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    Options for treating drug-resistant lice

     

    Treatments

    • Pyrethroids—pyrethrins like Rid and permethrin lotion 1% (Nix) -- may not work due to the development of drug resistance.
    • Malathion lotion 0.5% (Ovide) works in a single application for most patients, but is limited to those 6 and older. Resistance has been reported in the United Kingdom.
    • Ivermectin lotion 0.5% (Sklice) got FDA approval in 2012. It kills baby lice (nymphs) and works as a single application on dry hair without nit combing. It’s approved for children 6 months and older.
    • Spinosad 0.9% topical suspension (Natroba) was approved by the FDA in 2011. It’s approved for children aged 4 and up, and is also effective as a single application on dry hair without nit combing. Retreatment is usually not needed.
    • Benzyl alcohol lotion 5% (Ulesfia) received FDA approval in 2009 and requires repeat treatment on the ninth day. It’s approved for ages 6 months to 60 years.
    • Professional nitpicking services are available at $75-$100 an hour.
    • The AirAllé Lice Treatment, which uses heated air in a different way than a blow dryer, costs $170. One treatment is needed (it includes an hour of nit-picking and an hour of device usage), and it’s approved for ages 4 and up.

    Keep in mind, Dr. Hunt says, that if you see large, live lice, they may be a sign of a reinfestation. Also, she says, lice of different sizes can be a sign of possible resistance.

    And be aware of how lice may affect patients and their families. “Patients diagnosed with an infestation or their family members may express embarrassment that the diagnosis reflects poorly on their home cleanliness or personal hygiene,” Dr. Hunt says. “Additionally, prior partial treatments or treatment failures may result in patients feeling reluctant to accept the diagnosis and treatment plan. Being aware of and sensitive to these potential patient concerns helps facilitate communication about infestations.”

    References

    1. Yoon KS, Previte DJ, Hodgdon HE, et al. Knockdown resistance allele frequencies in North American head louse (Anoplura: Pediculidae) populations. J Med Entomol. 2014;51(2):450-7.

    Randy Dotinga
    Randy Dotinga is a medical writer based in San Diego, Calif.

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