All in the Netherlands available official registered head lice medications ( Prioderm®, Noury®, Loxazol®, Para-Speciaal®) are topical insecticides.


Insecticides general

Resistance

Each year the percentage lice that are resistant to topical insecticides raises. Regular use of topical insecticides leads to more and more resistance. The highest score now is about 80% resistance to permethrin with at the same time 66% to malathion (Leicestershire County and Rutland Primary Care Trust (PCT) dec. 2007). Research in Denmak proves that it could even be worse (Kristensen M et al 2006).
To administer a higher dose does not have any effect. Resistant is just resistant.

Absorption in the body

Insecticides are absorbed in the blood through the skin and by breathing in, though mouth and nose. As these substances are fat soluble, they will quickly relocate into fatty tissue, like brain and nerves. The absorption through the skin is facilitated by the fatty substances in the anti-lice remedies, like petroleum oil, butane, lanoline, terpineol and canada balm. When the hair is already covered with a fatty product, the absorption is of course even better. Naturally the skin is slightly damaged by this lice bites, which simplifies the whole process even more. The same story applies to eczema.

Baby’s, infants and children

Baby’s, infants and childrens differ in some aspects from adults (Chance G.W. and Harmsen E. 1998).

Baby’s, infants and children have more body fat to accumulate these fat soluble insecticides. A newborn's caloric requirement per unit of weight is five times higher than for an adult. So together with the food, even more contaminants are added. The younger the children are, the more limited their ability to metabolize and eliminate residual toxic substances. To the unborn and newborn their vulnerabilities are maximal. Unborn children are not able to metabolize the active substances, this substances transferre across the placenta. These substances are also transferred to breast milk.

Baby’s, infants and children’s brain's show a rapid growth. Brains and nerves do contain an awful lot of fat. As the insecticides accumulate here, there must be some clear negative effect.

And indeed, insecticides can disrupt the endocrine system and have repercussions on fetal development (an indirect effect). That contaminants can affect children directly at very early stages of development by damaging the nervous system, so affecting behaviour and interfering with the immune system and the reproductive organs.
The various stages in the development of the embryo, the fetus and the child, are controlled by specific chemical messengers. This messengers are programmed to emerge at a particular site in the body and be accepted at another, at a precise concentration and at a specific time.
If another chemical interferes with these messengers, it may cause irreversible damage at any one of these stages. The result may be seen in development and in the functioning of the reproductive system which may unleash a myriad of problems.

Studies conducted in the United States in the area of children's health have highlighted the fact that the main illnesses currently affecting children are chronic in nature. The mortality rate from asthma and the rate of hypospadias (a birth defect at the opening of the urethra) have doubled, cases of leukaemia and brain cancer have increased, and neurological developmental problems have spread (P.J. Landrigan, et al 1998). It is also suspected that other long-term problems result from exposure to pesticides, such as non-Hodgkin's lymphoma and reproductive organ tumours (Chance G.W. and Harmsen E. 1998).

There is a possible link between the parents' place of work (families living in agricultural areas, for instance) and an increased rate of childhood cancer and birth defects (V.F.Garry VF et al 1996, Sierra Club of Canada 1999). Dr. Colborn of the World Wildlife Fund, and Ms. McElgunn, of the Learning Disabilities Association of Canada, also put forward the hypothesis that pesticides might have negative effects on behaviour, due to the effects on neurological development.

Dr. Martin noted in one of the Meetings from the Standing Committee on Environment and Sustainable Development (Canada) :

Quote:
“With regard to neurological effects ... we see kids all the time who after using it either as an insect repellent or for head lice will have seizures and prolonged confusion. That happens all the time. We think that's just an acute effect ... Over the long term what does that do? If you can have that effect from putting insect repellent on your infant's head, what happens to your neurological system after 15 years of exposure? We need to be studying it, and we need to be funding the studying of it.„

The Association of Flight Attendants (AFA) warns of the risks of permethrin exposures to humans and is waging a war to stop the spraying of permethrin on airplanes http://www.headlice.org/news/2003/notosprays.htm. The Pentagon is warning family members not to send U.S. troops in the Persian Gulf, flea and tick collars designed for pets. They can cause dangerous pesticides to be absorbed through the skin. The main ingredient in most flea collars is permethrin http://www.headlice.org/news/2003/troopcollars.htm.

The Natural Resources Defense Council is pointing out that products intended to kill fleas and ticks can also poison pets and the people who handle them. Particularly toddlers, who's normal behaviour bring them in close contact with their pets http://www.headlice.org/news/2003/troopcollars.htm.
It appears children may be more sensitive to permethrin than adults. Permethrin is almost 5 times more acutely toxic to 8-day-old rats than it is to adult rats (Cantalamessa, F. 1993).

Children are more exposed to malathion than are adults. The Minnesota Children’s Exposure Study found malathion breakdown products in children about five times as often as a comparable study of adults; concentrations were about 4 times higher (Adgate, J.L. et al. 2001).
Children's excretion is less and the absoption is higher. As malathion runs through the placenta, infants are already exposed to malathion before birth when they are most vulnerable (Ostrea, E.M. et al. 2002).

(Over)Dosage

Some labels give instructions to repeat the treatment after one week. Loxasol® recommends even every week, during eight weeks. But the NTG (1997) warns that, as insecticides do accumulate in the body (Martindale 1996), repeated treatment is not desirable. The site for Vlaanderen (Gezondheid.be: http://www.gezondheid.be/index.cfm?fuseaction=art&art_id=370 ), states that the nasty sulphur smelling malathion, in fact only can be used once-only (or 3 times at most). And if so, then with a one week break.

Unfortunately, some children are head lice infested more than once a year. As every mother having children attending primary school knows. Oops…. And there are schools in which head lice infestation seem to be an ongoing epidemic. According Bannenberg & Emans (1995) children are infested on average 20-30 times during their total school years. So on average about 3 times a year. Metsaars et al (2000) found that 27% procent of pupils from 14 primary schools at Ede ever had head lice. And 18,2% were infested more times a year (Bos A F et al 2003).

In England the uptake of malathion through the skin (NTG, 1997) was explored . After only one treatment with malathion, the malation concentration in the urine proved to be 5 to 10 times higher, than the concentration in the urine from landworkers handling this insecticide. When soacked for 12 uurs, the malathion level proved to be 5 times higher as permitted for these landworkers. And attention: The height of this permitted dose is based on adults!!

Another topical insecticide is often advised, when some topical insecticide doesn't effect the lice. The applying of the next topical insecticide, with almost no pause between, does in fact increase the dose.
And the higher, the longer the exposure, the bigger the health risk. Expressed in an equation: risk = toxicity x exposure.


Active ingredients of head lice medications

Research General

Toxic hazards of substances are defined with certain methods. To interpret this outcomes correctly, you need to have some insight into those methods. See Research of Hazardous Substances.

Reseach Specific

Malathion and Permetrin

Malathion is the active substance in Prioderm® lotion and shampoo, and Noury®.
Permetrin is the active substance in Loxazol®.
There were furious protests against malathion en permethrin. Both are very controversial insecticides and also for mammals dangerous nerve poisons. Studying the official research is making the commotion understandable. This two substances:

Bioallethrin

Bioallethrin, the active substance in Para-Speciaal®, seems to be innocent. It is very hard to find something useful on the Web.
That you can find nothing on the Web, does not mean that this stuff is harmless. It is very well possible that the test results have not yet emerged into the official.
In http://www.pesticideinfo.org/Search_Chemicals.jsp most category's are categorised as ‘not listed’, this is differs totally from ‘not’.

On toxnet about Bioalletrin the next was available:
Bioallethrin affects the immune system of test animals, but especially it effects the behaviour: Learn and memory problems, lowered alertness, more mobile, more restless. You could almost say ADHD like behaviour.

Piperonyl butoxide (PBO)

Piperonyl-butoxide is a synergist used in a wide variety of pesticides and is another substance in Para-Speciaal®.
This substance also does affect test animals immune system. And also does influence their behaviour (including more restless behaviour and lowering the urge to explore).

Piperonyl butoxide affects the liver, the kidneys, raises the cholesterol level, causes anaemia, injures the DNA, is very probable carcinogenic and affects hormones including sex hormones.
Piperonyl butoxide also inhibits the general detoxification enzymes (the P450 mono-oxygenases), which does have gigantic implications on a lot of processes. So toxic waste elimination is disturbed (including medicines), as well as the action of medicines and sex hormones is changed… .


Additives in anti head lice remedies

All anti-head lice remedies do contain additives. Some are not that innocent. As for instance butane, isopropanol, and terpeniol.

Butane

Butane (in Para-Speciaal®) is since the FCKW-ban used as propellant in sprays. It is just like isopropanol, very flammable.
Butane is the most commonly misused volatile substance in the UK. It can provoke very realistic hallucinations and cause permanent brain damage. 52% of solvent related deaths in 2000 was due to butane (Field-Smith M et al).
Inhalation of butane can cause euphoria, drowsiness, narcosis, asphyxia, cardiac arrhythmia, and frostbite which can result in death from asphyxiation and ventricular fibrillation. http://en.wikipedia.org/wiki/Butane, http://de.wikipedia.org/wiki/Butan.
The Hazardous Substance Data Bank. (2002. Butane. http://toxnet.nlm.nih.gov) add to this: Headace, numbness, sleeplesness, mental confusion, uncoordinated movement, and memory loss.

Isopropanol

Isopropanol (added in Prioderm® lotion and Loxazol®), (synonym: isopropyl alcohol) is highly flammable. It is among other things applied as disinfectant, and added in body care products.
Isopropanol is absorbed through the skin and through inhalation and in the liver converted to acetone. Isopropanol depresses het CNS (central nervous system depressant) causes as such dizziness, headache, lowered pulse, lowered blood pressure, vomiting, low body temperature, slurred speech, unconsciousness, and coma (http://www.nlm.nih.gov/medlineplus/ency/article/002660.htm)

Isopropanol corrodes hand gloves out of certain rubbers. So pay attention to which gloves you wear!!!

Terpineol

Terpineol (added in Prioderm® lotion), terpineolen are aromatics, mostly added to perfume, cologne, laundry detergent, bleach powder, laundry bleach, fabric softener, stickup air freshener, vaseline lotion, cologne, soap, hairspray, after shave, roll-on deodorant http://de.wikipedia.org/wiki/Terpineole, http://www.immuneweb.org/articles/perfume.html.

Quote:
“Much of the misconceptions regarding the MCS syndrome arise from lack of understanding regarding the toxic nature of the chemicals involved. The industrial state of the art is to derive various fragrances, scents, and flavors artificially and almost exclusively from petrochemical sources. Many of the chemicals are toxic and known causes of diseases. The list is incomplete. There are literally thousands of such toxic chemicals.„ (R. L. Stegman, 2007, Hill RM et al 1975, Cording CJ, et al 2000).

Alpha-Terpineol is one of these toxic substances.

Although the official data reveal hardly any facts about terpineol (http://www.pesticideinfo.org/Detail_Chemical.jsp?Rec_Id=PC34545.


Label instructions common drug treatments

Pregnancy and lactation

All label instructions mention the lack of sufficient data. Nevertheless is strongly advised to consult a physician before applying.

Comment:
Animal tests (rats and mice) do suggest that negative effects are very well possible.

Lactating mothers are advised against using these remedies. The fact that malation is relocating in the mothers milk is mentioned here.

Comment:
The last fact is correct and seen the nature of the active substances in the other anti-lice remedies, a similar remark would have desirable. But how should a pregnant mum treat her child having head lice… .

Asthma and bronchitis

Comment:
Para speciaal® can not be used in case of asthma and bronchitis;
And also breathing problems with overdosing malation is mentioned else where.

Precautions

All label instructions advise to handle the product with gloves and to be aware of a slightly damaged scalp.

Comment:
So it is known that absorption through the scalp is dangerous, (even the Pentagon knows http://www.headlice.org/news/2003/troopcollars.htm) hence this is nowhere explicitly mentioned… .
Ventilating the accommodation not only deals with fire safety, it also lowers absorption through the lungs! Comment:
Isopropyl (in Loxazol® en Prioderm® Lotion) very easy transfers through hand gloves out of natural rubber or Polyethylene or Polyvinyl Alcohol. Polyvinyl or Chloride Saranex gloves give a mediocre protection (From: http://www.osha.gov/SLTC/healthguidelines/isopropylalcohol/recognition.html).

Comment:
To avoid eye contact makes utterly sense, the possibility to suffer hearing loss if the eardrums get infected (malathion) could make one suspicious.

Overdosing

In case of swallowing a physician always should be called in.

Malathion poisoning symptoms caused by swallowing are: NOURY® also mentions: Handling this poisoning emergency is to give an emetic or gastric lavage and to transport to a medical facility (Prioderm®), make the person vomit (NOURY®). Priodem notes: “no milk, ricinusoil or liquid paraffin, these fatty substances will only speed up the absorption from malathion.„ NOURY® mentions: “…(if available) administer a laxative and also activated charcoal .„

Comment:
All this does not look like something to give a 7 months old ‘child’.

The label instruction says: Children below 6 months old (at 6 months old a child can only sit on its own for a few seconds: so baby’s) are only allowed to be treated under a doctors supervision. Para-Speciaal® can not be sprayed near children younger than 2 years old: “Before treating a child below 2 years old with Para-Speciaal®, first consult your physician. Very young children ought to be exposed a lot shorter. And the spray cannot be sprayed directly on the head, Para-Speciaal® has to be put on the head by a piece of wadding … „

Comment:
As if children under 2 years of age have a different kind of lice!!!!!!!!?
According ouders.nl (http://www.ouders.nl/mpri2003-luizentips.htm) all children below 6 years! should have a health check and a health risk evaluation by the physician before using this stuff.

Function of the physician

Comment:

Case:
A little boy, 6 was treated with a malathion containing anti-lice remedy, during 3-4 months. The physician said this was OK! Just before Christmas the boy developed flu-like symptoms. He became lethargic and his personality changed. By Christmas he had become incontinent and could hardly walk. Dr. Vyvyan Howard, senior lecturer in fetal and infant toxio-pathology at the University of Liverpool agreed that this could very well have been a organofosafate (malathion) poisoning.
Reference: "Head-lice Lotion Poses Health Risk to Children", The London Times, October 5, 1997, p.3. Quoted the Pharmaceutisch Weekblad (1998).

One could wonder what other physicians might have said… . Anti-lice treatment is no subject in their training, and refresher courses are almost always taken care of, by the manufacturers themselves. And one could also wonder what their main interest is.

Other medicines

Non of the remedies would interfere with other medicines , nor effect driving skill in a negative sense.

Comment:
Piperonylbutoxide in Para-Speciaal® inhibits detoxification enzymes, so the effect of drugs including anti-depressives, anti-epileptics, asthma medicines is prolonged and intensified. This must have an effect on driving scills… .
And if you consider the effect of malathion and permethrine on the brain guess what… . The National Pediculosis Association (NPA) states that the official anti-lice remedies can not be applied in combination with epilepsy, asthma, braintumors, cancer and AIDS. From: http://www.headlice.org/news/2003/insidevc.htm
Ouders.nl added in 2003: Children having a weak health and children taking medication.

Way to use

Comment:
In 12 hours soaking (Noury® en Prioderm® Lotion (malathion)) a high dose of the substances can absorb through the skin. Unfortunately the shorter time Para-Speciaal® (bioalletrine and piperonylbutoxide ) Loxazol® (permethrin) need, is compensated by the higher uptake through the lungs.
Why does Prioderm® shampoo (malathion) have to soak ‘only’ for 2 x 5 minutes to get the same result?

Comment:
All the products (except Para-Speciaal® ) need a second treatment after one week. The NTG (1997) certainly does not advise this, Martindale (1996) notes: As insecticides do accumulate in the body repetitive treatment is undesirable.

Comment:
The combing instructions equal very much the combing-methods explained in the ‘Bug Busting Programme‘ (http://www.chc.org/bugbusting/) and the ‘wet comb method’ from theVlaams Agentschap Zorg & Gezondheid (http://www.zorg-en-gezondheid.be/luizen.aspx). These people however do advise against het use of common drug treatments.

Side-effects

According all label instructions side-effects are rather rare. Mentioned are itch, slight readness, skin-rash, temporaly dandruft, contact dermatitis, and allergic reactions.

Comment:
A quite poor list, looking at the described effects of active and additive substances.



Conclusion

Short term
The effects include all described poisoning symptoms and interferences with medicines and possible effects due to metabolism aberrations.

Long term
Research reveals that the substances in the anti-head lice remedies very probable:
Especially (unborn) children and their! children are the victims. It seems plausible that common drug treatments to fight lice adds to the augmentation of ADHD and cancer.
The descriptions in the label instructions may meet with the general law and rules, a bit more explicitly would be desirable.


Implications

Quote:
“The impact of environmental contaminants on the normal function of human and animal hormone systems has been a significant concern in the last decade.„ (National Research Council. Commission on Life Sciences. Board on Environmental Studies and Toxicology. Committee on Hormonally Active Agents in the Environment. 1999. Hormonally active agents in the environment. Washington, D.C.: National Academy Press, p. 10.)

Quote:
“Hormones are biologically active molecules that control all responses and functions of the body. Dramatic changes in the activity of cells in humans and other animals "are caused by extremely small amounts" of hormones or other chemicals that disrupt this system.„ (Eubanks, M.W. 1997. Hormones and health. Environ. Health Persp. 105: 482-487.)

Insecticides (common drug treatments fighting lice) are substances adding to the dysfunction of hormonal systems.

Accumulation, synergism

Insecticides (common drug treatments fighting lice) are not the only substances accumulating in the body (NTG, 1997), other harmful substances do accumulate there too, which is of course undesirable (Martindale 1996).

Quote:
“Chemicals that were relatively harmless when used independently of each other could become highly toxic to the brain when used together… governments should consider restricting the availability of some household chemicals until more was known about their interaction in the brain with each other and with other substances such as over-the-counter medicines.„ (Mohamed Abou-Donia, a professor of pharmacology, cancer biology and neurobiology at Duke University Medical Centre. 2001)

How harmful a certain substance for a certain person is depends for instance on:
To add an extra burden with common drug treatments fighting lice, does not seem to a good idea. Also bearing in mind the increasing cases of ADHD and related abnormalities, the increasing indifference and aggression, which could very well have a chemical component in them too.

Only recently we get a glimpse of how these many artificial substance influence ourselves and our habitat. Our habitat we heavily depend on. As fish, insects (pollination). But also effects on behaviour and consequences even for second and third generations get attention only recently. As emerges from recent studies on the active substances in anti head lice remedies.

This is a strong argument to find other ways to treat head lice infestigion.


Banned substances

Malathion

Malathion was banned 1996 in the U.S. under the suspicion of hormone-disruptor (http://www.europarl.europa.eu/meetdocs/2004_2009/documents/pr/545/545962/545962nl.pdf).
In the EU malation was per December 6th 2007 banned as crop-protector. It still is permitted as prescription drug. In Germany the substance is totally banned.

Permetrin

In the Europeon Union permetrin is no longer allowed as crop-protection. Also due to the fact that it kills bees at a very low dose. In the United Nations the EPA considered permethrin as a possible carcinogenic to humans. Animal tests revealed amongst others lung and kidney tumours in mice.

Lindane

The EPA decided 2006 August 2nd not to ban lindane as insecticide. In the Netherlands Lindane is banned. Anti-head lice remedies containing lindane, are banned in a lot of countries. Lindane (related to the pesticide DDT) is thought to be connected to neurological disorders and cancer. In Germany lindane was banned as prescription drug (as well as in lice killing treatments) by the end of 2007, based on an EU regulation.


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