Hair & Nails

Oral ivermectin was found superior to malathion lotion in eliminating persistent head lice infestation in a study of children and their household contacts, according to a report in the March 11 issue of the New England Journal of Medicine.

“Ivermectin may be a good alternative to malathion when topical insecticide resistance is suspected,” said Dr. Olivier Chosidow of the Université Pierre et Marie Curie, Paris, and his associates.

Resistance of head lice to both pyrethroids and malathion appears to be increasing. Ivermectin has been used to treat onchocerciasis, lymphatic filariasis, helminthiases, and ectoparasite infections such as scabies.

Dr. Chosidow and his colleagues assessed the efficacy and safety of ivermectin against head lice in a randomized, double-blind controlled trial of patients recruited from the community who had persistent infestation despite using topical pyrethroid-based or malathion insecticide.

The study involved 812 children and their contacts in 376 households in the United Kingdom, Ireland, France, and Israel. The study households were randomly assigned to receive either active oral ivermectin plus a placebo lotion (185 households and 398 patients) or active malathion lotion plus a placebo tablet (191 households and 414 patients) to ensure blinding to treatment assignment. The medications were given by trained staff at clinics to ensure that they were used properly.

After two treatments, given 1 week apart, any patients who still had head lice infestation were switched to the alternative treatment.

The primary end point – clearance of head lice infestation on day 15 after the first two treatments – was achieved in more than 95% of the ivermectin patients, compared with 85% of the malathion patients. A total of 92% of households in the ivermectin group were cleared of head lice, compared with 79% of households in the malathion group.

Seventy patients with persistent infestation switched to the alternative treatment. After another 2 weeks, 100% of the patients using malathion and 97% of those using ivermectin achieved clearance of head lice, the investigators said (N. Engl. J. Med. 2010;362:896-905).

Seven patients in the ivermectin group (1.8%) and five in the malathion group (1.2%) discontinued treatment because of adverse effects, including impetigo, nausea or vomiting, gastroenteritis, and rash or urticaria.

Two serious adverse events occurred: One girl taking ivermectin developed seizures 6 days after the first dose, and one girl taking malathion developed a severe headache requiring hospitalization 6 days after the first application. Both girls recovered. The seizure was found to have a right rolandic focus, and the patient was given a prescription for oxcarbazepine.

The study was funded by Johnson & Johnson–Merck Sharp & Dohme–Chibret. Dr. Chosidow reported receiving consulting fees from Laboratoires Pierre Fabre and Johnson & Johnson, and lecture fees from Pohl Boskamp.

_{(Image Copyright: CDC/Reed and Carnrick Pharmaceuticals)}

Oral ivermectin was found superior to malathion lotion in eliminating persistent head lice infestation in a study of children and their household contacts, according to a report in the March 11 issue of the New England Journal of Medicine.

“Ivermectin may be a good alternative to malathion when topical insecticide resistance is suspected,” said Dr. Olivier Chosidow of the Université Pierre et Marie Curie, Paris, and his associates.

Resistance of head lice to both pyrethroids and malathion appears to be increasing. Ivermectin has been used to treat onchocerciasis, lymphatic filariasis, helminthiases, and ectoparasite infections such as scabies.

Dr. Chosidow and his colleagues assessed the efficacy and safety of ivermectin against head lice in a randomized, double-blind controlled trial of patients recruited from the community who had persistent infestation despite using topical pyrethroid-based or malathion insecticide.

The study involved 812 children and their contacts in 376 households in the United Kingdom, Ireland, France, and Israel. The study households were randomly assigned to receive either active oral ivermectin plus a placebo lotion (185 households and 398 patients) or active malathion lotion plus a placebo tablet (191 households and 414 patients) to ensure blinding to treatment assignment. The medications were given by trained staff at clinics to ensure that they were used properly.

After two treatments, given 1 week apart, any patients who still had head lice infestation were switched to the alternative treatment.

The primary end point – clearance of head lice infestation on day 15 after the first two treatments – was achieved in more than 95% of the ivermectin patients, compared with 85% of the malathion patients. A total of 92% of households in the ivermectin group were cleared of head lice, compared with 79% of households in the malathion group.

Seventy patients with persistent infestation switched to the alternative treatment. After another 2 weeks, 100% of the patients using malathion and 97% of those using ivermectin achieved clearance of head lice, the investigators said (N. Engl. J. Med. 2010;362:896-905).

Seven patients in the ivermectin group (1.8%) and five in the malathion group (1.2%) discontinued treatment because of adverse effects, including impetigo, nausea or vomiting, gastroenteritis, and rash or urticaria.

Two serious adverse events occurred: One girl taking ivermectin developed seizures 6 days after the first dose, and one girl taking malathion developed a severe headache requiring hospitalization 6 days after the first application. Both girls recovered. The seizure was found to have a right rolandic focus, and the patient was given a prescription for oxcarbazepine.

The study was funded by Johnson & Johnson–Merck Sharp & Dohme–Chibret. Dr. Chosidow reported receiving consulting fees from Laboratoires Pierre Fabre and Johnson & Johnson, and lecture fees from Pohl Boskamp.

_{(Image Copyright: CDC/Reed and Carnrick Pharmaceuticals)}

Oral ivermectin was found superior to malathion lotion in eliminating persistent head lice infestation in a study of children and their household contacts, according to a report in the March 11 issue of the New England Journal of Medicine.

“Ivermectin may be a good alternative to malathion when topical insecticide resistance is suspected,” said Dr. Olivier Chosidow of the Université Pierre et Marie Curie, Paris, and his associates.

Resistance of head lice to both pyrethroids and malathion appears to be increasing. Ivermectin has been used to treat onchocerciasis, lymphatic filariasis, helminthiases, and ectoparasite infections such as scabies.

Dr. Chosidow and his colleagues assessed the efficacy and safety of ivermectin against head lice in a randomized, double-blind controlled trial of patients recruited from the community who had persistent infestation despite using topical pyrethroid-based or malathion insecticide.

The study involved 812 children and their contacts in 376 households in the United Kingdom, Ireland, France, and Israel. The study households were randomly assigned to receive either active oral ivermectin plus a placebo lotion (185 households and 398 patients) or active malathion lotion plus a placebo tablet (191 households and 414 patients) to ensure blinding to treatment assignment. The medications were given by trained staff at clinics to ensure that they were used properly.

After two treatments, given 1 week apart, any patients who still had head lice infestation were switched to the alternative treatment.

The primary end point – clearance of head lice infestation on day 15 after the first two treatments – was achieved in more than 95% of the ivermectin patients, compared with 85% of the malathion patients. A total of 92% of households in the ivermectin group were cleared of head lice, compared with 79% of households in the malathion group.

Seventy patients with persistent infestation switched to the alternative treatment. After another 2 weeks, 100% of the patients using malathion and 97% of those using ivermectin achieved clearance of head lice, the investigators said (N. Engl. J. Med. 2010;362:896-905).

Seven patients in the ivermectin group (1.8%) and five in the malathion group (1.2%) discontinued treatment because of adverse effects, including impetigo, nausea or vomiting, gastroenteritis, and rash or urticaria.

Two serious adverse events occurred: One girl taking ivermectin developed seizures 6 days after the first dose, and one girl taking malathion developed a severe headache requiring hospitalization 6 days after the first application. Both girls recovered. The seizure was found to have a right rolandic focus, and the patient was given a prescription for oxcarbazepine.

The study was funded by Johnson & Johnson–Merck Sharp & Dohme–Chibret. Dr. Chosidow reported receiving consulting fees from Laboratoires Pierre Fabre and Johnson & Johnson, and lecture fees from Pohl Boskamp.

_{(Image Copyright: CDC/Reed and Carnrick Pharmaceuticals)}

BERLIN — Oral ivermectin proved superior to conventional therapy with malathion lotion for the treatment of difficult to eradicate head lice infestations in a large multinational randomized trial.

The number needed to treat—that is, the number of patients who needed to be treated with two doses of oral ivermectin 1 week apart instead of two applications of topical malathion in order for one additional patient to become louse-free—was 9.8, Dr. Olivier Chosidow reported at the annual congress of the European Academy of Dermatology and Venereology.

“Our randomized trial suggests strongly that ivermectin could be valuable, at least in patients who've previously failed standard therapy because their head lice aren't sensitive enough to local insecticides,” said Dr. Chosidow of the University of Paris.

He reported on 812 patients with head lice infestation in 376 randomized households. All participants were at least 2 years old and weighed at least 15 kg. At enrollment, all had live head lice detected by combing which had not been eradicated by topical insecticide therapy 2–6 weeks earlier. The households were randomized to double-blind/double-placebo supervised treatment with two single doses of oral ivermectin (Stromectol, Mectizan) at 400 mcg/kg or 0.5% malathion lotion, both administered on days 1 and 8.

The primary study end point was the absence of head lice upon inspection by combing on day 15. The success rate was 95% in the ivermectin group, compared with 85% in the malathion group. The secondary end points were the absence of head lice on days 2, 8, 22, and 29. The ivermectin group fared significantly better at each time point.

Generally mild treatment-related adverse events were noted in 7.5% of the ivermectin group and 10.9% who received malathion. There were no serious adverse events. It is well-established that ivermectin does not cross the human blood/brain barrier, according to Dr. Chosidow. Families appreciated the convenience of oral therapy.

Oral ivermectin is not approved by the Food and Drug Administration for the treatment of pediculosis. However, the Centers for Disease Control and Prevention guidelines recommend it for the treatment of scabies as an alternative to first-line topical 5% permethrin.

Dr. Erwin Tschachler, EADV secretary-general elect, singled out Dr. Chosidow's study as one of the infectious disease highlights of the congress.

“This is the first time an oral therapy for this parasitic infestation has been successful,” commented Dr. Tschacler, head of the research division for biology and pathobiology of the skin at the University of Vienna Medical School.

Although head lice are associated with low socioeconomic status, no socioeconomic stratum is immune to infestation, and outbreaks are a growing problem in many European countries, he added.

Dr. Chosidow received a research grant from Johnson & Johnson, which sponsored the ivermectin study.

'Ivermectin could be valuable, at least in patients who've previously failed standard therapy.'

Source Dr. Chosidow

BERLIN — Oral ivermectin proved superior to conventional therapy with malathion lotion for the treatment of difficult to eradicate head lice infestations in a large multinational randomized trial.

The number needed to treat—that is, the number of patients who needed to be treated with two doses of oral ivermectin 1 week apart instead of two applications of topical malathion in order for one additional patient to become louse-free—was 9.8, Dr. Olivier Chosidow reported at the annual congress of the European Academy of Dermatology and Venereology.

“Our randomized trial suggests strongly that ivermectin could be valuable, at least in patients who've previously failed standard therapy because their head lice aren't sensitive enough to local insecticides,” said Dr. Chosidow of the University of Paris.

He reported on 812 patients with head lice infestation in 376 randomized households. All participants were at least 2 years old and weighed at least 15 kg. At enrollment, all had live head lice detected by combing which had not been eradicated by topical insecticide therapy 2–6 weeks earlier. The households were randomized to double-blind/double-placebo supervised treatment with two single doses of oral ivermectin (Stromectol, Mectizan) at 400 mcg/kg or 0.5% malathion lotion, both administered on days 1 and 8.

The primary study end point was the absence of head lice upon inspection by combing on day 15. The success rate was 95% in the ivermectin group, compared with 85% in the malathion group. The secondary end points were the absence of head lice on days 2, 8, 22, and 29. The ivermectin group fared significantly better at each time point.

Generally mild treatment-related adverse events were noted in 7.5% of the ivermectin group and 10.9% who received malathion. There were no serious adverse events. It is well-established that ivermectin does not cross the human blood/brain barrier, according to Dr. Chosidow. Families appreciated the convenience of oral therapy.

Oral ivermectin is not approved by the Food and Drug Administration for the treatment of pediculosis. However, the Centers for Disease Control and Prevention guidelines recommend it for the treatment of scabies as an alternative to first-line topical 5% permethrin.

Dr. Erwin Tschachler, EADV secretary-general elect, singled out Dr. Chosidow's study as one of the infectious disease highlights of the congress.

“This is the first time an oral therapy for this parasitic infestation has been successful,” commented Dr. Tschacler, head of the research division for biology and pathobiology of the skin at the University of Vienna Medical School.

Although head lice are associated with low socioeconomic status, no socioeconomic stratum is immune to infestation, and outbreaks are a growing problem in many European countries, he added.

Dr. Chosidow received a research grant from Johnson & Johnson, which sponsored the ivermectin study.

'Ivermectin could be valuable, at least in patients who've previously failed standard therapy.'

Source Dr. Chosidow

BERLIN — Oral ivermectin proved superior to conventional therapy with malathion lotion for the treatment of difficult to eradicate head lice infestations in a large multinational randomized trial.

The number needed to treat—that is, the number of patients who needed to be treated with two doses of oral ivermectin 1 week apart instead of two applications of topical malathion in order for one additional patient to become louse-free—was 9.8, Dr. Olivier Chosidow reported at the annual congress of the European Academy of Dermatology and Venereology.

“Our randomized trial suggests strongly that ivermectin could be valuable, at least in patients who've previously failed standard therapy because their head lice aren't sensitive enough to local insecticides,” said Dr. Chosidow of the University of Paris.

He reported on 812 patients with head lice infestation in 376 randomized households. All participants were at least 2 years old and weighed at least 15 kg. At enrollment, all had live head lice detected by combing which had not been eradicated by topical insecticide therapy 2–6 weeks earlier. The households were randomized to double-blind/double-placebo supervised treatment with two single doses of oral ivermectin (Stromectol, Mectizan) at 400 mcg/kg or 0.5% malathion lotion, both administered on days 1 and 8.

The primary study end point was the absence of head lice upon inspection by combing on day 15. The success rate was 95% in the ivermectin group, compared with 85% in the malathion group. The secondary end points were the absence of head lice on days 2, 8, 22, and 29. The ivermectin group fared significantly better at each time point.

Generally mild treatment-related adverse events were noted in 7.5% of the ivermectin group and 10.9% who received malathion. There were no serious adverse events. It is well-established that ivermectin does not cross the human blood/brain barrier, according to Dr. Chosidow. Families appreciated the convenience of oral therapy.

Oral ivermectin is not approved by the Food and Drug Administration for the treatment of pediculosis. However, the Centers for Disease Control and Prevention guidelines recommend it for the treatment of scabies as an alternative to first-line topical 5% permethrin.

Dr. Erwin Tschachler, EADV secretary-general elect, singled out Dr. Chosidow's study as one of the infectious disease highlights of the congress.

“This is the first time an oral therapy for this parasitic infestation has been successful,” commented Dr. Tschacler, head of the research division for biology and pathobiology of the skin at the University of Vienna Medical School.

Although head lice are associated with low socioeconomic status, no socioeconomic stratum is immune to infestation, and outbreaks are a growing problem in many European countries, he added.

Dr. Chosidow received a research grant from Johnson & Johnson, which sponsored the ivermectin study.

'Ivermectin could be valuable, at least in patients who've previously failed standard therapy.'

Source Dr. Chosidow

BUDAPEST, HUNGARY — The oral probiotic Lactobacillus paracasei achieved substantial, clinically meaningful reductions in dandruff in a double-blind, placebo-controlled randomized trial.

Consumption of the probiotic also resulted in several secondary benefits, including reduced scalp erythema, itching, and greasiness, along with a steady decline over time in scalp Malassezia yeast counts, Dr. Audrey Gueniche reported at the annual congress of the European Society for Dermatological Research.

She and her coworkers at L'Oréal in Clichy, France, had previously shown that the probiotic speeds recovery of skin barrier function following controlled damage induced by tape stripping. They also demonstrated that L. paracasei helps regulate skin immune function.

Since those defects play an important role in dandruff conditions, the investigators decided to explore L. paracasei as a potential treatment for this common flaky scalp condition.

Thirty white men with moderate to severe dandruff were randomized to 57 days of daily consumption of L. paracasei in powder form or to placebo. Participants had to agree not to consume yogurt or other food products produced by the bacterial fermentation of milk during the trial and not to alter their customary face and scalp hygiene routine.

Biweekly clinical assessments documented declining levels of free and adherent dandruff, the coprimary study endpoints. The divergence between probiotic and placebo became significant after 4–5 weeks. After 57 days, the probiotic group had a 70% reduction from baseline in their standardized free dandruff score and a 72% decrease in adherent dandruff, compared with reductions of 23% and 34%, respectively, in the placebo group.

Investigator ratings of scalp erythema showed a 58% reduction in the probiotic group after 57 days and a 31% decrease with placebo. The reductions in dandruff and erythema scores were still maintained 1 week after the end of probiotic supplementation, according to Dr. Gueniche.

Global efficacy ratings made by blinded investigators on day 57 showed that 64% of patients in the probiotic arm were scored as having "good improvement" or "total healing," compared with 27% of controls, she reported.

Patients in the probiotic group rated their dandruff as reduced by 57% at the study's end, compared with a self-assessed 16% decrease in the placebo group. The L. paracasei group rated its scalp pruritus as 47% improved, versus a 13% reduction for controls. The probiotic users also rated their scalp erythema as 72% improved, compared with a 43% reduction reported in the placebo group.

Total Malassezia yeast counts showed a significant decrease over time in the probiotic group. In terms of M. restricta and M. globosa—the two species that have been identified as the major players in dandruff conditions—scalp counts increased sharply in the placebo group from day 15 on but remained steady over time in the probiotic treatment arm, Dr. Gueniche said.

Source Elsevier Global Medical News

BUDAPEST, HUNGARY — The oral probiotic Lactobacillus paracasei achieved substantial, clinically meaningful reductions in dandruff in a double-blind, placebo-controlled randomized trial.

Consumption of the probiotic also resulted in several secondary benefits, including reduced scalp erythema, itching, and greasiness, along with a steady decline over time in scalp Malassezia yeast counts, Dr. Audrey Gueniche reported at the annual congress of the European Society for Dermatological Research.

She and her coworkers at L'Oréal in Clichy, France, had previously shown that the probiotic speeds recovery of skin barrier function following controlled damage induced by tape stripping. They also demonstrated that L. paracasei helps regulate skin immune function.

Since those defects play an important role in dandruff conditions, the investigators decided to explore L. paracasei as a potential treatment for this common flaky scalp condition.

Thirty white men with moderate to severe dandruff were randomized to 57 days of daily consumption of L. paracasei in powder form or to placebo. Participants had to agree not to consume yogurt or other food products produced by the bacterial fermentation of milk during the trial and not to alter their customary face and scalp hygiene routine.

Biweekly clinical assessments documented declining levels of free and adherent dandruff, the coprimary study endpoints. The divergence between probiotic and placebo became significant after 4–5 weeks. After 57 days, the probiotic group had a 70% reduction from baseline in their standardized free dandruff score and a 72% decrease in adherent dandruff, compared with reductions of 23% and 34%, respectively, in the placebo group.

Investigator ratings of scalp erythema showed a 58% reduction in the probiotic group after 57 days and a 31% decrease with placebo. The reductions in dandruff and erythema scores were still maintained 1 week after the end of probiotic supplementation, according to Dr. Gueniche.

Global efficacy ratings made by blinded investigators on day 57 showed that 64% of patients in the probiotic arm were scored as having "good improvement" or "total healing," compared with 27% of controls, she reported.

Patients in the probiotic group rated their dandruff as reduced by 57% at the study's end, compared with a self-assessed 16% decrease in the placebo group. The L. paracasei group rated its scalp pruritus as 47% improved, versus a 13% reduction for controls. The probiotic users also rated their scalp erythema as 72% improved, compared with a 43% reduction reported in the placebo group.

Total Malassezia yeast counts showed a significant decrease over time in the probiotic group. In terms of M. restricta and M. globosa—the two species that have been identified as the major players in dandruff conditions—scalp counts increased sharply in the placebo group from day 15 on but remained steady over time in the probiotic treatment arm, Dr. Gueniche said.

Source Elsevier Global Medical News

BUDAPEST, HUNGARY — The oral probiotic Lactobacillus paracasei achieved substantial, clinically meaningful reductions in dandruff in a double-blind, placebo-controlled randomized trial.

Consumption of the probiotic also resulted in several secondary benefits, including reduced scalp erythema, itching, and greasiness, along with a steady decline over time in scalp Malassezia yeast counts, Dr. Audrey Gueniche reported at the annual congress of the European Society for Dermatological Research.

She and her coworkers at L'Oréal in Clichy, France, had previously shown that the probiotic speeds recovery of skin barrier function following controlled damage induced by tape stripping. They also demonstrated that L. paracasei helps regulate skin immune function.

Since those defects play an important role in dandruff conditions, the investigators decided to explore L. paracasei as a potential treatment for this common flaky scalp condition.

Thirty white men with moderate to severe dandruff were randomized to 57 days of daily consumption of L. paracasei in powder form or to placebo. Participants had to agree not to consume yogurt or other food products produced by the bacterial fermentation of milk during the trial and not to alter their customary face and scalp hygiene routine.

Biweekly clinical assessments documented declining levels of free and adherent dandruff, the coprimary study endpoints. The divergence between probiotic and placebo became significant after 4–5 weeks. After 57 days, the probiotic group had a 70% reduction from baseline in their standardized free dandruff score and a 72% decrease in adherent dandruff, compared with reductions of 23% and 34%, respectively, in the placebo group.

Investigator ratings of scalp erythema showed a 58% reduction in the probiotic group after 57 days and a 31% decrease with placebo. The reductions in dandruff and erythema scores were still maintained 1 week after the end of probiotic supplementation, according to Dr. Gueniche.

Global efficacy ratings made by blinded investigators on day 57 showed that 64% of patients in the probiotic arm were scored as having "good improvement" or "total healing," compared with 27% of controls, she reported.

Patients in the probiotic group rated their dandruff as reduced by 57% at the study's end, compared with a self-assessed 16% decrease in the placebo group. The L. paracasei group rated its scalp pruritus as 47% improved, versus a 13% reduction for controls. The probiotic users also rated their scalp erythema as 72% improved, compared with a 43% reduction reported in the placebo group.

Total Malassezia yeast counts showed a significant decrease over time in the probiotic group. In terms of M. restricta and M. globosa—the two species that have been identified as the major players in dandruff conditions—scalp counts increased sharply in the placebo group from day 15 on but remained steady over time in the probiotic treatment arm, Dr. Gueniche said.

Source Elsevier Global Medical News