Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1452-1453 (doi:10.1542/peds.2005-0396)

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Pearlman, D. L. Search for Related Content PubMed PubMed Citation Articles by Pearlman, D. L. Related Collections Therapeutics & Toxicology Related AAP Red Book topics: Pediculosis Capitis (Head Lice) Social Bookmarking                         What's this?

Nuvo Lotion and the Future of Head-Lice Treatment

Dale L. Pearlman, MD
Family Dermatology Medical Office
Menlo Park, CA 94025

To the Editor.—

I thank Roberts and Burgess¹ for bringing readers' attention to my September 2004 Pediatrics article² about a new, simple, and effective treatment for head lice. Nuvo lotion, the first of the new class of "dry-on suffocation-based pediculicides," produced a 96% cure rate for even resistant head lice without use of neurotoxins, nit removal, or extensive household cleanup. This result is comparable to the best ever reported for any pediculicide and far exceeds typical 6% placebo response rates reported previously.³ Furthermore, we observed a 94% long-term cure rate. I invite more researchers to evaluate this new treatment and hope that it will bring to children, parents, and health care providers a new method to treat head lice.

Roberts and Burgess raise several concerns about my article, which I address below.

1. Does potential bias invalidate my "impressive bottom line?" I ethically stated my potential financial conflict of interest so that readers may consider it as 1 factor among many when evaluating the article. The inventor can still truthfully present the data, and readers can still decide whether the conclusions make sense.
   
2. Was a reliable scientific method used in this study? This peer-reviewed article reports a prospectively designed trial using the most advanced objective criteria for diagnosis of head-lice infestation and cure. Diagnosis was based on finding lice. According to the American Academy of Pediatrics: "Ideally, diagnosis should be based on the observation of a live louse."⁴ Roberts himself previously wrote that "authorities suggest that diagnosis should be based only on finding a living, moving louse."⁵ We detected lice by using a version of the wet-combing test that Roberts has described as much more reliable at finding lice than visual inspection of the scalp.⁵ It is curious that Roberts and Burgess fault the study for an "extremely serious flaw" because a "proper scalp examination" was not done, despite the fact that Roberts himself had previously warned about the inaccuracy of such examinations: "Visual inspection of the hair and scalp is widely practiced, but this approach may miss three quarters of infestations."⁵
   
3. Is suffocation really the method of action of Nuvo lotion? The 2 scanning electron microscopic images in the article showed an untreated louse and then, for comparison, 1 totally coated with the dried-on lotion. Fig 1 shows a close up of a breathing hole (spiracle) on a treated louse. One can see the plug of dried lotion totally obstructing the usually open spiracle hole. Lice with plugged-up airways suffocate.
   
4. Is nit removal really not needed to cure head lice? Patients in 1 protocol did nit removal, and the other protocol did not remove nits. We found that nit removal made no statistical difference in either cure rate or long-term remission rate. By applying the lotion 3 times at 1-week intervals, we killed any hatching lice before they could reach maturity and lay new eggs.
   

View larger version (134K): [in this window] [in a new window]   Fig 1. Head louse spiracle plugged by dried-on, suffocation-based pediculicide lotion. (Scanning electron microscope, magnified x136.)

 
It is a new world for treating head lice.

REFERENCES

1. Roberts RJ, Burgess IF. New head-lice treatments: hope or hype? Lancet. 2005;365 :8 –10[CrossRef][Web of Science][Medline]

2. Pearlman DL. A simple treatment for head lice: dry-on, suffocation-based pediculicide. Pediatrics 2004;114(3) . Available at: www.pediatrics.org/cgi/content/full/114/3/e275

3. Taplin D, Meinking TL, Castillero PM, Sanchez R. Permethrin 1% creme rinse for the treatment of Pediculus humanus var capitis infestation. Pediatr Dermatol. 1986;3 :344 –348[Medline]

4. Frankowski BL. American Academy of Pediatrics guidelines for the prevention and treatment of head lice infestation. Am J Manag Care. 2004;10 :S269 –S272[Medline]

5. Roberts RJ. Clinical practice. Head lice. N Engl J Med. 2002;346 :1645 –1650[Free Full Text]

---

PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				D. Pearlman Cetaphil Cleanser (Nuvo Lotion) Cures Head Lice Pediatrics, December 1, 2005; 116(6): 1612 - 1612. [Full Text] [PDF]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Pearlman, D. L. Search for Related Content PubMed PubMed Citation Articles by Pearlman, D. L. Related Collections Therapeutics & Toxicology Related AAP Red Book topics: Pediculosis Capitis (Head Lice) Social Bookmarking                         What's this?