55,56 As natural products, they are not required to meet FDA ef fi cacy and safety standards for pharmaceuticals. HairClean 1-2-3 (Quantum Health, Eugene, OR [anise, ylang-ylang, coconut oils, and isopropyl alcohol]) was found to be at least as effective as the permethrin product Nix by 1 investigator. 2 Although many plants naturally produce insecticides for their own protection that may be synthesized for use by humans, such as pyrethroids, some of these insecticidal chemicals produce toxic effects as well. The safety and ef fi cacy of herbal products are currently not regulated by the FDA, and until more data are available, their use in infants and children should be avoided. Occlusive Agents Occlusive agents, such as “ petrolatum shampoo, ” mayonnaise, butter or margarine, herbal oils, and olive oil, applied to suffocate the lice are widely used but have not been evaluated for effectiveness in randomized controlled trials. To date, only anecdotal information is available concerning effectiveness. An uncontrolled, nonrandomized 2004 study reported a 96% “ cure ” rate with Cetaphil cleanser (Galderma Laboratories, Fort Worth, TX) applied to the hair, dried on with a handheld hair dryer, left on overnight, and washed out the next morning and repeated once per week for 3 weeks. Instructions for its use are available on the Internet. 57 It has not been approved by the FDA for use as a pediculicide. Dimethicone lotion (4% long-chain linear silicone in a volatile silicone base) in two 8-hour treatments 1 week apart eradicated head lice in 69% of participants in the United Kingdom. 58 In the United States, the OTC product LiceMD (Reckitt-Benckiser, Slough, England) contains dimethicone, an emollient. Isopropyl myristate 50% (Resultz; Nycomed Canada, Inc, Oakville, Ontario, Canada), a hair rinse that dissolves the waxy exoskeleton of the louse, which leads to dehydration and death of the louse, has recently become available in Canada. 59,60 Close surveillance of patients treated with non – FDA-approved products may improve discovery of treatment failure early, so other evidence-based and FDA treatments might be implemented. Desiccation The AirAllé (Larada Sciences, Salt Lake City, UT) device is a custom-built PEDIATRICS Volume 135, number 5, May 2015 e1359 by guest on May 3, 2015 pediatrics.aappublications.org Downloaded from
machine that uses one 30-minute application of hot air in an attempt to desiccate the lice. One study showed that subjects had nearly 100% mortality of eggs and 80% mortality of hatched lice. 61 The machine is expensive, and the operator requires special training in its use. A regular blow dryer should not be used in an attempt to accomplish this result, because investigators have shown that wind and blow dryers can cause live lice to become airborne and, thus, potentially spread to others in the vicinity.
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