Paediatrics: how to manage pediculosis capitis

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Abstract

Background: Pediculosis capitis is a common human parasitic infestation in childhood. This article aims to provide a narrative updated review on the management of pediculosis capitis.

Methods: A PubMed search was performed with Clinical Queries using the key terms “pediculosis capitis” OR “head lice” OR “head louse”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews published within the past 10 years. The search was restricted to articles published in English literature. The information retrieved from the search was used in the compilation of the present article.

Results: Topical permethrin and pyrethrin formulated with piperonyl butoxide are the pediculicides of choice in areas where resistance to these products is low. When resistance to these products is suspected based on local levels of resistance or when treatment with these products fails despite their correct use, and reinfestation does not seem to be responsible, other topical treatment options include malathion, benzyl alcohol, dimethicone, spinosad and ivermectin. Wet combing should be considered for children younger than 2 years. Oral ivermectin and trimethoprim/sulfamethoxazole should be reserved for patients who do not respond to appropriate topical pediculicides.

Conclusion: Many topical pediculicides are effective for the treatment of pediculosis capitis. The use of some of these pediculicides is limited for safety reasons, especially in children younger than 2 years. Resistance to pediculicides, especially those with a neurotoxic mode of action, is another concern which may limit the use of some of these pediculicides. New products should be evaluated for effectiveness and safety. Wet combing is time-consuming and should not be used as the sole intervention in the general population.

Keywords: dimethicone, head lice, pediculicides, pediculosis capitis, permethrin, pyrethrin, wet combing.

Citation: Leung AKC, Lam JM, Leong KF, Barankin B, Hon KL. Paediatrics: how to manage pediculosis capitis. Drugs Context. 2021;11: 2021-11-3. https://doi.org/10.7573/dic.2021-11-3

Contributions: AKCL is the principal author. JML, KFL, BB and KLH are coauthors who contributed and helped with the drafting of this manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: AKCL and KLH are Associate Editors of Drugs in Context and confirm that this article has no other conflicts of interest otherwise. This manuscript was sent out for independent peer review. All other authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/02/dic.2021-11-3-COI.pdf

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2022 Leung AKC, Lam JM, Leong KF, Barankin B, Hon KL. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2022 Leung AKC, Lam JM, Leong KF, Barankin B, Hon KL. https://doi.org/10.7573/dic.2021-11-3. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/paediatrics-how-to-manage-pediculosis-capitis

Correspondence: Alexander KC Leung, The University of Calgary, The Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada T2M 0H5. Email: aleung@ucalgary.ca

Provenance: Invited; externally peer reviewed.

Submitted: 5 November 2021; Accepted: 2 February 2022; Publication date: 14 March 2022.

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