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Lice Resistant to Common Treatments

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"I think this is groundbreaking work," adds W. Steven Pray, PhD, RPh, who also reviewed the study for WebMD. "I have always seen resistance as a problem." Pray is professor of nonprescription products and devices at the School of Pharmacy at Southwestern Oklahoma State University in Weatherford.

Drugstores are often the first place parents or other adults run to after getting a note of a lice spread at school or finding a louse on a child. Therefore, pharmacists have a big role to play in educating parents, schools, and other health care providers about the proper way to fight lice, Pray adds. The message that he tries to get across to consumers and pharmacy students is that the weapons in the battle against lice are fingernails and a comb -- no chemicals, oils, salves, shampoos, or shower caps.

"We don't recommend Nix and Rid anymore, because of the resistance issue. I get people who look at me over the counter and tell me, 'I have used these six, seven, 10 times. I promise you I am using them right. And still I see lice.' They are using them everyday!" says Pray.

"And I tell them right off the bat, 'Let's get away from pesticides completely, and just go into combing,'" he says. "It is more effective to comb. All you need is a good comb and it doesn't involve any danger. Otherwise you are putting pesticides on the child's head, repeatedly. Even once is too much for me. And all we are doing is setting up more resistance."

Physicians may be asked to treat patients who have had no success with over-the-counter products, but few prescription products are available today, and all are controversial. Many physicians, when faced with this problem, simply give their patients literature from the lice treatment manufacturers. If they do write a prescription, it may be for Lindane, which used to be available without a prescription under the name Kwell. But Lindane has been linked to serious nerve damage and deaths and is not recommended by most experts.

The development of new, safe, and effective lice treatments has been hampered by a lack of funding for research facilities where lice can be raised and thoroughly studied, says Clark.

"We have never really given enough thought to a resistance management strategy," says Clark. "What we do is market one thing at a time and use it until it becomes useless. What I find very unacceptable is that everyone knows [resistance] is out there and nobody is doing anything about it."

"We still have the old tried-and-true method, which was tried in me in 1940, and that is to cut all the hair off," says Butler. "And hand-combing. That has been used forever. Even the Pharaohs were buried with combs, and they found nits on the combs."

The study was funded by the National Pediculosis Foundation.

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