The efficacy of Australian essential oils for the treatment of head lice infestation in children: A randomised controlled trial.

BACKGROUND: The increase in resistance of head lice to neurotoxic pediculicides and public concern over their safety has led to an increase in alternative treatments, many of which are poorly researched or even untested. METHODS: A multicentre, randomised, assessor-blind, parallel-group trial (Trial 1) was conducted to compare the safety and efficacy of a head lice treatment containing Australian eucalyptus oil and Leptospermum petersonii (EO/LP solution; applied thrice with 7-day intervals between applications) with a neurotoxic treatment containing pyrethrins and piperonyl butoxide (P/PB mousse; applied twice with a 7-day interval) in children. A single-blind, open trial (Trial 2) was conducted to assess the efficacy of EO/LP solution following a single application. In addition, skin irritancy and sensitisation tests using EO/LP solution were performed in adults and children. In vitro tests were performed to further assess the ovicidal and pediculicidal efficacy of EO/LP solution. RESULTS: EO/LP solution was found to be more than twice as effective in curing head lice infestation as P/PB mousse in per-protocol participants (Trial 1; 83% vs 36%, P < 0.0001), and was also found to be 100% pediculicidal following a single application (Trial 2). Adverse events were limited to transient itching, burning or stinging. Further skin testing with the EO/LP solution reported no irritation or sensitisation in adults, or irritation in children. In vitro exposure of lice and eggs to the EO/LP solution resulted in 100% mortality. CONCLUSION: The efficacy, safety and relative ease of use of the EO/LP solution make it a viable alternative in treating head lice.

In vitro Investigation of the Pediculicidal Activities of the Volatile Oil Components of Some Medical Plants Raised in Turkey.

OBJECTIVE: The human head louse Pediculus capitis has recently acquired resistance to commercially available insecticides, which has expanded the search concerning the pediculicidal activities of some herbal products. The present study aimed to assess the in vitro pediculicidal activities of volatile oils extracted from 10 medical plants raised in Turkey: Rosa damascena (red provins rose), Pelargonium graveolens (geranium), Lavandula angustifolia (lavender), Salvia triloba (salvia), Rosmarinus officinalis (rosemary; two different chemotypes), Citrus bergamia (citrus tree), Cymbopogon nardus (citronella), Citrus limonum (lemon), and Cymbopogon flexuosus (lemongrass). METHODS: Head lice obtained from school children in Manisa Province were initially grouped as adults and nymphs and were then kept under optimal conditions (temperature of 27°C and humidity of 50%). A pinch of hair and filter paper were placed in Petri dishes and seven adults and seven nymphs were separately put in Petri dishes. The extracts obtained from each volatile oil were dropped on the lice specimens. RESULTS: The active movement of the external (antenna and legs) and internal (midgut and intestine) organs of the lice was monitored and recorded starting from 5th min for 24 hours by 10 to 30 minutes intervals. The time of death was defined as the loss of active movement and cessation of intestinal activities of lice. The results were analyzed using Statistical Packages for the Social Sciences (SPSS) version 15. CONCLUSION: The results showed that the volatile oil of Rosmarinus officinalis (two different chemotypes) was more effective than the other oils.

The potential application of plant essential oils to control Pediculus humanus capitis (Anoplura: Pediculidae).

The human head louse, Pediculus humanus capitis (Anoplura: Pediculidae), is an ectoparasite confined to the scalp and human hairs. The repeated use of insecticides for the control of head lice during past decades has resulted in the development of marked levels of resistance. Natural compounds such as essential oils (EOs) have been suggested as alternative sources for insect control agents. In order to introduce a new pediculicide based on EOs, the effectiveness of the product and their effects on human being must be analyzed. In consequence, the biological activity of EOs from the leaves and fruits of Schinus areira (Anacardiaceae) and the leaves of Thymus vulgaris (Lamiaceae), Aloysia polystachya and Aloysia citriodora (Verbenacea) were evaluated against the eggs and adults of P. humanus capitis by fumigant and contact toxicity bioassays. Additionally, dermal corrosion/irritation tests were performed on New Zealand albino rabbits. In a fumigant bioassay, EOs from the leaves and fruits of S. areira were the most toxic against P. humanus capitis adults while these EOs and T. vulgaris were the most effective against the eggs. In contact bioassay, the EO from T. vulgaris was the most toxic against both stages. In the corrosion/irritation tests, the EOs did not produce dermal effects. According to the results, the essential oils from the leaves of T. vulgaris would be a valid tool for the management of P. humanus capitis. This EO produces a high knockdown effect in adults (followed by mortality) and toxicity in the eggs when it is applied for 21 min at a low concentration.

A ghost covered in lice: a case of severe blood loss with long-standing heavy pediculosis capitis infestation.

An 11-year-old child presented with poor school attendance, and signs and symptoms of severe anaemia. He was heavily covered in lice. He was investigated for other causes of anaemia. Following treatment for head lice and also iron supplementation, he was back in full-time education. This case highlights the link between head lice (pediculosis capitis) infestation and iron-deficiency anaemia.

An ex vivo, assessor blind, randomised, parallel group, comparative efficacy trial of the ovicidal activity of three pediculicides after a single application--melaleuca oil and lavender oil, eucalyptus oil and lemon tea tree oil, and a "suffocation" pediculicide.

BACKGROUND: There are two components to the clinical efficacy of pediculicides: (i) efficacy against the crawling-stages (lousicidal efficacy); and (ii) efficacy against the eggs (ovicidal efficacy). Lousicidal efficacy and ovicidal efficacy are confounded in clinical trials. Here we report on a trial that was specially designed to rank the clinical ovicidal efficacy of pediculicides. Eggs were collected, pre-treatment and post-treatment, from subjects with different types of hair, different coloured hair and hair of different length. METHOD: Subjects with at least 20 live eggs of Pediculus capitis (head lice) were randomised to one of three treatment-groups: a melaleuca oil (commonly called tea tree oil) and lavender oil pediculicide (TTO/LO); a eucalyptus oil and lemon tea tree oil pediculicide (EO/LTTO); or a "suffocation" pediculicide. Pre-treatment: 10 to 22 live eggs were taken from the head by cutting the single hair with the live egg attached, before the treatment (total of 1,062 eggs). TREATMENT: The subjects then received a single treatment of one of the three pediculicides, according to the manufacturers' instructions. Post-treatment: 10 to 41 treated live eggs were taken from the head by cutting the single hair with the egg attached (total of 1,183 eggs). Eggs were incubated for 14 days. The proportion of eggs that had hatched after 14 days in the pre-treatment group was compared with the proportion of eggs that hatched in the post-treatment group. The primary outcome measure was % ovicidal efficacy for each of the three pediculicides. RESULTS: 722 subjects were examined for the presence of eggs of head lice. 92 of these subjects were recruited and randomly assigned to: the "suffocation" pediculicide (n = 31); the melaleuca oil and lavender oil pediculicide (n = 31); and the eucalyptus oil and lemon tea tree oil pediculicide (n = 30 subjects). The group treated with eucalyptus oil and lemon tea tree oil had an ovicidal efficacy of 3.3% (SD 16%) whereas the group treated with melaleuca oil and lavender oil had an ovicidal efficacy of 44.4% (SD 23%) and the group treated with the "suffocation" pediculicide had an ovicidal efficacy of 68.3% (SD 38%). CONCLUSION: Ovicidal efficacy varied substantially among treatments, from 3.3% to 68.3%. The "suffocation" pediculicide and the melaleuca oil and lavender oil pediculicide (TTO/LO) were significantly more ovicidal than eucalyptus oil and lemon tea tree oil pediculicide (EO/LTTO) (P < 0.0001). Ranking: 1. "Suffocation" pediculicide (68.3% efficacy against eggs); 2. Melaleuca oil and lavender oil (44.4%) pediculicide; 3. Eucalyptus oil and lemon tea tree oil (3.3%) pediculicide. The "suffocation" pediculicide and TTO/LO are also highly efficacious against the crawling-stages. Thus, the "suffocation" pediculicide and TTO/LO should be recommended as first line treatments.

[In vitro efficacy of three novel delousing formulations against the head louse (Pediculus capitis L.)]. / Ucinnost trí nových odvsivovacích prípravku na ves detskou (Pediculus capitis L.) v in vitro testech--krátké sdelení.

A total of 498 head lice (2nd and 3rd instar larvae, females and males) combed out of the hair of 38 children, were exposed to the delousing formulations Diffusil H Forte Spray (carbaryl 1%), Diffusil Care (isopropyl myristate, cyclomethicone, and dimethiconol) and Paranit (coconut oil, anise oil, and ylang ylang oil) in in vitro tests. The first two formulations, i. e. Diffusil H Forte Spray and Diffusil Care, caused 100% mortality of exposed lice, while Paranit only killed 12.2% of exposed lice.

Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780.

Permethrin is the most widely used pediculicide, but evidence of resistance from several countries and anecdotal reports from Germany suggest that permethrin lotion is now less effective. We designed a randomized, controlled, parallel group trial involving 100 participants with active head louse infestation to investigate the activity of a coconut and anise spray and to see whether permethrin lotion is still effective, using two applications of product 9 days apart. The spray was significantly more successful (41/50, 82.0%) cures compared with permethrin (21/50, 42.0%; p < 0.0001, difference 40.0%, 95% confidence interval of 22.5% to 57.5%). Per-protocol success was 83.3% and 44.7%, respectively. Thirty-three people reported irritant reactions following alcohol contact with excoriated skin. We concluded that, although permethrin lotion is still effective for some people, the coconut and anise spray can be a significantly more effective alternative treatment.

Effectiveness of lotions based on essential oils from aromatic plants against permethrin resistant Pediculus humanus capitis.

In Argentina, field populations of the head louse Pediculus humanus capitis De Geer (Phthiraptera: Pediculidae) have developed resistance to permethrin and other pyrethroids. Thus, the aim of this work was the development of a lotion containing essential oils from plants and an alcoholic coadjuvant to improve biological effect. Ethanol + isopropanol (1 + 1 in volume) 50% in water and ethanol 96% were taken as bases for preparation of experimental lotions containing essential oils from plants. We found that experimental lotions containing lavender, peppermint and eucalyptus oils in a 5% composition and the combination of eucalyptus and peppermint in a total concentration of 10%, dissolved in 50% ethanol + isopropanol (1 + 1) in water, showed the best knockdown effect. On the other side, lotion containing peppermint oil and eucalyptus oil (1 + 1) 10%, dissolved in ethanol 96%, showed to be as effective as the best commercial lotion now available in Argentina. Furthermore, addition of 1-dodecanol in all cases increased the effectiveness of all the experimental lotions. This difference is significantly important for 1-dodecanol concentration of 10%, reaching a toxic activity compared to the best commercial lotion available in the market.

Lethality of essential oil constituents towards the human louse, Pediculus humanus, and its eggs.

Essential oils have been widely used in traditional medicine for the eradication of lice, including head lice, but due to the variability of their constitution the effects may not be reproducible. In an attempt to assess the contribution of their component monoterpenoids, a range of common individual compounds were tested in in vitro toxicity model against both human lice (Pediculus humanus, an accepted model of head lice lethality) and their eggs, at different concentrations. No detailed study into the relative potencies of their constituent terpenoids has so far been published. Adult lice were observed for lack of response to stimuli over 3 h and the LT(50) calculated, and the percentage of eggs failing to hatch was used to generate ovicidal activity data. A ranking was compiled for adult lice and partially for eggs, enabling structure-activity relationships to be assessed for lethality to both, and showed that, for activity in both life-cycle stages, different structural criteria were required. (+)-Terpinen-4-ol was the most effective compound against adult lice, followed by other mono-oxygenated monocyclic compounds, whereas nerolidol was particularly lethal to eggs, but ineffective against adult lice.

Ovicidal and adulticidal activities of Cinnamomum zeylanicum bark essential oil compounds and related compounds against Pediculus humanus capitis (Anoplura: Pediculicidae).

The toxicity of cinnamon, Cinnamomum zeylanicum, bark essential oil compounds against eggs and adult females of human head louse, Pediculus humanus capitis, was examined using direct contact and vapour phase toxicity bioassays and compared with the lethal activity of their related compounds, benzyl alcohol, cinnamic acid, cinnamyl acetate, 4-hydroxybenzaldehyde and salicylaldehyde, as well as two widely used pediculicides, d-phenothrin and pyrethrum. In a filter-paper contact toxicity bioassay with female lice at 0.25 mg/cm(2), benzaldehyde was 29- and 27-fold more toxic than pyrethrum and d-phenothrin, respectively, as judged by median lethal time (LT(50)) values. Salicylaldehyde was nine and eight times more active than pyrethrum and d-phenothrin, respectively. Pediculicidal activity of linalool was comparable with that of d-phenothrin and pyrethrum. Cinnamomum bark essential oil was slightly less effective than either d-phenothrin or pyrethrum. Benzyl alcohol and (E)-cinnamaldehyde exhibited moderate pediculicidal activity. After 24h of exposure, no hatching was observed with 0.063 mg/cm(2) salicylaldehyde, 0.125 mg/cm(2) benzaldehyde, 0.5mg/cm(2)Cinnamomum bark essential oil, 1.0 mg/cm(2) (E)-cinnamaldehyde, and 1.0 mg/cm(2) benzyl cinnamate. Little or no ovicidal activity was observed with d-phenothrin or pyrethrum. In vapour phase toxicity tests with female lice, benzaldehyde and salicylaldehyde were much more effective in closed containers than in open ones, indicating that the mode of delivery of these compounds was largely due to action in the vapour phase. Neither d-phenothrin nor pyrethrum exhibited fumigant toxicity. Cinnamomum bark essential oil and test compounds described merit further study as potential pediculicides or ovicides for the control of P. h. capitis.

[Persistent scalp infestation by Dermanyssus gallinae in an Emilian country-woman]. / Infestazione persistente del cuoio capelluto da Dermanyssus gallinae in una contadina emiliana.

A case of persistent infestation of the scalp due to Dermanyssus gallinae.--Infestation due to Dermanyssus gallinae, the common red mite of poultry, in a country-woman aged 69 years from Crevalcore (Emilia-Romagna region, Northern Italy), is described. The case was unusual either for its location, the scalp, and for its persistence, 9 months. Specimens of the mite were also found in the henhouse adjacent to the patient's house. Apparently the woman recovered by means of daily washing of camomile tea.