Neurotoxicos vs Oclusivos para Piojos...
Occlusive vs Neurotoxic Agents for Topical Treatment of Head Lice Infestation
TAKE-HOME MESSAGE
- This systematic review of 16 randomized controlled trials shows that topical occlusive agents may be more pediculicidal than neurotoxic agents (final cure rate, RR 1.20). However, this benefit was limited to synthetic combination occlusive products in the post hoc subgroup analysis. There was no difference between occlusive agents and neurotoxic agents with respect to adverse effects such as skin and eye irritation (RR, 0.65).
- Topical occlusive agents, such as petroleum jelly and silicone oils, act by coating and blocking the excretory system of head lice, thus killing them. Not only are they unlikely to induce treatment resistance, but occlusive agents may also be superior to or as equally effective as neurotoxic pediculicides, with only few minor side effects. Optimal occlusive formulation and dosing regimen need to be determined.
– InYoung Kim, MD, PhD
- Written by
Pediculosis capitis is a worldwide public health issue, posing potential health risks (secondary bacterial infection, anemia) in affected children and carrying a significant economic and educational impact on patients, families, and schools. The "ideal" pediculicide (highly effective, safe, and cosmetically acceptable) remains somewhat elusive. Traditionally, agents exerting toxicity to the louse nervous system have been first-line treatments for pediculosis capitis (eg, permethrin, malathion, pyrethrins).
In this systematic review of 16 randomized controlled trials, the suggestion of superior efficacy of some occlusive agents (specifically synthetic combination occlusive agents) versus neurotoxic agents in the treatment of pediculosis capitis supports the use of occlusive treatments and emphasizes the need for further investigation of such formulations. This treatment advantage was seen particularly in studies where there was a low cure rate with neurotoxic pediculicide treatment. There was no significant difference in the adverse effects, which were few and mostly mild, between the two groups of agents. Given the concern of many physicians/ parents/ patients regarding use of potentially "toxic" agents, effective non-neurotoxic agents represent an attractive treatment option. Occlusive agents avoid issues such as contraindication for use in those with chrysanthemum allergy (as with pyrethrin products) and concerns of flammability (with malathion). Based on their mechanism of action, occlusive treatments also avoid the issue of development of lice treatment resistance, which is encountered increasingly in various parts of the world with widespread use of neurotoxic pediculicides.
Further studies should be performed, systematically evaluating the efficacy of occlusive agents, to confirm the initial findings above and to define optimal formulations and dosing schedules for these products.
BACKGROUND
Topical occlusive agents, such as petroleum jelly and silicone oils, kill head lice by coating and blocking its excretory system and are unlikely to induce treatment resistance. Although a popular alternative to neurotoxic pediculicides, their efficacy and safety remain unclear.
METHODS
We searched CENTRAL, MEDLINE, HERDIN (from inception to October 31, 2017), and other relevant sources for randomized controlled trials that compared topical occlusive agents with neurotoxic pediculicides to treat patients with head lice infestation. Using Cochrane collaboration methods, we selected studies, assessed risk of bias, and pooled similar studies. We assessed certainty of evidence using GRADEPro.
RESULTS
Seventeen trials (N = 2005) testing occlusive agents met inclusion criteria. Risk of bias was moderate across trials, mainly from lack of blinding of participants and personnel. As a class, occlusive agents may be more pediculicidal than neurotoxic agents (final cure rate, RR 1.20, 95% CI 1.02, 1.41; 16 RCTs, N = 1779; I2 = 88%; low certainty of evidence). Post hoc subgroup analysis suggests that this benefit may be limited to synthetic combination occlusive products. Adverse effects, such as skin and eye irritation, are similar between groups (RR 0.65, 95% CI 0.36, 1.17; 15 RCTs, N = 1790; I2 = 28%; low certainty of evidence).
CONCLUSIONS
In treating head louse infestation, evidence suggests occlusive agents may be superior to or equally efficacious as neurotoxic pediculicides. Adverse effects are few and minor. Future trials should use appropriate comparators and consider effects of confounders such as neurotoxin resistance. Additionally, optimal occlusive formulation and dosing regimen need to be determined
Occlusive Versus Neurotoxic Agents for Topical Treatment of Head Lice Infestation: A Systematic Review and Meta-Analysis
Pediatr Dermatol 2019 Oct 22;[EPub Ahead of Print], RNS Flores-Genuino, CMS Gnilo, BL DofitasSkin Care Physicians of Costa Rica
Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574
Please excuse the shortness of this message, as it has been sent from
a mobile device.
posted by dermatica at
November 14, 2019
0 Comments:
Post a Comment
Subscribe to Post Comments [Atom]
<< Home