treatment of head lice. homeopathy and allopathy

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1 This lesson is supported by an educational grant from Hyland s, Inc. Treatment of head lice: homeopathy and allopathy Introduction One day while helping in my son s kindergarten class, I was summoned along with the other grown-ups to do a head lice check in another classroom. Apparently, a child was just sent home with head lice. This scenario is common in schools. The bane of many parents is having a child diagnosed with head lice. Head lice, popularly known as cooties, are dreaded by both teacher and parent, as they are contagious and bothersome. Lice are parasites that feed on human blood. They can be found on the head, body and the pubic area. Three types of lice affect humans and affect different parts of the body: Pediculus humanus capitis (head louse), Pediculus humanus corporis (body louse, clothes louse) and Pthirus pubis ( crab louse, pubic louse). Although not usually dangerous or associated with significant morbidity, head lice infestation is common in school-aged children who usually are in close contact, especially during the school year. Because of the close proximity of children and lice s contagious nature, head lice are easily spread. For many parents, they can be stubborn to treat and downright annoying. The goal of this CE lesson is to educate the clinician on head lice in children and offer standard and natural medical treatments as courses of action. Incidence For many parents a diagnosis of head lice can be angst ridden, as it often is associated with being unclean or having poor hygiene. In addition, children may not be permitted to attend school and may be kept at home, causing caregivers and children to miss several days of work and school. The estimated cost of head lice infestation in the United States is up to $1 billion dollars annually. 1 Infestations of head lice occur worldwide, and the head louse can affect children of any socioeconomic background it is not related to frequency of shampooing or hygiene. Head lice commonly affect children from 3 years to 12 years of age, resulting in approximately 6 million to 12 million infestations each year in the United States. 2 Head lice are more common in girls, and less common in African-Americans, which may be due to the oval-shaped hair shaft that makes it more difficult for the parasite to attach. Head lice are spread by close human contact, especially direct contact with the head. Hair combs and brushes are considered less likely routes of transmission because they contain dead or injured lice, making it difficult for survival and reproduction. Lice are not spread by household pets or other animals. 3 Hair length does not influence rates; however, in cultures with frequent hair brushing such as in the United States individuals heads usually have a dozen live lice on the scalp. Individuals in cultures with different grooming practices (i.e., no brushing) can present with live lice infestations numbering more than 100. Regardless, head lice infestation can be an annoying, recurrent problem for children and their parents. Head lice are not responsible for the spread of other diseases. Only the body louse is known to spread disease. Most cases of head lice are treated by parents who purchase over-the-counter pediculicides, which can lead to medication overuse and By: Lauren S. Feder, M.D., C.C.H. The Medical Group of Lauren Feder, M.D. Initial release date: Aug. 2, 2010 Planned expiration date: Aug. 2, 2011 This program is accredited for 1.25 (one and one-quarter) hours of continuing education credit of which 0.5 (one-half) hour is considered pharmacology credit. Program Goal: To improve the clinician s ability to counsel patients regarding the standard and homeopathic treatment of head lice. Learning Objectives: Upon completion of this program, the clinician should be able to: 1. Identify the incidence, prevalence, diagnosis and natural history of head lice. 2. Describe the current home care and allopathic treatment of head lice. 3. Compare the basic treatment principles of allopathic and homeopathic treatment. 4. Differentiate homeopathic products from other herbal and natural products for head lice. 5. Educate patients on over-the-counter, prescription and alternative treatments for head lice, including directions for use and potential side effects or contraindications. This independent learning activity is accredited for 1.25 (one and one-quarter) hours of continuing education (of which 0.5 [one-half] hour is accredited for pharmacology) by Partners in Healthcare Education, LLC, an approved provider of nurse practitioner continuing education by the American Academy of Nurse Practitioners, provider # To obtain credit: Answer the test questions at the end of this lesson and complete the evaluation online at RetailClinician.com. After completion of the post test with a score of 70% or above, and completion of the program evaluation, a printable certificate will be available. Questions regarding statements of credit should be directed to W. Lane Edwards Jr. at Lane@4healtheducation.com. This lesson is available free of charge to retail clinicians. Copyright 2010 by Lebhar-Friedman Inc. All rights reserved. Retail Clinician RetailClinician.com Fall

2 misuse. In addition, more cases are proving to be resistant to many of these agents. It is important that clinicians be familiar with available treatments, including the traditional OTC and prescription treatments, as well as natural medical alternatives. Epidemiology The most common head lice complaints are a crawling sensation, tickling and itching of the scalp, and loss of sleep. Persistent scratching can cause the skin to become raw and irritated. The nearby lymph glands also can be swollen. On rare occasions this may lead to a secondary bacterial infection, such as impetigo, or a localized adenopathy from inflammation. Head lice (Figure 1) are most often diagnosed through physical exams of the scalp. They are small, wingless insects that live on the human scalp, attaching themselves to the shafts of hair. The adult louse measures approximately 2 mm to 3 mm long, or the size of a single sesame seed. Its color varies, but it usually is a pale gray. The female louse lays approximately 10 eggs a day, known as nits, which hatch in 10 to 14 days. The lifespan of a louse is three to four weeks. The offspring (nymphs) mature and mate, and the cycle repeats itself every three weeks. The insect cannot hop or fly, but is mobile through crawling as fast as 6 cm to 30 cm per minute. Head lice often are over diagnosed in schools, so it is important that a child does indeed have lice before beginning any treatments. figure 1 Head lice (larger female is on the right) Source: SuperHomeRemedies.com As a parasite, the louse survives by feeding off of blood from the scalp every few hours. During feeding, saliva is injected into its host causing itching, which can take up to four to six weeks to become apparent due to increasing sensitivity to the saliva. The female louse produces a sticky substance that glues the nits to the base of the hair shaft. Because of their parasitic nature, removing the lice from the head kills the lice, as they will not survive after approximately one to two days, and the eggs will fail to hatch due to temperature change and sensitivity. Because of the warmth of the body, nits that are located beyond 1 cm from the scalp are not usually viable. Diagnosis and prevention Head lice usually are diagnosed through visual inspection of the scalp and are most easily seen along the hairline at the back of the head or behind the ears. To diagnose head lice, a child s scalp must be closely examined, parting the hair section by section. Easier to view are nit casings, which appear white against darker hair. Nits camouflage easily and have been confused with particles of dandruff, hair spray and other hair artifacts. When checking a child s scalp for lice, it is best to use gloves and part the hair in sections in order to better view the scalp and hairlines. Head lice can be problematic in a school setting where children remain in close contact. Although receiving a note from school regarding lice outbreaks is not usually welcomed by parents, it is important for them to be familiar with signs and symptoms of head lice. The American Academy of Pediatrics, or AAP, policy states that it is not necessary to keep a healthy child home because of head lice. 4 Following treatment, children can be allowed to return to school, although some schools adhere to a strict no nit policy. Educating families about head lice includes informing them of preventive measures of future infestations and reoccurrences. Preventive treatment of close contacts of the infested child without screening is a common practice. In addition, general measures include cleaning of personal articles and bedding. It is recommended that parents check their children s scalps regularly and avoid head-to-head contact, including contact through such personal items as hats, combs and brushes. Other family members need to be examined for lice and treated immediately if necessary. Environmental steps Clothing, personal items, linens and towels that had been used by the individual two days prior to treatment should be machine washed in hot water and dried in a hot air cycle. Lice and nits cannot withstand temperatures greater than 130 F (50 C to 60 C). Soak combs and brushes in hot water for at least 10 minutes. For articles of clothing and bedding that cannot be washed, they should either be dry cleaned or sealed in plastic bags for a minimum of two weeks. This allows time for a cycle of nits to hatch and die. Floors, carpets and furniture should be vacuumed thoroughly. Applying pediculocidal sprays on inanimate objects is not needed and not recommended due to toxicity to humans. Basic treatment principles of allopathic and homeopathic medicine Many parents prefer to try the more natural, gentle and nontoxic approaches before resorting to potentially toxic pesticides. In addition, many of the standard brands are considered ineffective due to some recent strains of lice becoming resistant to their effects. Although the actual percentage is not known, resistance is not uncommon. Insects develop resistance to pediculicides over time. 2 Holistic medicine encompasses a wide variety of practices, including homeopathic medicine, herbs, Chinese medicine and acupuncture, Ayurveda, osteopathy, naturopathy and chiropractic medicine. The word holistic derives from whole, and holistic medicine takes an integrated approach to treatment, asking not only what is happening symptomatically to the body but also what emotional, psychological or environmental factors may be contributing 2 Fall 2010 RetailClinician.com Retail Clinician

3 to the issue. Also crucial to holistic medicine is the emphasis on natural, nontoxic remedies and procedures. Holistic practitioners generally believe that natural products are safer and often may add a more effective means of treating illness than conventional medicines, with fewer side effects and less wear and tear to the body. 2 While conventional allopathic medicine tends to rely on chemical and mechanical explanations for illness, holistic practices understand it in terms of balance. A body seeks balance, or homeostasis, but occasionally, due to a variety of factors, it is not strong enough to ward off disease. Homeopathy and other forms of natural medicine seek to restore balance by strengthening the whole person s ability to resist illness. Conventional medicine, in contrast, seeks to combat illness by combating primarily its symptoms. 2 Natural medicine is simple, practical and easy to incorporate into already existing home rituals. Some parents may worry that natural approaches will demand more time and energy; however, natural medicines can prove to be time- and costefficient. In addition, such natural medicines as homeopathy often are safer and just as, if not more, effective than conventional prescription drugs. They are safe for use by newborns, nursing mothers and mothers-to-be, and can be bought over-the-counter at a reasonable cost. Homeopathic remedies are not a replacement for standard medicine, but are an empowering alternative for parents. 2 Homeopathy and other forms of natural medicine have proved effective in treating both acute and chronic illnesses, including head lice. As pharmaceutical usage has increased over the last 30 years, so too has widespread resistance to its effectiveness. 2 Homeopathy Homeopathy is based on the administration of minute doses of drugs, which are capable in their natural state of producing symptoms like those of the disease being treated. This principle is known as the law of similars. In other words, a substance that could cause symptoms in large amounts can heal you in minute homeopathic doses. A common homeopathic medicine, for example, is Allium cepa (red onion), used to treat runny nose and red eyes from a cold or hay fever the very symptoms red onion would cause if you were cutting it in the kitchen. 5 There are more than 2,000 homeopathic medicines derived from various plant, mineral and animal substances. Through a series of dilutions and successions, natural substances are distilled until all that is left in the medicine is their print, or essence. Just as if one were to touch a pane of glass and leave a fingerprint, so in homeopathy the active agents of the substance remain while potential toxicity is diluted out. Because of this, homeopathic medicines are safe and nontoxic for children and adults. 5 Many people view homeopathy as an alternative, and hence nonmainstream, form of medicine; but, in fact, until relatively recently, homeopathy occupied a central place in American health care. In Washington, D.C., only one memorial is dedicated to a physician the founder of homeopathy Dr. Samuel Hahnemann. In Hahnemann s time, in the late 17th and early 18th centuries, patients often suffered as much from their treatments as from their illnesses: Standard medical practices included bloodletting, leaching and mercury poisoning. Early in his medical career, Hahnemann rejected these injurious therapies and shifted his focus to finding a different method of healing. He called his eventual discovery homeopathy. 5 News of Hahnemann s system spread, and by the early 1800s, homeopathy had arrived in America. Its popularity in the United States grew considerably after doctors used homeopathic remedies with great success during the cholera epidemic of In addition, many people not only were seeing homeopathic doctors but also were relying on homeopathic remedies to treat common mild ailments at home. By 1900, there were more than 100 homeopathic hospitals in the United States alone. Conventional doctors defended their turf, however. The American Medical Association began a direct response to the popularity and success of homeopathy, and effectively forced this once very mainstream medical practice to the sidelines of U.S. health care. 5 For children, homeopathy and other forms of holistic medicine can prove to be safer and more reliable therapies than standard courses of antibiotics or OTC medications. Children s bodies grow and change at an incredibly rapid pace, and part of their healthy development is the fine-tuning of their immune systems. Mild acute conditions such as head lice are common, and natural remedies allow one to treat the discomfort without interrupting the immune response. For nonserious ailments like these, homeopathic remedies also are safe and easy for parents to administer, saving a potential trip to the doctor s office. 5 Herbal medicine In addition to homeopathy, cultures across the world have recognized the healing properties of herbal medicine, and have passed this knowledge through the generations so that it remains a vital force in holistic healing today. Herbal medicine also is known as botanical medicine or phytomedicine, and some of its betterknown remedies include echinacea, goldenseal and St. John s wort. Herbal preparations still can interact with medications, so it is important that patients check with an herbalist or healthcare provider about the safety of using a treatment in conjunction with other prescriptions. Head lice treatment options The goal of head lice treatment is to begin early to expedite the cure and minimize the transmission of head lice to others. Standard medical practices include such home care treatment as use of fine-tooth combs, as well as OTC and prescription pediculicides. However, due to lice resistance, as well as side effects of some pediculicides, consumers are gaining interest in the use of alternative treatment options as well. Table 1 contains selected products Retail Clinician RetailClinician.com Fall

4 for the treatment of head lice, which will be covered in additional detail in this section. Manual removal/combing A fine-tooth comb preferably a nit comb can be used to remove the nits, along with a magnifying glass and proper TABLE 1 Selected products for the treatment of head lice Ingredients Brand names Directions for use Repeat dosing Side effects and contraindications Other comments Over-the-counter Pyrethrins and piperonyl butoxide A-200 maximum strength, Pronto complete lice removal system, Rid maximum strength Apply like shampoo to dry hair for 10 minutes, then rinse off with cool water. Treatment may be repeated if necessary once in 24-hour period. Repeat treatment in seven to 10 days to kill newly hatched nymphs. Side effects are considered rare, but patients have reported skin rash, sneezing/stuffy nose and trouble breathing. Contraindicated in people with hypersensitivity to pyrethrins, ragweed, chrysanthemums or any component of the formulation. Side effects were reported in 1% to 10% of patients and included localized burning, stinging, tingling of the scalp, pruritus, erythema and scalp rash. Neurotoxic to nymphs, but 30% of eggs may remain Permethrin 1% Acticin, Elimite, Nix complete lice treatment system Apply to hair that has been shampooed and towel dried, leave on hair for 10 minutes then rinse off. Treatment may be repeated within seven to 10 days if lice or nits are detected. Currently AAPrecommended treatment for head lice. Permethrin resistance has been documented. Contraindicated for use in infants less than 2 months. Prescription Lindane 1% Kwell Use no longer indicated Use no longer indicated Can cause rash, hair loss, itching, headache, seizures and even death. Black box warning: May be associated with severe neurologic toxicities (contraindicated in premature infants and uncontrolled seizure disorders). Not considered a drug of first choice; use only in patients who have failed first-line treatments, or in patients who cannot tolerate other agents. No longer readily used because of its adverse effects, low ovicidal properties and reports of resistance. Medication guide required. (Continued on page 5) 4 Fall 2010 RetailClinician.com Retail Clinician

5 lighting. Grooming is considered an effective way to eliminate lice. It is easier to comb out lice when the hair is wet. While this also is time-consuming, there are no side effects. Combing toward the scalp, against the hair grain, makes it easier to TABLE 1 (continued) Selected products for the treatment of head lice Ingredients Brand names Directions for use Repeat dosing Prescription Malathion 0.5% Ovide Apply as a lotion on dry hair (use no heat and leave uncovered) and wash off after eight to 12 hours. Alternative treatment options Essential oils Various Apply to dry hair and leave in for 15 minutes, then shampoo hair and use nit comb. Follow labeling for more product-specific information. Gel Lice Out lice Wash and dry immobilizing gel hair, apply gel and comb in sections to remove nits according to package directions and then rinse hair. Quassia amara 2X HPUS Quit Nits advance lice treatment cream Apply on the dry hair of individuals with head lice. Cover with shower cap and leave on for four hours or overnight for serious infestations (remove children s shower cap prior to bed). Treatment may be repeated within seven to 10 days if live lice are detected. Treatment may be repeated per individual product labeling. Can repeat picking of nits twice a day for two weeks. Safe for repeated use if needed. Side effects and contraindications Side effects can include skin and scalp irritation of undefined frequency. Safety and efficacy has not been established in children less than 6 years of age. Varies, refer to specific product labeling. No reported side effects No reported side effects Other comments Use with caution and only if the condition is found to be resistant to other pediculicides. Homeopathic Eucalyptus globulus 1X HPUS and essential oils Quit Nits everyday preventative spray Spray preventative spray in the clean hair of family members or other contacts who do not have head lice infestation. Retail Clinician RetailClinician.com Fall

6 dislodge the nits. It is important to clean the comb after each use. This procedure can be performed daily for several nights, and then every three nights as needed. Traditionally, some parents shave a child infested with lice. Although it may make it more difficult for lice to find a warm, comfortable spot, and easier for parents to search for lice, this may draw unwanted attention to the child. Pharmacological treatment Pediculicides are available as shampoos, creams and lotions. Although many parents treat their children s conditions with OTC medications, parents should be encouraged to see a healthcare practitioner if the condition does not improve or if there are any signs of infection, usually from scratching. If the skin becomes infected from scratching, clinicians may prescribe an antibiotic either topically or orally. Oral antihistamines and topical steroids creams can be prescribed for relief of mild burning or itching of the scalp following the use of both OTC and prescription topical pediculicides. There are a variety of OTC and prescription medications that include pyrethrin, permethrin, lindane and malathion. OTC treatment options Pyrethrins Pyrethrins, often combined with piperonyl butoxide, are composed of extracts from the chrysanthemum plant and are neurotoxic to nymphs, however less so to eggs because the eggs do not have a nervous system. Up to 30% of eggs may remain following treatment. The product is applied like a shampoo to dry hair for 10 minutes and then rinsed off with cool water. The cool method is preferred as hot water causes vasodilatation of the scalp, which may increase absorption of pyrethrin. Because bathing in cool water is not well tolerated by most children, it is recommended to do this over a sink. Treatment may be repeated if necessary once in a 24- hour period. Because pyrethrins are not totally ovicidal, it is recommended to repeat treatment in seven to 10 days to kill newly hatched nymphs. Although pyrethrins are considered to have low toxicity to mammals, allergic reactions and sensitivities are possible, but rare. Side effects are considered rare, but patients have reported skin rash including skin irritation and infection sneezing/stuffy nose and trouble breathing. Pyrethrins are pregnancy category C, and safety in breast-feeding is unknown. Pyrethrins are contraindicated in people who have a hypersensitivity to pyrethrins, ragweed, chrysanthemums or any component of the formulation. 6 Permethrin Permethrin 1% is a synthetically produced pyrethrin. Permethrin presents more advantages than pyrethrin as it is less toxic to humans and is not known to cause allergies to people who are sensitive to plants, including chrysanthemum. Permethrin is applied as a cream rinse to hair that has been shampooed and then towel dried. Similar to pyrethrin, it is meant to be rinsed off after being left on the scalp for 10 minutes. Permethrin leaves a residue on the hair intended to be toxic to up to 30% of newly hatched nymphs following the initial treatment. Some clinicians recommend repeat treatments within seven to 10 days if live lice are detected, while others advise routine repeat use regardless of outcome. The latter approach may be causing permethrin resistance. 7 Side effects were reported in 1% to 10% of patients and included localized burning, stinging, tingling of the scalp, pruritus, erythema and scalp rash. Permethrin is pregnancy category B, and safety in breast-feeding is unknown. It is contraindicated for use in infants less than 2 months of age. Permethrin 1% currently is the AAP-recommended treatment for head lice. 4 Prescription treatment options Lindane Lindane is a prescription shampoo that works as an organochloride. Lindane can cause rash, hair loss, itching, headache, seizures and even death. Lindane is pregnancy category C, and there are no well-controlled studies in pregnant women. Lindane enters breast milk and is contraindicated in breast-feeding. Because of its adverse effects, and its low ovicidal properties and reports of resistance, Lindane no longer is readily used. 8,9 Malathion Malathion 0.5% has gained notoriety as a pesticide that is widely used in public health pest control programs, agriculture and landscaping. It is known to be poisonous to the brain and immune system, and may cause cancer. 10 Malathion also has an application for being used in the treatment of head lice. It is an organophosphate (cholinesterase inhibitor) with high ovicidal activity. Malathion is applied as a lotion to dry hair and washed off after eight to 12 hours. It can be reapplied if live lice are detected after seven to 10 days. Known for its respiratory toxicity if accidentally ingested, malathion is flammable due to its alcohol content. 11 Malathion should be used with caution and only if the condition is found to be resistant to other pediculicides. Malathion is pregnancy category B, and should not be used on infants. Its safety in breast-feeding mothers and children under 6 years of age is uncertain. 12 Alternative treatment options Traditionally, treatments of head lice infections include standard preparations as outlined above. However, due to lice resistance, as well as side effects to some of these insecticides, consumers are gaining interest in the use of natural medicines and homeopathy for many conditions, including head lice. Oil and gel Oil may be helpful in eliminating lice by covering and potentially suffocating them. Instruct the parent or caregiver to coat the entire scalp and hair with olive oil or mayonnaise after combing out the nits. Cover the head with a shower cap or towel, and leave on for six to eight hours. Then the caregiver should shampoo the hair, which may take several washings. Examine the scalp and remove any existing nits. The parent or 6 Fall 2010 RetailClinician.com Retail Clinician

7 caregiver should repeat every four days, as needed, for three weeks. There also are OTC gels and oils available. One example is LiceOut lice immobilizing gel, which traps lice allowing nit combs to remove lice and nits. LiceOut lice immobilizing gel is considered safe and nontoxic. 13 There also are commercially prepared essential oil treatments containing lavender, lemon, rosemary and other oils that may be effective. 13 Homeopathic In the homeopathic material medica, there are dozens of medicines for use in head lice, which can make it confusing for the consumer in choosing the right one. To simplify matters, homeopathic medicines also are available in a variety of combinations, including ones for head lice. These ready-made formulas for the treatment of pediculosis can be convenient for people who don t know the exact remedy they need, who cannot find the specific remedy they re looking for sold alone or who are unable to consult a homeopath. One commercially available combination product is Quit Nits. The advance lice treatment cream contains Quassia amara 2X HPUS, which has been shown to kill lice and nits. The second product, an everyday preventative spray, contains Eucalyptus globulus 1X HPUS and essential oils, which have been shown to repel lice. Quit Nits advance lice treatment cream is scientifically proven to be effective in killing lice and nits after overnight exposure. 14 It is nontoxic, contains no chemical pesticides and has no side effects. Unlike other pediculicides, Quit Nits is safe for women during pregnancy, nursing mothers and children less than 2 years old. Practice points Conclusion Proper diagnosis of head lice begins with familiarity in examining the child s scalp. Head lice affects millions of children each year in the United States. OTC and prescription preparations are used by parents often prior to consulting with a healthcare provider. To date, there has been more evidence of mounting resistance to insecticides. In addition to the standard pediculicides, there are homeopathic and herbal products that are safe and nontoxic, and are viable options for families. For families who self-diagnose and treat, they should be counseled that if lice are present following two to three applications, they should seek medical treatment. This may mean a misdiagnosis or that the lice are resistant to the chosen treatment. In that case, parents may be given a prescription medication or counseled on using the natural homeopathic or herbal alternatives. 1. Head lice are a contagious, benign condition affecting millions of children in the United States during the school year. Head lice are spread by close, direct contact with the head, regardless of socioeconomics and hygiene. 2. Common complaints of head lice include a crawling sensation, tickling and itching of the scalp. On occasion, scratching can lead to skin irritation and infection. 3. Lice are diagnosed by examining the scalp, and are most easily seen along the hairline at the back of the head and behind the ears. A child s scalp must be closely examined, parting the hair section by section. Easier to view are nit casings, which appear white against darker hair. 4. An adult louse appears the size of a sesame seed, pale gray in color. The female louse lays 10 eggs a day, known as nits, which hatch within 10 to 14 days. They have a lifespan of three to four weeks. As a parasite, the louse survives by feeding off of blood from the scalp every few hours. 5. Standard medical practices include such home care treatments as the use of nit combs, as well as pediculicides obtained both over-the-counter and by prescription. Resistance to these medications, as well as side effects, has prompted parents to successfully use natural preparations, which include homeopathy, herbs, oils and gels. 1 Perlstein, M.D. David, Shiel, Jr. MD William, MedicineNet.com Available at: Accessed June 10, Frankowski, MD MPH, Weiner, MD Committee on School Health, Committee on Infectious Diseases. American Academy of Pediatrics. Head Lice. Pediatrics. Vol. 110 No. 3 September 2002, pp Centers for Disease Control and Prevention. Head lice. Available at: Accessed June 10, American Academy of Pediatrics. Health Issues: Lice. Available at: pages/lice.aspx Accessed June 30, Feder, M.D. Lauren, Natural Baby and Childcare. Hatherleigh Publishers Medicinenet.com. Pyrethrins and piperonyl butoxide shampoo. Available at: Accessed June 10, Yoon KS, Gao JR, Lee SH, et al. Permethrin-Resistant Human Head Lice, Pediculus capitis, and Their Treatment. Archives of Dermatology. 2003; 139: MedlinePlus. Drugs, Supplements, and Herbal Information. Available at: Accessed June 10, Downs AM. Managing head lice in an era of increasing resistance to insecticides. American Journal of Clinical Dermatology. 2004; 5(3): Reeves JD, Driggers DA, Kiley VA. Child Leukemia & Aplastic Anemia after Malathion Exposure. Lancet. 1981; Aug 8: Idriss S, Levitt J. Malathion for head lice and scabies: treatment and safety considerations. Journal of Drugs in Dermatology. 2009; (8): Flinders D, De Schwenitz P. American Family Physician. 2004; 69(2): Washington State Department of Health DOH Pub /99. Lice Aren t Nice. Available at: pdf Accessed June 10, Burgess I. and Harris M. Report of tests to establish efficacy of one formulation (Wild Child) against adult lice and their eggs with a 40 minute, 2 hour, and overnight exposure May Quit Nits. Quit Nits FAQs. Available at: Accessed June 10, Retail Clinician RetailClinician.com Fall

8 Treatment of head lice: homeopathy and allopathy Learning Assessment Successful completion of Treatment of head lice: homeopathy and allopathy is accredited for 1.25 (one and one-quarter) hours of continuing education credit, of which 0.5 (one-half) hour is considered pharmacology credit. To obtain credit, answer the following questions and complete the evaluation online at RetailClinician.com. 4. is based on the administration of minute doses of drugs, which are capable in their natural state of producing symptoms like those of the disease being treated. a. Allopathy b. Conventional medicine c. Herbal medicine d. Homeopathy 8. Which product no longer is readily used to treat head lice because of its adverse effects, low ovicidal properties and reports of resistance? a. Malathion 0.5% b. Lindane c. Permethrin 1% d. Eucalyptus globulus 1X HUPS and essential oils 1. Head lice incidence is higher in which of the following groups? a. Children more than 12 years of age b. Boys c. Girls d. African-Americans 2. What type of louse is known to spread disease? a. Head louse b. Body louse c. Pubic louse d. None of the above 3. Head lice usually are diagnosed through visual inspection of the scalp and are most easily seen along the hairline at the back of the head or behind the ears. a. True b. False 5. Which of the following can interact with other medications? a. Homeopathic medicines b. Herbal medicines c. A&B d. None of the above 6. What is currently the American Academy of Pediatrics recommended treatment for head lice? a. Lindane b. Malathion 0.5% c. Permethrin 1% d. Pyrethrins and piperonyl butoxide 7. should be applied like shampoo to dry hair for 10 minutes then rinsed off with cool water. a. Pyrethrins and piperonyl butoxide b. Malathion 0.5% c. Essential oils d. All of the above 9. Which head lice treatment is pregnancy category B, should not be used in infants and has uncertain safety in breast-feeding mothers and children under 6 years of age? a. Malathion 0.5% b. Lindane c. Permethrin 1% d. Pyrethrins and piperonyl butoxide 10. A parent of a child with head lice is looking for a product that is nontoxic, contains no chemical pesticides and has no side effects. Which of the following meets those specifications? a. Malathion 0.5% b. Lindane c. Quassia amara 2x HPUS d. Permethrin 1% 8 Fall 2010 RetailClinician.com Retail Clinician