Head lice infestation, or pediculosis, is a common problem, particularly among children aged 3 to 12. Although typically not dangerous, the problem can cause embarrassment and discomfort among sufferers. Intense itching and inflammation of the scalp area are the most common symptoms, and in some cases excessive scratching can even lead to infection. Pediculosis is highly contagious, and it is important to treat the infestation as soon as possible.
Symptoms of infestation include the presence of nymphs (newly hatched lice) or adult lice, which are about the size of a sesame seed, or nits, which are the eggs laid by the adult lice from which the nymphs hatch. Nits may be mistaken for dandruff, but they are stuck to the hair shaft and usually cannot be brushed out.1
Many options, both prescription and OTC, exist for treating head lice. Still others are available through a compounding pharmacist. One of the most common treatments in the United States involves the use of permethrin, a pesticide available in OTC preparations such as Nix and RID. Permethrin can be very effective in the treatment of pediculosis. It usually requires only a single application and manual removal of the nits.2
Another topical pesticide used in the United States is malathion, a prescription treatment for lice marketed under the name Ovide. This product is applied to the hair, is allowed to dry, and then is washed out with a nonmedicated shampoo after 8 to 12 hours. Adverse reactions to malathion and permethrin include scalp rash and temporary exacerbation of symptoms.2 Patients who are immunocompromised may be advised against using such treatments, and these treatments generally are not recommended for use on infants.
Other treatments, both medicated and nonmedicated, are available through a compounding pharmacy, which may offer the patient more options than the commercially available ones. Ivermectin has been shown to be effective in treating pediculosis, although no topical form is currently available commercially. Ivermectin can be prepared by an experienced compounding pharmacist in a lotion or cream-rinse base.3
Certain preparations also are available that may be appropriate when the use of pesticides is contraindicated or is for any reason undesirable. A compounding pharmacist can prepare a topical lotion consisting of 1% to 2% cetyl alcohol in a base, which will cause the existing lice to suffocate. The preparation is applied to the hair and allowed to dry. The hair is carefully combed to remove any remaining nits. This treatment may be repeated if necessary.
Another nonchemical preparation contains pennyroyal, eucalyptus, and rosemary oils in an olive oil base. This compound is combed through the hair with a regular comb. A metal lice comb is used to remove live lice and nits. The hair should then be covered, and the preparation is left on overnight. This treatment usually is effective with 1 application, but it may be repeated.4
Preventive measures may be available as well, for use following treatment of pediculosis. Shampoos and conditioners with tea tree oil may be prepared and can help prevent reinfestation. A lice-repellent spray can be prepared that contains ylang ylang, anise, and coconut oils.4 These oils have scents that are naturally repellent to the lice, and they often are combined in a bitter-tasting isopropyl alcohol base. Other preventive aromatic lice treatments include essential oils such as ginger oil, geranium oil, jojoba, thyme, lavender, or peppermint oil.5
It is important to consider all available methods when determining the course of treatment for head lice infestation. Compounding pharmacies offer a host of options unavailable on the commercial market, including many treatments that are nonchemical in nature. Compounding allows the prescriber to think outside the box, and the treatment can be tailored to the needs of the individual patient.
Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.
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