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Author: Admin | 2025-04-28
Insecticidal agents that are neurotoxic to lice include permethrin 1% lotion or shampoo (Nix), pyrethrins 0.3%/piperonyl butoxide 4% shampoo (Rid), malathion 0.5% lotion (Ovide), spinosad 0.9% suspension (Natroba), ivermectin 0.5% lotion (Sklice), and oral ivermectin (Stromectol; off-label use). Permethrin 1% is recommended as first-line treatment for head lice.1,8,18 Pharmacologic Treatments for Head Lice" description="FDA = U.S. Food and Drug Administration; OTC = over the counter.*—Estimated retail price based on information obtained at http://www.goodrx.com (accessed October 22, 2018) and Walgreens. Generic price listed first; brand name price listed in parentheses.†—FDA approved in May 2017 but not yet marketed in the United States.‡—Off-label use.Adapted with permission from Gunning K, Pippitt K, Kiraly B, Sayler M. Pediculosis and scabies: treatment update. Am Fam Physician. 2012;86(6):537, with additional information from references 1, 4, 8, and 11 through 17."> Noninsecticidal agents that rely on suffocation or exoskeleton dissolution include benzyl alcohol 5% lotion (Ulesfia), dimethicone solution (Nix Ultra, Lice MD), and isopropyl myristate solution (Resultz; approved by the U.S. Food and Drug Administration in May 2017 but not yet marketed in the United States). The Canadian Paediatric Society recommends dimethicone solution and isopropyl myristate solution as second-line agents if permethrin fails after two treatments.8 A key to formulating an effective treatment regimen is recognizing the effectiveness of available treatments in destroying viable eggs because this dictates if retreatment is necessary. Malathion, spinosad, and topical ivermectin are considered ovicidal, and they will kill both live lice and eggs in one treatment. Nonovicidal agents (permethrin, pyrethrins, benzyl alcohol, dimethicone, oral ivermectin, and isopropyl myristate) typically require a repeat application for complete eradication. Timing for nonovicidal treatments is based on the life cycle of the louse.19 An initial application followed by a second application seven to 10 days later (nine days is optimal) should be sufficient to eradicate
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