Skip to main content
Top
Published in: BMC Dermatology 1/2019

Open Access 01-12-2019 | Lice | Research article

High efficacy of a dimeticone-based pediculicide following a brief application: in vitro assays and randomized controlled investigator-blinded clinical trial

Authors: Jorg Heukelbach, Doerte Wolf, John Marshall Clark, Hans Dautel, Kristina Roeschmann

Published in: BMC Dermatology | Issue 1/2019

Login to get access

Abstract

Background

Increasing resistance of head lice against neurotoxic agents and safety concerns have led to the search for treatment alternatives. Dimeticones with a physical mode of action are safe, and bear a reduced risk for the development of resistance.

Methods

We performed in vitro bioassays to assess pediculicidal and ovicidal activities of a new dimeticone-based product, and a randomized controlled clinical trial to assess efficacy, following 10 min application. Of 153 individuals screened, 100 participants with active head louse infestations were randomly assigned to treatment with either a dimeticone-based test product, or a 0.5% permethrin-based reference product (50 participants per group). Participants received two topical applications of either the test (10 min) or reference products (45 min) at days 0 and 7 or 8. Outcome measures included the efficacies of treatment and their safety, as well as global and local tolerability at baseline, and days 1, 7, and 10.

Results

After 10 min exposure, all lice treated with the dimeticone test product were classified as non-viable in the in vitro assay. Ovicidal activity after treatment of eggs with the dimeticone test product was 96.8%. In the clinical trial, 96 patients completed all study visits. In the full analysis set (FAS) population, on day 1 after one application, 98% of patients were cured in the test group, as compared to 84% cured in the reference group. All participants in both groups were free of head lice on day 10, following two applications (100% cure rate). In total, 42 adverse events (AEs) in 23 patients of both treatment groups were recorded, with the majority of AEs classified as mild.

Conclusions

We have shown a high level of pediculicidal and ovicidal activity, and clinical efficacy and safety, of a brief application of a new dimeticone-based product. The short application time and reduced risk for the development of resistance are key drivers for improved patients’ compliance.

Trial registration

EU Clinical Trials Register EudraCT 2016–004635-20. Registered 14 November 2016.
Literature
1.
go back to reference Feldmeier H, Heukelbach J. Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues. Bull World Health Organ. 2009;87:152–9.PubMedCrossRef Feldmeier H, Heukelbach J. Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues. Bull World Health Organ. 2009;87:152–9.PubMedCrossRef
3.
go back to reference Bailey AM, Prociv P. Persistent head lice following multiple treatments: evidence for insecticide resistance in Pediculus humanus capitis. Australas J Dermatol. 2000;41:250–4.PubMedCrossRef Bailey AM, Prociv P. Persistent head lice following multiple treatments: evidence for insecticide resistance in Pediculus humanus capitis. Australas J Dermatol. 2000;41:250–4.PubMedCrossRef
4.
go back to reference Durand R, et al. Detection of pyrethroid resistance gene in head lice in schoolchildren from Bobigny, France. J Med Entomol. 2007;44:796–8.PubMed Durand R, et al. Detection of pyrethroid resistance gene in head lice in schoolchildren from Bobigny, France. J Med Entomol. 2007;44:796–8.PubMed
5.
go back to reference Hunter J, Barker S. Susceptibility of head lice (Pediculus humanus capitis) to pediculicides in Australia. Parasitol Res. 2003;90:476–8.PubMedCrossRef Hunter J, Barker S. Susceptibility of head lice (Pediculus humanus capitis) to pediculicides in Australia. Parasitol Res. 2003;90:476–8.PubMedCrossRef
6.
go back to reference Kasai S, et al. Prevalence of kdr-like mutations associated with pyrethroid resistance in human head louse populations in Japan. J Med Entomol. 2009;46:77–82.PubMedCrossRef Kasai S, et al. Prevalence of kdr-like mutations associated with pyrethroid resistance in human head louse populations in Japan. J Med Entomol. 2009;46:77–82.PubMedCrossRef
7.
go back to reference Kristensen M, Knorr M, Rasmussen A-M, Jespersen JB. Survey of permethrin and malathion resistance in human head lice populations from Denmark. J Med Entomol. 2006;43:533–8.PubMedCrossRef Kristensen M, Knorr M, Rasmussen A-M, Jespersen JB. Survey of permethrin and malathion resistance in human head lice populations from Denmark. J Med Entomol. 2006;43:533–8.PubMedCrossRef
8.
go back to reference Vassena C, et al. Prevalence and levels of permethrin resistance in Pediculus humanus capitis De Geer (Anoplura: Pediculidae) from Buenos Aires, Argentina. J Med Entomol. 2003;40:447–50.PubMedCrossRef Vassena C, et al. Prevalence and levels of permethrin resistance in Pediculus humanus capitis De Geer (Anoplura: Pediculidae) from Buenos Aires, Argentina. J Med Entomol. 2003;40:447–50.PubMedCrossRef
9.
go back to reference Lee SH, et al. Molecular analysis of kdr-like resistance in permethrin-resistant strains of head lice, Pediculus capitis. Pesticide Biochem Physiol. 2000;66:130–43.CrossRef Lee SH, et al. Molecular analysis of kdr-like resistance in permethrin-resistant strains of head lice, Pediculus capitis. Pesticide Biochem Physiol. 2000;66:130–43.CrossRef
10.
go back to reference SupYoon K, Symington SB, Lee SH, Soderlund DM, Clark JM. Three mutations identified in the voltage-sensitive sodium channel α-subunit gene of permethrin-resistant human head lice reduce the permethrin sensitivity of house fly Vssc1 sodium channels expressed in Xenopus oocytes. Insect Biochem Mol Biol. 2008;38:296–306.PubMedCrossRef SupYoon K, Symington SB, Lee SH, Soderlund DM, Clark JM. Three mutations identified in the voltage-sensitive sodium channel α-subunit gene of permethrin-resistant human head lice reduce the permethrin sensitivity of house fly Vssc1 sodium channels expressed in Xenopus oocytes. Insect Biochem Mol Biol. 2008;38:296–306.PubMedCrossRef
11.
go back to reference Bialek R, Zelck UE, Fölster-Holst R. Permethrin treatment of head lice with knockdown resistance–like gene. N Engl J Med. 2011;364:386–7.PubMedCrossRef Bialek R, Zelck UE, Fölster-Holst R. Permethrin treatment of head lice with knockdown resistance–like gene. N Engl J Med. 2011;364:386–7.PubMedCrossRef
12.
go back to reference Burow H, Bialek R, Dornseiff M, Schwartz T. Kopflausbefall in Deutschland: Korrelation zwischen Häufigkeit des “Resistenz-gens” und klinischer Wirksamkeit von 0, 5% permethrin-Lösung. Kinder- und Jugendarzt. 2010;41:224–8. Burow H, Bialek R, Dornseiff M, Schwartz T. Kopflausbefall in Deutschland: Korrelation zwischen Häufigkeit des “Resistenz-gens” und klinischer Wirksamkeit von 0, 5% permethrin-Lösung. Kinder- und Jugendarzt. 2010;41:224–8.
13.
go back to reference Gellatly KJ, et al. Expansion of the knockdown resistance frequency map for human head lice (Phthiraptera: Pediculidae) in the United States using quantitative sequencing. J Med Entomol. 2016;53:653–9.PubMedPubMedCentralCrossRef Gellatly KJ, et al. Expansion of the knockdown resistance frequency map for human head lice (Phthiraptera: Pediculidae) in the United States using quantitative sequencing. J Med Entomol. 2016;53:653–9.PubMedPubMedCentralCrossRef
14.
go back to reference Carson DS, Tribble PW, Weart CW. Pyrethrins combined with piperonyl butoxide (RID) vs 1% permethrin (NIX) in the treatment of head lice. Am J Dis Child. 1988;142:768–9.PubMed Carson DS, Tribble PW, Weart CW. Pyrethrins combined with piperonyl butoxide (RID) vs 1% permethrin (NIX) in the treatment of head lice. Am J Dis Child. 1988;142:768–9.PubMed
15.
16.
go back to reference Stough D, Shellabarger S, Quiring J, Gabrielsen AA. Efficacy and safety of spinosad and permethrin creme rinses for pediculosis capitis (head lice). Pediatrics. 2009;124:e389–95.PubMedCrossRef Stough D, Shellabarger S, Quiring J, Gabrielsen AA. Efficacy and safety of spinosad and permethrin creme rinses for pediculosis capitis (head lice). Pediatrics. 2009;124:e389–95.PubMedCrossRef
17.
go back to reference Heukelbach J, Oliveira FA, Richter J, Häussinger D. Dimeticone-based pediculicides: a physical approach to eradicate head lice. Open Dermatol J. 2010;4:77–81. Heukelbach J, Oliveira FA, Richter J, Häussinger D. Dimeticone-based pediculicides: a physical approach to eradicate head lice. Open Dermatol J. 2010;4:77–81.
19.
go back to reference Burgess IF, Brown CM, Lee PN. Treatment of head louse infestation with 4% dimeticone lotion: randomised controlled equivalence trial. Br Med J. 2005;330:1423.CrossRef Burgess IF, Brown CM, Lee PN. Treatment of head louse infestation with 4% dimeticone lotion: randomised controlled equivalence trial. Br Med J. 2005;330:1423.CrossRef
20.
go back to reference Burgess IF, Lee PN, Matlock G. Randomised, controlled, assessor blind trial comparing 4% dimeticone lotion with 0.5% malathion liquid for head louse infestation. PLoS One. 2007;2:e1127.PubMedPubMedCentralCrossRef Burgess IF, Lee PN, Matlock G. Randomised, controlled, assessor blind trial comparing 4% dimeticone lotion with 0.5% malathion liquid for head louse infestation. PLoS One. 2007;2:e1127.PubMedPubMedCentralCrossRef
21.
go back to reference Heukelbach J, Canyon D, Oliveira F, Muller R, Speare R. In vitro efficacy of over-the-counter botanical pediculicides against the head louse Pediculus humanus var capitis based on a stringent standard for mortality assessment. Med Vet Entomol. 2008;22:264–72.PubMedCrossRef Heukelbach J, Canyon D, Oliveira F, Muller R, Speare R. In vitro efficacy of over-the-counter botanical pediculicides against the head louse Pediculus humanus var capitis based on a stringent standard for mortality assessment. Med Vet Entomol. 2008;22:264–72.PubMedCrossRef
22.
go back to reference Kurt Ö, et al. Treatment of head lice with dimeticone 4% lotion: comparison of two formulations in a randomised controlled trial in rural Turkey. BMC Public Health. 2009;9:441.PubMedPubMedCentralCrossRef Kurt Ö, et al. Treatment of head lice with dimeticone 4% lotion: comparison of two formulations in a randomised controlled trial in rural Turkey. BMC Public Health. 2009;9:441.PubMedPubMedCentralCrossRef
23.
go back to reference Richling I, Böckeler W. Lethal effects of treatment with a special dimeticone formula on head lice and house crickets (Orthoptera, Ensifera: Acheta domestica and Anoplura, phthiraptera: Pediculus humanus). Insights into physical mechanisms. Arzneimittel-Forschung. 2007;58:248–54. Richling I, Böckeler W. Lethal effects of treatment with a special dimeticone formula on head lice and house crickets (Orthoptera, Ensifera: Acheta domestica and Anoplura, phthiraptera: Pediculus humanus). Insights into physical mechanisms. Arzneimittel-Forschung. 2007;58:248–54.
24.
go back to reference Wolf L, Eertmans F, Wolf D, Rossel B, Adriaens E. Efficacy and safety of a mineral oil-based head lice shampoo: a randomized, controlled, investigator-blinded, comparative study. PLoS One. 2016;11:e0156853.PubMedPubMedCentralCrossRef Wolf L, Eertmans F, Wolf D, Rossel B, Adriaens E. Efficacy and safety of a mineral oil-based head lice shampoo: a randomized, controlled, investigator-blinded, comparative study. PLoS One. 2016;11:e0156853.PubMedPubMedCentralCrossRef
25.
go back to reference Semmler M, et al. Randomized, investigator-blinded, controlled clinical study with lice shampoo (Licener®) versus dimethicone (Jacutin® Pedicul fluid) for the treatment of infestations with head lice. Parasitol Res. 2017;116(7):1863–70.PubMedCrossRef Semmler M, et al. Randomized, investigator-blinded, controlled clinical study with lice shampoo (Licener®) versus dimethicone (Jacutin® Pedicul fluid) for the treatment of infestations with head lice. Parasitol Res. 2017;116(7):1863–70.PubMedCrossRef
26.
go back to reference Feldmeier H. Pediculosis capitis: new insights into epidemiology, diagnosis and treatment. Eur J Clin Microbiol Infect Dis. 2012;31:2105–10.PubMedCrossRef Feldmeier H. Pediculosis capitis: new insights into epidemiology, diagnosis and treatment. Eur J Clin Microbiol Infect Dis. 2012;31:2105–10.PubMedCrossRef
27.
go back to reference Oliveira F, Speare R, Heukelbach J. High in vitro efficacy of Nyda® L, a pediculicide containing dimeticone. J Eur Acad Dermatol Venereol. 2007;21:1325–9.PubMedCrossRef Oliveira F, Speare R, Heukelbach J. High in vitro efficacy of Nyda® L, a pediculicide containing dimeticone. J Eur Acad Dermatol Venereol. 2007;21:1325–9.PubMedCrossRef
28.
go back to reference Sonnberg S, et al. Ex vivo development of eggs from head lice (Pediculus humanus capitis). Open Dermatol J. 2010;4:82–9. Sonnberg S, et al. Ex vivo development of eggs from head lice (Pediculus humanus capitis). Open Dermatol J. 2010;4:82–9.
29.
go back to reference Burkhart CN, Burkhart CG. Recommendation to standardize pediculicidal and ovicidal testing for head lice (Anoplura: Pediculidae). J Med Entomol. 2001;38:127–9.PubMedCrossRef Burkhart CN, Burkhart CG. Recommendation to standardize pediculicidal and ovicidal testing for head lice (Anoplura: Pediculidae). J Med Entomol. 2001;38:127–9.PubMedCrossRef
30.
go back to reference Heukelbach J, Asenov A, Liesenfeld O, Mirmohammadsadegh A, Oliveira FA. A new two-phase dimeticone pediculicide shows high efficacy in a comparative bioassay. BMC Dermatol. 2009;9:12.PubMedPubMedCentralCrossRef Heukelbach J, Asenov A, Liesenfeld O, Mirmohammadsadegh A, Oliveira FA. A new two-phase dimeticone pediculicide shows high efficacy in a comparative bioassay. BMC Dermatol. 2009;9:12.PubMedPubMedCentralCrossRef
31.
go back to reference Strycharz JP, Lao AR, Alves A-M, Clark JM. Ovicidal response of NYDA formulations on the human head louse (Anoplura: Pediculidae) using a hair tuft bioassay. J Med Entomol. 2012;49:336–42.PubMedCrossRef Strycharz JP, Lao AR, Alves A-M, Clark JM. Ovicidal response of NYDA formulations on the human head louse (Anoplura: Pediculidae) using a hair tuft bioassay. J Med Entomol. 2012;49:336–42.PubMedCrossRef
32.
go back to reference Barker SC, Burgess IF, Meinking TL, Mumcuoglu KY. International guidelines for clinical trials with pediculicides. Int J Dermatol. 2012;51:853–8.PubMedCrossRef Barker SC, Burgess IF, Meinking TL, Mumcuoglu KY. International guidelines for clinical trials with pediculicides. Int J Dermatol. 2012;51:853–8.PubMedCrossRef
33.
go back to reference RKI. Kopflausbefall - RKI-Ratgeber für Ärzte. Epidemiol Bull. 2008;47/2003:250–2. RKI. Kopflausbefall - RKI-Ratgeber für Ärzte. Epidemiol Bull. 2008;47/2003:250–2.
34.
go back to reference Burgess IF, Lee PN, Kay K, Jones R, Brunton ER. 1, 2-octanediol, a novel surfactant, for treating head louse infestation: identification of activity, formulation, and randomised, controlled trials. PLoS One. 2012;7:e35419.PubMedPubMedCentralCrossRef Burgess IF, Lee PN, Kay K, Jones R, Brunton ER. 1, 2-octanediol, a novel surfactant, for treating head louse infestation: identification of activity, formulation, and randomised, controlled trials. PLoS One. 2012;7:e35419.PubMedPubMedCentralCrossRef
35.
go back to reference Bialek R. Studie zur Therapie der pediculosis capitis (Kopflausbefall) mit 0, 5% permethrin. Kinder-und Jugendarzt. 2005;36:197–202. Bialek R. Studie zur Therapie der pediculosis capitis (Kopflausbefall) mit 0, 5% permethrin. Kinder-und Jugendarzt. 2005;36:197–202.
36.
go back to reference Burgess IF, Brunton ER, Burgess NA. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr. 2010;169:55–62.PubMedCrossRef Burgess IF, Brunton ER, Burgess NA. Clinical trial showing superiority of a coconut and anise spray over permethrin 0.43% lotion for head louse infestation, ISRCTN96469780. Eur J Pediatr. 2010;169:55–62.PubMedCrossRef
37.
go back to reference Haustein U-F, Rogalski C, Paasch U. Einmalbehandlung des Kopflausbefalls (pediculosis capitis) mit 0, 5% permethrin. Aktuelle Dermatologie. 2002;28:406–9.CrossRef Haustein U-F, Rogalski C, Paasch U. Einmalbehandlung des Kopflausbefalls (pediculosis capitis) mit 0, 5% permethrin. Aktuelle Dermatologie. 2002;28:406–9.CrossRef
38.
go back to reference Kay K, Brunton E. R. Soya oil-based shampoo superior to 0.5% permethrin lotion for head louse infestation. Medic Devices: Evidence Res. 2011;4:35–42. Kay K, Brunton E. R. Soya oil-based shampoo superior to 0.5% permethrin lotion for head louse infestation. Medic Devices: Evidence Res. 2011;4:35–42.
39.
go back to reference Parison J, Canyon DV. In: Heukelbach J, editor. UNI-MED Management and control of head lice infestations; 2010. Parison J, Canyon DV. In: Heukelbach J, editor. UNI-MED Management and control of head lice infestations; 2010.
40.
41.
go back to reference Heukelbach J, et al. Ovicidal efficacy of high concentration Dimeticone: a new era of head lice treatment. J Am Acad Dermatol. 2011;64:e61–2.PubMedCrossRef Heukelbach J, et al. Ovicidal efficacy of high concentration Dimeticone: a new era of head lice treatment. J Am Acad Dermatol. 2011;64:e61–2.PubMedCrossRef
42.
go back to reference Burgess IF, Brunton ER, Burgess NA. Single application of 4% dimeticone liquid gel versus two applications of 1% permethrin creme rinse for treatment of head louse infestation: a randomised controlled trial. BMC Dermatol. 2013;13:5.PubMedPubMedCentralCrossRef Burgess IF, Brunton ER, Burgess NA. Single application of 4% dimeticone liquid gel versus two applications of 1% permethrin creme rinse for treatment of head louse infestation: a randomised controlled trial. BMC Dermatol. 2013;13:5.PubMedPubMedCentralCrossRef
43.
go back to reference Tomalik-Scharte D, et al. Dermal absorption of permethrin following topical administration. Eur J Clin Pharmacol. 2005;61:399–404.PubMedCrossRef Tomalik-Scharte D, et al. Dermal absorption of permethrin following topical administration. Eur J Clin Pharmacol. 2005;61:399–404.PubMedCrossRef
45.
go back to reference EMA/CMDh. Scientific conclusions taking into account the PRAC assessment report on the PSUR(s) for permethrin; 2018. EMA/CMDh. Scientific conclusions taking into account the PRAC assessment report on the PSUR(s) for permethrin; 2018.
Metadata
Title
High efficacy of a dimeticone-based pediculicide following a brief application: in vitro assays and randomized controlled investigator-blinded clinical trial
Authors
Jorg Heukelbach
Doerte Wolf
John Marshall Clark
Hans Dautel
Kristina Roeschmann
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Dermatology / Issue 1/2019
Electronic ISSN: 1471-5945
DOI
https://doi.org/10.1186/s12895-019-0094-4

Other articles of this Issue 1/2019

BMC Dermatology 1/2019 Go to the issue