From the Progress Newsletter, Spring 1996
The National Pediculosis Association
has issued an alert to warn American families. The NPA reports that a worst-case
scenario is emerging, as head lice appear to be resistant to commercially
available chemical treatments. With resistance to the prescription chemical
lindane already documented, it is likely that the over-the-counter pediculicides
have followed suit. Lice resistance to permethrin was anticipated in 1990 by
doctors John D. Edman, Medical Entomologist and John M. Clark, Insecticide
Toxicologist, both at the University of Massachusetts at Amherst.
For the past year, the NPA has
been averaging 50 calls a day from parents and health professionals reporting
product treatment failure. Frustrated parents have responded to persistent
infestations by using treatment products repeatedly, or by resorting to
dangerous alternatives such as treatments containing lindane, lice sprays, dog
flea and tick shampoo, and kerosene.
Many diseases affect our child
population today, but few are as communicable and as widespread as pediculosis
capitis, and few involve the repeated direct exposure of young children to
pesticides. Parents and health professionals nationwide have reported treatment
failures as consumers use "everything on the drug store shelf," only to continue
finding adult-sized crawling lice. Everyone has a different opinion; even
experts disagree. Dr. Sanford Matthews told Atlanta's television viewers that
this years head lice have become drug resistant: "lice have developed an
appetite for the various remedies and are having them for lunch." In a Boston
television interview, Dr. Charles Brown, a pediatrician at the Newton Wellesley
Hospital, unfortunately responded to treatment failure questions by recommending
that parents "Treat the entire family."
There are many elements that can
play a role in treatment failure. While there is more than sufficient reason to
seriously consider insect resistance, we must also acknowledge other possible
contributing factors such as noncompliance with nit removal, failure to follow
product treatment instructions, and false hope generated by product marketing. A
1986 NPA commentary may have said it best: "Assured by the manufacturers that
pediculicides constitute fully effective treatment. Physicians have deemed
pediculosis of low importance both as a topic of research and in clinical
practice. At the same time, parents are desperate to believe in any promised
cure-all. As a result, we have all been fair game for misleading pharmaceutical
information. We have proceeded on the basis of too little consideration for
safety and too much faith in efficacy claims." (Arch Dermatol - Vol 122)
Until the treatment failure crisis
is addressed by the scientific and medical community as well as the product
manufacturers, the NPA is focusing its efforts on getting parents
"BACK-TO-BASICS." The crisis in effectiveness comes at a time when possible
louse borne disease is reported (New England Journal of Medicine, February 16,
1995) in the U.S. among the homeless.
Jill Reynolds, a registered nurse
working in the public schools in Kalamazoo, Michigan and authority on head lice
management views this crisis as a call to action for parents. "The stigma of
head lice infestation divides friends and damages families. 'Back-to-basics'
means revisiting a philosophy of friends and neighbors helping each other,
parents supporting the school with volunteerism and backing it up with similar
efforts at home. Outbreaks of lice can bring schools to their knees. A crisis
intervention approach to head lice outbreaks is an impediment to education.
Instead, head lice prevention and education should be part of every school
A Massachusetts mother recently
drove over three hours to the NPA offices to insist that we contact the
manufacturers of products being advertised in magazines and on television. She
was deeply distraught yet angry at the same time. "The ads give moms false hopes
that by buying a lice shampoo you can kill all the lice and their eggs. My
doctor recommended to use these products over and over again, even though I told
him that they were not working. I treated myself and my family at least eight
times. I have bad eyesight. No one will help me check my own head. I called my
insurance company, HMO Blue in Massachusetts, to see if I could get a visiting
nurse to help me. And while they paid for one visit, it just wasn't enough. When
I requested additional help I was told that lice do not represent a medical
problem worthy of reimbursement for a visiting nurse. I don't know about lice
being a medical problem but I do know that I cannot continue applying these
chemicals to myself and family, especially on my little 4-year old daughter."
She has called the manufacturer and asked for a refund.
While treatment failures have been
reported for all of the commercially available pediculicides, the majority of
reports have involved the two largest selling products, NIX and RID. On October
5, 1995, the NPA contacted the manufacturers Warner-Wellcome (marketers of NIX)
and Pfizer (makers of RID) to report the NPA's growing perception of a national
crisis regarding product treatment failure. Warner-Wellcome expressed concern
and offered to help the NPA collect and compile treatment failure reports.
Pfizer declined to participate with the NPA but offered assistance to consumers
via its own toll-free number.
The NPA does not claim to have all
the answers to the serious question of possible lice resistance. However, in the
meantime, we are offering the following suggestions for those who use a lice
treatment product and experience treatment failure:
- Discontinue use at the earliest
sign of treatment failure. Do not reuse the same product in the hope of
killing the lice. Remember that lice treatment products are pesticides.
Repeated use of such pesticides pose a variety of serious health risks as
adverse reaction reports to NPA's national registry have indicated.
- Never resort to dangerous
remedies such as lindane, kerosene, or pet shampoos.
- Never use a lice spray. Lice
sprays are pesticides marketed for use on children's bedding, cars, rugs,
garments, and furniture. Vacuuming is the safe and effective alternative to
spraying. Head lice are human parasites and will not survive without human
blood. Parents need not exhaust their physical and emotional selves by
obsessive housecleaning and "bagging." They should save their energies for
that which pays the most benefit: manual removal of both lice and eggs from
the infested individuals.
- Manual removal is crucial. Since head lice move quickly throughout the
head, it may be helpful to have two people checking an infested person at the
same time. Even under the best of conditions, a few lice or nits may be
missed. Use a nit removal comb to screen the infested person every day and
- Continue to check your children
often. Screen for lice and nits. Early detection is the best prevention. Make
checking for lice and nits part of routine hygiene.
David Satcher, Director of The
Centers for Disease Control and Prevention told the NPA, "CDC does not have
resources for surveillance or applied research programs regarding pediculosis or
scabies." Instead, CDC refers callers to local and state health departments.
These are the same state officials who are also desperate for answers to this
emerging public health crisis.
The low priority assigned to this
parasitic condition by the CDC has helped to create this climate in which there
continues to be no collective will to address it.
The $100 million dollar a year
pediculicide industry is a growing one. Brisk sales of lice treatments spell
good news for profit margins but bad news for- the public's health, especially
when too many products are repeat purchases and therefore represent repeat
chemical exposures for a family suffering with treatment failure.