Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 965-974 (doi:10.1542/peds.2006-3087)
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Pediculosis Capitis (Head Lice)
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REVIEW ARTICLE

Therapy for Head Lice Based on Life Cycle, Resistance, and Safety Considerations

Mark Lebwohl, MD, Lily Clark, MD and Jacob Levitt, MD

Department of Dermatology, Mount Sinai School of Medicine, New York, New York

The timing of head lice maturation most favorable to their survival in the presence of anti-lice agents is the maximum time as an ovum (12 days) and the shortest possible time of maturing from newly hatched nymph to egg-laying adult (8.5 days). Pediculicides that are not reliably ovicidal (pyrethroids and lindane) require 2 to 3 treatment cycles to eradicate lice. Ovicidal therapies (malathion) require 1 to 2 treatments. Treatment with an agent to which there is genetic resistance is unproductive. In the United States, lice have become increasingly resistant to pyrethroids and lindane but not to malathion. Treatment with malathion has favorable efficacy and safety profiles and enables the immediate, safe return to school. Nit combing can be performed adjunctively. No-nit policies should be rendered obsolete.

Key Words: head lice • malathion • resistance • life cycle

Abbreviations: MRSA—methicillin-resistant Staphylococcus aureus • GABA—{gamma}-amino butyric acid • FDA—US Food and Drug Administration • OTC—over-the-counter

Accepted Jan 9, 2007.


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