From the NPA’s Progress newsletter,
On January 12, 1995, the National Pediculosis Association issued yet
another alert to the public to avoid lindane-containing treatments for
individuals with lice or scabies. (Such infestations are endemic among the
American population, with estimates of as many as 1.2 million individuals
treated annually for lice alone.) Lindane, described by its original U.S.
manufacturer as a powerful contact and internal poison, is a known
neurotoxin widely prescribed for direct application to young children,
pregnant women, nursing mothers, and the elderly: Lindane is 99% pure
gammahexachlorocyclohexane - manufactured with the raw materials of
benzene and chlorine. In addition to its neurotoxic properties, lindane
has been associated with aplastic anemia, leukemia, and other blood
A national reporting registry for lice and scabies related issues was
established by the NPA in May 1994, and has received reports of over 330
adverse reactions to various pesticidal lice and scabies product
treatments. Although the reactions have been reported by patients (or
their families) rather than physicians, their numbers and particulars are
sufficiently compelling to prompt additional serious concern about the
exposure to lindane.
Consistent among the most common adverse effects associated with exposure
to lindane and reported to the NPA's registry are illnesses including:
seizures, behavioral changes, neuromuscular complaints, attention deficit
disorders, chronic skin eruptions, and death. It was only when Ladies Home
Journal published an article on the subject in June of 1994 that people
first considered the possibility that their use of the chemical lindane
made them ill. In spite of the endemic state of lice and scabies, and
therefore the likelihood of subsequent exposure to potentially harmful
chemical treatments, physicians rarely inquire about such exposures when
taking routine medical histories.
NPA’s alert also goes out to residential .facilities where fear of a lice
or scabies outbreak often prompts indiscriminate applications of lindane
with little appreciation of the risks involved. This is especially
worrisome when one considers the hazards for individuals who receive (or
apply) multiple treatments. In 1994 a formal state investigation was
launched on behalf of individuals who died following lindane treatments in
a Kalamazoo, Michigan nursing home where it was mandated that everyone
receive lindane treatments in order to prevent an outbreak of scabies.
According to Solomon et al, (Archives of Dermatology 1990), given the
extremely narrow range of safety of this drug and the risk imposed by the
"kindling" effect, which potentiates convulsion seizures, and that this
potentiation may be carried on for a considerable period of time, there is
no good reason to use lindane in children or adults when other perfectly
effective, safer pediculicides are available.
While there are safer alternatives for treating lice and scabies
available, they too are pesticides and must be used with extreme caution.
(NPA and Centers for Disease Control urge everyone to avoid the use of
"environmental" lice sprays marketed for childrens' bedding and often
packaged in tandem with lice shampoos and lotions. These sprays are
unwarranted, and may pose personal and environmental hazards. Reports to
the NPA registry strongly indicate that such sprays maybe even more
haemful than earlier appreciated).
The FDA has received 137 possible adverse reactions to lindane reported
between 1976 (the date of its own lindane alert issued to the medical
community) and 1992. The difference between FDA's numbers and the over 330
reports to NPA in a much shorter period raises questions concerning
current reporting criteria and methods. The FDA's claim that insufficient
evidence exists to ban human exposure to lindane has been maintained in
the absence of controlled epidemiological studies on human exposure and
without an exposure registry or any research directed toward the
population most at risk; individuals who have lindane applied directly to
their bodies. The FDA, despite years of controversy over lindane's
potential toxic effects (especially to children), continues to call the
substance "safe and effective when used as directed."
None of the cases reported to the FDA were attributed to "proper use" of
lindane. One may be tempted to ascribe the NPA's much higher number of
reports to cases of improper usage, but, in fact, many of these reports to
the NPA involve cases in which lindane was used in accordance with
physicians' directives. In any event, the reports to the NPA indicate that
"improper use" is "normal use," for a large number of lindane users will
utilize the product contrary to its instructions.
On November 22, 1994, the National Pediculosis Association sent its first
volume of 330 adverse reaction reports to Dr. Sandy Kweder, Acting
Director of the Division of Epidemiology and Surveillance of the FDA. “I
encourage the NPA to seek serious scientific scrutiny to clarify the
relationship between potentially toxic pediculicides and scabicides and
the incidence of toxic reactions, whether immediate or delayed,” says John
C. Snyder, M.D., Professor of Population and Public Health, Emeritus,
Harvard School of Public Health.
According to Samuel Epstein, M.D., Director of the Chlcago-based Cancer
Prevention Coalition, from 1973 to 1991 the incidence rates of brain and
other nervous system cancers in children ages 0-14 have increased by
38.4%. His organization is joining a growing list of others calling upon
the Food and Drug Administration (FDA) for an outright ban of lindane
based on what his group believes is sufficient evidence of lindane's
It has been almost 15 years since Consumer's Union filed its original
petition to ban lindane. Too many have suffered as a result of FDA's lack
of resolve to protect the public from this dangerous chemical. Based on
important new evidence collected via the NPA's national reporting
registry, NPA is issuing this national alert to avoid all
Commonly used brand names for lindane include among others: Kwell, Lindane
1%, Bio-Well, GBH, G-Well, Kwildane, Scabene, and Kwellada.