Lice, scabies and bedbugs continue to be problematic for dermatologists

Mounting resistance to traditional head lice therapies, such as over-the-counter topical permethrin and synthetic pyrethroids, has prompted research into alternative therapies, according to a speaker at the 68th Annual Meeting of the American Academy of Dermatology in Miami Beach, Fla.

Albert C. Yan, MD, chief of dermatology at the Children’s Hospital of Philadelphia and associate professor in the departments of pediatrics and dermatology at the University of Pennsylvania, discussed this and therapies for other parasitic infections, including scabies and bedbugs.

Alternative lice therapies currently under investigation include trimethoprim-sulfamethoxazole combined with topical medications, products that can suffocate lice and novel agents or devices that work to physically destroy lice.

Yan cited several studies that looked at these alternatives but noted that “specific alternative therapy used will depend in large part on the dermatologist’s assessment of the safety and efficacy of available therapies and the degree of infestation.”

Avoiding shared combs, brushes or other personal care items is the best way to prevent transmitting lice and other parasitic infections, Yan emphasized.

Scabies are another problematic parasite, with more than 300 million cases appearing worldwide every year. Technological advances, especially those in epiluminescence microscopy, are helping physicians identify scabies by looking for specific patterns that indicate the pigmented areas of mites, Yan said.

Although topical 5% permethrin cream remains the gold standard for treating scabies in patients older than 3 months, physicians may consider treating younger children and pregnant women with sulfur compounds in petrolatum. Oral ivermectin may also be effective for those with widespread or resistant infection.

Bedbugs (Cimex lectularius) have also become a growing nuisance in recent years, increasing in prevalence by as much as 500%, according to Yan, who cited increased international travel and the discontinued use of DDT as reasons for the increase. He recommended topical corticosteroids and warm compresses to relieve bedbug-related itchiness.

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