Prescription Lice Medication May Do More Harm Than Good

From the WebMD Archives

Sept. 14, 2000 -- Those pesky head lice. You can spray them neon colors, bathe them in shampoo, or drown them in olive oil. And you can ask your doctor for a prescription for something, if you're feeling really desperate.

But if you're in California, chances are you won't be able to get lindane, a head and body lice medication also known by its former trade name, Kwell. Last week, the state, which often leads the nation in many environmental and health issues, banned lindane because it was fouling California's water supply. The action was also taken because of numerous reports linking lindane to seizures, death, and an increased chance of developing cancer.

The action is being celebrated by some health advocates, and many expect other states to follow California. Supporters of the ban are also pushing for the Environmental Protection Agency to impose a national ban on lindane. Consumers Union, which publishes Consumer Reports, began urging the FDA to remove the drug from the market back in 1983.

"Consumers Union tells consumers that if their doctor prescribes lindane -- and many still do -- to throw the prescription slip away," says Elisa Odabashian, senior program and financial manager for the Union's West Coast office. "Lindane is not as good at killing lice as the over-the-counter products. Furthermore, lindane is bad for the environment. It washes down the drain to waste water treatment plants and passes through to downstream creeks, rivers, lakes, and oceans since it is not removed well by the treatment plants. A single treatment of lindane has the potential to pollute six million gallons of water."

The ban "sends a message that there is a price to pay not just for the person who is using lindane; there is a large price that society pays," says Bob Truding, MD, a pediatric gastroenterologist at Beaumont Hospital in Royal Oak, Mich. Truding is also a scientific advisor to the National Pediculosis Association (NPA), the primary source of information and education about head lice for the past 10 years. Pediculosis is another name for an infestation of head lice.

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Each year, head lice afflicts millions of children and adults, with many cases being detected about this time of year as school begins and children are suddenly in tighter quarters. The lice reproduce quickly, with a newborn reaching maturity within 10 days. Eggs also hatch in about 10 days.

Researchers today do not believe lice carry disease. But many children are hurt or exposed to potential injuries through the use of unsafe products designed to kill the lice. Just a few weeks ago, a Colorado child who had lice was critically burned when gasoline that was applied to her hair -- but was washed off -- later caught fire. Because of overuse, many lice products available without a prescription don't work as well as they used to because the lice have developed a resistance to them.

The Federal Trade Commission (FTC) is concerned about the number of head lice products advertised on the Internet, many of which make promises that are not backed up by science. In April, nearly 30 sites were sent a warning letter about this, and the FTC is now deciding whether to take action against some of them.

Another prescription product, called Ovide, contains a chemical called malathion. This is the same substance that is used to kill mosquitoes during aerial spraying and may cause reactions in some people. Ovide is also not without controversy, as some believe it may be flammable because alcohol is one of its major ingredients.

So what's a parent to do? "I think combing is extremely important," says Laura Koss, a FTC staff attorney.

Paula Hensel, RN, a pediatric nurse practitioner and former public health department nurse, tells WebMD she counsels families to refrain from panicking when head lice are discovered and says over-the-counter shampoos are "worth a try."

But Hensel, who practices at Marshfield Clinic in Wisconsin, quickly adds that these preparations won't kill all the lice, and most of the eggs will escape injury, too. "I think what is required is a lot of patience, just sitting down and combing," says Hensel, noting that a comb developed by the NPA is the best she has seen. "This one is much better than the others and gets the job done quicker," she says.

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"We would like to think that you don't have to use any medications, that by combing you should be able to comb them all out," says Truding.

Experts advise cleaning the living area and bed linens but stress that more energy should go into checking all family members for signs of lice. None recommended using sprays that are sold with lice insecticides.

All of the myriad products available make lice removal "very complicated," admits Deborah Altschuler, NPA president. "But it really isn't complicated. All parents want their children to be lice and [egg]-free. But no matter what you do, you have to remove the lice and [eggs]."

She adds that regular screening of children and other precautions, such as not sharing hats, are also essential to keep outbreaks from occurring.

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