To the Editor.—
I am writing because of concern about the article “Therapy for Head Lice Based on Life Cycle, Resistance, and Safety Considerations.”1 My first concern is the recommendation to use malathion, an organophosphate pesticide, as the first-line therapy when permethrin is also recommended by the American Academy of Pediatrics Committee on Infectious Diseases for this purpose.2 As an organophosphate, malathion is in the class of pesticides that includes chlorpyrifos, which has now been banned as a home-use pesticide. Malathion is also not recommended for children <6 years of age. Thus, malathion has a greater possibility for toxicity than permethrin.3,4 Under these circumstances, it would seem reasonable to use permethrin unless treatment failure is documented.
My second concern is that the third author of this article serves as vice president of and is a major shareholder in the sole pharmaceutical company that manufactures...
Joanna Ibarra BSc (Hons) MA FRSH, Programme Co-ordinator, Community Hygiene Concern, UK Reg. Charity No: 801371 Manor Gardens Centre, 6-9 Manor Gardens, London N7 6LA, UK
To the Editor.-
Further to the concerns expressed by Prof Weil, (1) about the article “Therapy for Head Lice Based on Life Cycle, Resistance, and Safety Considerations.” (2), I should like to add a third issue, the inaccurate description by Lebwohl, Clark, and Levitt of Bug Busting wet combing as “nit combing”. Both the randomized controlled trial reports cited (3, 4) make it amply clear that a Bug Buster kit comprises instructions and specific plastic louse-detection combs to undertake four sequential combings on wet, conditioned hair, leaving three days between each (i.e. on days 1, 5, 9 and 13). No nit or egg removal is required to break the life-cycle using this method. It exploits biological vulnerabilities of Pediculus capitis, as the parasite remains motionless whilst immersed in moisture, permitting its comfortable removal from the hair with the correctly-designed comb. Nit combs intended for egg removal are not suitable.
Wet combing using a louse-detection comb was introduced as a method for diagnosis, to detect low levels of lice. The UK Department of Health advises parents to use this method to check the efficacy of any treatment (5) and suggests use of the Bug Buster kit alone as a treatment option. It has the advantage of being cost-effective (only one reusable kit per family) and sustainable, many families continuing to use their original kit for detection and eradication for a whole year or more.
References
1. Weil WB. Therapy for head lice. Pediatrics. 2007; 120:688.
2. Lebwohl M, Clark L, Levitt J. Therapy for head lice based on life cycle, resistance, and safety considerations. Pediatrics. 2007;119:965–974.
3. Roberts RJ, Casey D, Morgan DA, Petrovic M. Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial. Lancet 2000;356:540-4.
4. Hill N, Moor G, Cameron MM, Butlin A, Preston S, Williamson MS, Bass C. Single blind, randomised, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom. BMJ 2005;311:384-6. (Full text Online first, BMJ, doi:10.1136/bmj.38537.468623.EO (published 5 August 2005)
5. NHS. The Prevention and Treatment of Head Lice. London: Department of Health, 2005.
Conflict of Interest:
Community Hygiene Concern is a charity, part-funded by sales of Bug Busting educational materials on a non-profit making basis.