Mounting resistance to traditional
head lice therapies, such as over-the-counter topical
permethrin and synthetic pyrethroids, has prompted research into alternative
therapies, according to a speaker at the 68th Annual Meeting of the American
Academy of Dermatology in Miami Beach, Fla.
Albert C. Yan, MD, chief of dermatology at the Children’s
Hospital of Philadelphia and associate professor in the departments of
pediatrics and dermatology at the University of Pennsylvania, discussed this
and therapies for other parasitic infections, including scabies and bedbugs.
Alternative lice therapies currently under investigation include
trimethoprim-sulfamethoxazole combined with topical medications, products that
can suffocate lice and novel agents or devices that work to physically destroy
lice.
Yan cited several studies that looked at these alternatives but noted
that “specific alternative therapy used will depend in large part on the
dermatologist’s assessment of the safety and efficacy of available
therapies and the degree of infestation.”
Avoiding shared combs, brushes or other personal care items is the best
way to prevent transmitting lice and other parasitic infections, Yan
emphasized.
Scabies are another problematic parasite, with more than 300 million
cases appearing worldwide every year. Technological advances, especially those
in epiluminescence microscopy, are helping physicians identify scabies by
looking for specific patterns that indicate the pigmented areas of mites, Yan
said.
Although topical 5% permethrin cream remains the gold standard for
treating scabies in patients older than 3 months, physicians may consider
treating younger children and pregnant women with sulfur compounds in
petrolatum. Oral ivermectin may also be effective for those with widespread or
resistant infection.
Bedbugs (Cimex lectularius) have also become a growing nuisance
in recent years, increasing in prevalence by as much as 500%, according to Yan,
who cited increased international travel and the discontinued use of DDT as
reasons for the increase. He recommended topical corticosteroids and warm
compresses to relieve bedbug-related itchiness.