may represent a hazard to poorly informed patients. This literature review suggests that general practitioners should prescribe scabicides with increased caution for certain at-risk groups, and give adequate warnings regarding potential toxicity.

The transcutaneous absorption of a 1% lindane cream (Kwell) was determined after application according to the official label. By 3 days after application the plasma lindane level increased from nondetectable to 10.3 +/- 2.2 ng/ml. Sufficient lindane was absorbed to increase the plasma clearance of antipyrine from 0.027 +/- 0.009 to 0.037 +/- 0.011 1/kg/hr (p less than 0.05). these findings indicate significant transcutaneous absorption of lindane occurs following a single application and are compatible with the neurological toxicity reported following the topical application of lindane cream.

Any topical treatment may lead to systemic side-effects through epidermal penetration. In children the ratio surface treated/weight is usually high, implying greater risk. Factors which determine percutaneous absorption in childhood are reviewed as well as the main drugs which are toxic when applied to the skin.

Head lice commonly evoke feelings of disgust, revulsion, anger, and shame among parents and patients. There should, however, be no great cause for such alarm if a physician suspects pediculosis capitis. The recent introduction of several new pediculicidal drugs now allows a choice among four distinct therapeutic agents, which should substantially improve control of isolated cases and epidemics. Physicians must be aware that consumer groups are pressing public health authorities and drug manufacturers to establish proper treatment standards and safety warnings for the use of these agents. In addition, some controversy surrounds the use of lindane in children. This paper reviews the epidemiology and clinical appearance of pediculosis capitis in children, with emphasis on these recent developments. Pubic lice (Phthirus pubis) and body lice (Pediculus humanus corporis), both of which are much less common pediatric infestations, are mentioned only briefly.

A report of eight cases with grand mal seizures secondary to accidental ingestion/exposure to benzahexachlorine has been presented. Persistant neurological signs and biochemical tests have been described. Seizures affected even the domestic animals like cows and buffaloes. Discussion of various clinical syndromes, treatment of organochlorine pesticide and their persistence in human body for years after removal from source of exposure is emphasized. Preventive measures are recommended. the authors are not aware of any similar reports from this part of the country.

The effects of lindane, administered either IP (4, 6 or 8 mg/kg in dimethylsulfoxide, 0.5 ml/kg) or PO (30, 40 or 50 mg/kg in oil, 1 ml/kg), were compared in male rats. Effects appeared later and lasted longer after PO administration. After either route, convulsant effects occurred first and were over before hypothermic effects were maximal. Also, hypothermia subsided before hypophagia ended. After IP administration, hypothermia had the lowest threshold and convulsions the next lowest; reduced food intake was produced only by the highest dose, which also produced 43% deaths. By contrast, after PO administration, all doses reduced food intake and produced hypothermia, but deaths did not occur after even the highest dose. The different time courses and thresholds for the different indices of toxicity suggest that different target sites or mechanisms may be involved. Thus, effects on the gut, in addition to effects on the brain, may account for the longer duration and greater sensitivity of reduced food intake, compared to lethal and hypothermic effects, after PO administration of lindane. After administration of lindane IP, peripheral vasodilation (as demonstrated by an increase in tail temperature) preceded colonic hypothermia. This could be explained if lindane inappropriately activated heat-loss mechanisms.