5556 as natural products they are not required to

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
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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.