Comparison of phenothrin mousse, phenothrin lotion, and wet-combing for treatment of head louse infestation in the UK: a pragmatic randomised, controlled, assessor blind trial

Abstract

In this investigation of effectiveness of an alternative pediculicide dosage form, we recruited 228 children and 50 adult participants from Bedfordshire, UK, to a randomised, controlled, assessor blind trial comparing two insecticide products with mechanical removal of lice as a control group. Participants using insecticide were treated with either the investigative 0.5% phenothrin mousse, for 30 minutes, or 0.2% phenothrin lotion, for 2 hours as the reference product. Both treatments were applied only once, followed by shampoo washing. Those treated by wet-combing with conditioner were combed 4 times over 12 days. Parents/carers carried out the treatments to mimic normal consumer use. The outcome measure was the absence of lice, 14 days after treatment for the insecticides, and up to 14 days after completion of combing. Intention to treat analysis of the outcomes for 275 participants showed success for phenothrin mousse in 21/105 (20.0%), in 23/107 (21.5%) for phenothrin lotion, and in 12/63 (19.1%) for wet-combing. People receiving mousse were 1.07 (95% CI, 0.63 to 1.81) times more likely to still have lice after treatment compared with those treated with lotion. The group of participants who received the wet combing treatment were 1.13 (95% CI, 0.61 to 2.11) times more likely to still have lice after the treatment. None of the treatments was significantly (p < 0.05) more effective than any other. This study was carried out in an area where moderate resistance to phenothrin was demonstrated after the study by using a bioassay. Analysis of post treatment assessments found that failure of insecticides to kill louse eggs had influenced the outcome.

Effectiveness of Wet Combing Compared With 1% Permethrin Lotion for the Treatment of Pediculosis Capitis

“…Interestingly, contradictory results were obtained in a study that showed that wet combing (bug buster kit) was significantly better than pediculicides (pyrethroid or organophosphate) [23]. However, the comparison with the United Kingdom is not appropriate, because it has been reported that head lice in the UK are resistant to pyrethroids such as permethrin [24].…”

European guideline for the management of pediculosis pubis

“… Phenothrin 0.2% lotion on dry hair, wash out after 2 h {level of evidence Ib; grade A recommendation} Malathion 0.5% lotion on dry hair, wash out 12 h after application (level of evidence IV; grade C recommendation).…”

Management and Treatment of Human Lice

“…As with permethrin, resistance to this compound has already appeared in France [ 109 ], UK [ 110 ], and the Czech Republic [ 111 ]. In clinical trials, phenothrin has been demonstrated to also be more effective than wet-combing [ 21 ]. It seems likely that resistance to pyrethroids will develop much more rapidly than was the case with older compounds [ 112 ].…”