Topical Ivermectin Lotion for the Treatment of Head Lice

Summary and Comment |
October 31, 2012

Topical Ivermectin Lotion for the Treatment of Head Lice

  1. Mary Wu Chang, MD

One 10-minute application was very effective and could help avoid systemic medication.

  1. Mary Wu Chang, MD

Although head lice do not transmit disease, infestation causes pruritus, eczematization, social stigmatization, and school absence. Use of the first- line agents permethrin and pyrethrins is limited by emerging resistance. Lindane is disfavored because of neurologic toxicity, and malathion is flammable. Two recently approved agents, spinosad and benzyl alcohol lotion, are relatively expensive. Oral ivermectin has known efficacy when other treatments have failed. These researchers report the findings of two manufacturer-supported studies of topical ivermectin.

In multicenter, randomized, double-blinded, vehicle-controlled trials of a single dose of ivermectin 0.5% lotion without nit combing, a total of 132 index patients aged 6 months and older with three or more live lice (and more than 600 family members who had 1 or more live lice) received ivermectin lotion or vehicle alone. The primary end point was the number of patients who were louse-free by day 2 and remained louse-free through days 8 and 15. Ivermectin or vehicle was applied to dry hair and rinsed out after 10 minutes. In the intention-to-treat population, significantly more ivermectin recipients than vehicle recipients were louse-free on day 2 (95% vs. 31%), day 8 (85% vs. 21%), and day 15 (74% vs. 18%; P<0.001 for each comparison). Adverse events, including pruritus, excoriation, and erythema, occurred equally often with ivermectin and control (in approximately 1% of both groups).


Results of this large, rigorous study indicate that single-dose topical ivermectin 0.5% lotion without nit combing is well-tolerated and very effective. The day 15 louse-free rate of 74% resembles rates with other two-application topical agents and may reflect imperfect application, viable eggs, or reinfestation. A second application may improve prolonged clearance rates. Head-to-head studies, resistance data, postmarketing data, and cost-benefit analysis are needed to determine which topical agents should be first-line therapy, which should be reserved for certain populations, and when oral pediculicides are appropriate. Lastly, changes in no-nit policies are needed to prevent unnecessary school absenteeism.


Reader Comments (3)

A. T. Ryan retired

I know first hand that oral ivermectin is well-tolerated and very effective. Several years ago, my daughter got head lice from school. I kept her home for 3 days while I shampooed and nit picked her hair, washed her bedding, and vacuumed everything in my house. When she returned to school she was lice free. However, twoweeks later, I found that my hair was infested. I had no one to pick the nits from my hair. Although the shampoos killed the lice, it did nothing to the eggs. I tried everything, all the over-the-counter remedies, saw several different doctors who prescribed nix and malathion, I even tried remedies I found online (i.e., applying olive oil, or mayonnaise, or tar oil to my hair and sleeping with a plastic cap on my head). I spent hundreds of dollars on so-called cures for head lice. Nothing worked. I suffered for months. I eventually shaved my head and started wearing wigs. And, found that I still had lice. I read an online article that oral ivermetin was effective in eliminating resistant lice. I went to my doctor and begged him to give me a prescription for ivermetin. He was reluctant, but finally gave in. He prescribed 2 doses, one pill taken immediately, and one pill taken 14 days later. It worked. Finally, I was lice free. I had had lice for so long, that I stopped hugging my kids. I wouldn't let anyone get close to me. I thought I would never have hair again. All the turmoil I went through could have been avoided had I been prescribed ivermectin when I first contracted head lice. Nevertheless, I have been lice free ever since.

Sandeep Saluja

How would oral preparation compare with topical one?

Competing interests: None declared

John T Boyd

Why was nix or some other agent not used ? Is the new tx any better than current , no comparison made. Also what is the cost difference ?

Competing interests: None declared

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