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Home Remedies to Control Head Lice:Assessment of Home Remedies to Control theHuman Head Louse, Pediculus humanus capitis(Anoplura: Pediculidae) Miwa Takano-Lee, PhDJohn D. Edman, PhDBradley A. Mullens, PhDJohn M. Clark, PhD As the frequency and level of pediculicide resistance increases throughout the world, the need for novel solutions to controlpediculosis has intensified. The development and registration of new pesticides has become so costly that many chemicalcompanies are unwilling to pursue it and health-care providers now face a serious lack of new commercial pediculicides. Manyinfested people resort to using bhome-remedy Q approaches that have not been scientifically tested. In this article, we examinedthe potential value of six purportedly effective bhome remediesQ (vinegar, isopropyl alcohol, olive oil, mayonnaise, meltedbutter, and petroleum jelly) to treat head louse infestations and the likelihood of drowning lice by water submersion. Resultsindicated that only the application of petroleum jelly caused significant louse mortality but no treatment prevented lice fromlaying eggs. Most home remedy products did little to kill eggs, despite prolonged exposure. Petroleum jelly caused the greatestegg mortality, allowing only 6% to hatch. It was extremely difficult to drown lice, despite extended periods (i.e., 8 hr) of watersubmersion, suggesting that killing lice by depriving them of oxygen is inefficient. None of the home remedy products wesurveyed was an effective means of louse control. This suggests that when treatment failure occurs, an increased amount of timeand effort should be focused on alternative chemical pediculicides and/or manual louse removal (i.e., combing) rather thanusing any of these products.
n 2004 Elsevier Inc. All rights reserved.
EVERY YEAR, AN estimated 6–12 million making head louse treatment more problematic.
people, most between the ages of 5–12 in the Failure of over-the-counter pediculicides, despite United States, are infested with the human head repeated treatments, runs the risk that people will resort to unproven and often unsafe home remedies adversely affects the education of many school- In this article, we tested six common home children, because many schools have implemented remedies: vinegar, isopropyl alcohol, olive oil, a bno-nit Q policy, barring the return of students to mayonnaise, melted butter, and petroleum jelly.
the classroom, until they are louse- and nit-free.
Until recently, head lice have been treated relatively effectively with commercial pediculi- From the Center for Vector-Borne Diseases, University of cides, such as pyrethrins plus piperonyl butoxide, California, Davis, CA, Department of Entomology, University of 1% permethrin, 1% lindane, and 0.5% malathion California, Riverside, CA, and Department of Veterinary and Animal Science, University of Massachusetts, Amherst, MA.
Health, & the Committee on Infectious Diseases, Address correspondence and reprint requests to John D.
2002). However, within the last few years, Edman, PhD, Center for Vector-Borne Diseases, University ofCalifornia, Davis, CA 95616. E-mail: resistance to commercial pediculicides has been n 2004 Elsevier Inc. All rights reserved.
Meinking, 1999; Pollack et al., 1999) and is Journal of Pediatric Nursing, Vol 19, No 6 (December), 2004 Both adults and eggs were treated and their that clients used dangerous home products, such as survival compared with identical treatment by gasoline or kerosene, in an attempt to eliminate head water. In a separate experiment, we tested the feasibility of killing lice by prolonged water their use, home remedies are old and varied, ranging submersion. To reduce variability and to insure reproducibility and replication, we maintained cuoglu, 1996). Increased Internet access has head human head louse colonies with our human feeding louse treatment misinformation to spread without regulation. An Internet search of bhead louse home Clark, 2003) and tested them on our hair tuft remediesQ yielded more than 14,000 hits.
Although anecdotal reports of home remedies abound, only three research papers claim to have totested the efficacy of home reme Burkhart, 1998; Meinking, 1999; Schachner, Pediculicide resistance among head lice (Pe- diculus humanus capitis De Geer), as reflected in when live lice were placed directly in petroleum product failure, has been documented around the jelly and two kinds of hair pomades, lice were effectively immobilized and killed within 15 min, Harvey, & Coles, 1999; Lee et al., 2000; Mum- cuoglu et al., 1995; Picollo, Vassena, Casadio, Burkhart and Burkhart did not provide important Massimo, & Zerba, 1998; Pollack et al., 1999; experimental details, such as the number of lice Rupes, Moravec, Chmela, Ledvinka, & Zelenkova, tested, how much material was used per person, or 1995). Treatment failure also may be caused by where and in what condition the tested lice ski, & Spielman, 2000), but some resistance is that massaging 30 – 40 g of petroleum jelly was undeniable. A recent survey of pharmacists beffective,Q but failed to define beffectiveQ and gave revealed that 79–81% of users had encountered no indication how many petroleum treatments were resistance to pyrethroid products and 50% reported their clients were treating themselves other hand, reported that live adults were recovered with pyrethroid products at above the recommen- in all cases from schoolchildren treated overnight with olive oil, mayonnaise, or Vaseline, beneath a resistance is widespread, the degree of resistance shower cap. Unfortunately, no quantified data were is variable and can occur in pockets throughout presented, such as the sample size of students observed per treatment, their levels of infestation, insecticides such as malathion are available, but many parents are reluctant to use this formulation In summary, there has been a failure of re- because the application time is long (8–10 hr), the searchers to provide quantitative results or statis- odor is offensive, and the product is highly tical information on whether home remedies can control louse infestations. Therefore, there is an have begun to prescribe boff-labelQ materials that urgent need to quantify home remedy efficacy to lack Food and Drug Administration approval as properly instruct patients on safe and effective pediculicides, such as ivermectin, 5% permethrin, treatments. Unfortunately, few people even try to 10% crotamiton, and trimethoprim-sulfamethoxa- rear head lice for testing, and replicated trials on infested people are almost impossible to perform.
Only two completely nontoxic louse-removal We performed three experiments to investigate the methods exist: shaving the entire head or manually (1) effect of home remedy treatment on live lice, removing lice with a comb. The former guarantees (2) effect of home remedy treatment on egg complete success, but it is rather extreme and can viability, and (3) likelihood of drowning lice by prolonged water submersion. By performing these Faced with recurring infestations, parents often studies, we hoped to settle the controversy on purchase unproven products advertised on the whether home remedies are effective and assist Internet as ball-naturalQ cures or rely on various health-care providers with valuable treatment op- tions or information, especially in the face of pedi- quarters of pharmacists surveyed reported evidence remedy product (melted butter, vinegar, isopropyl Each of our procedures was an experimental alcohol, or olive oil) or deionized water (control) design, comparing either six experimental groups for 5 s. Nonliquid products (mayonnaise and with one water control (home remedy studies) or petroleum jelly) were applied by dabbing hair four timed treatments with one control time tufts with lice into 1.5-ml microcentrifuge tubes threshold (submersion experiment). To minimize containing the product, which was enough to experimental variation, we used lice from our completely cover the hairs. Treated hair tufts with lice were then placed onto filter paper in a Petri Mullens, & Clark, 2003). Each colony originated dish (35 mm in diameter), covered, and placed in from a different geographic region: San Bernardino, an incubator (318C, or 888F, 60 – 80% relative humidity). We collected three different sets Ecuador (EC), and Niadup and Ticantiki, Panama of outcome measures: (1) at 8 hr, the proportion (PA). The CA colony is resistant to pyrethroids, of live insects and female fecundity (the number of whereas the EC and PA colonies are susceptible eggs produced per female) was recorded; (2) at 24 hr, the proportion of live insects was again Based on Internet searches and discussions with recorded; (3) proportion of eggs hatching and parents and school nurses, we chose six home hatching rates were recorded for several days remedy products to test: mayonnaise (Miracle Whip following the treatment. Survival at 8 hr was Light, Kraft Foods North America, Glenview, IL), chosen as the observational threshold, because petroleum jelly (Longs Drugs, Walnut Creek, CA), control lice, remained robust, and suffered no salted butter (Challenge Dairy, Dublin, CA), white mortality. The 8-hr period also represented the distilled vinegar (Stater Bros. Markets, Colton, CA), approximate duration of an overnight treatment isopropyl alcohol (70% by volume, Aaron Indus- and provided ample time for treated lice to recover.
tries, Lynwood, CA), and olive oil (Trader Giotto’s Survival data (proportion of test population still extra virgin olive oil, South Pasadena, CA). With the alive at 8 and 24 hr) and hatching proportions were exception of isopropyl alcohol, these materials were statistically transformed (arcsine of the square root) chosen because they are considered to be common and compared by a one-way analysis of variance household items, relatively nontoxic, and inexpen- (ANOVA). Significance was determined at p b .05.
sive. Isopropyl alcohol is found in most households, Female fecundity and hatch rates were compared by but is flammable. Deionized water served as the ANOVA with significance determined at p b .05. If control, acting as a harmless wetting agent. Butter the ANOVA test revealed statistically significant was melted above a hot plate just prior to use and differences, then a Tukey means separation test was was only mildly warm to the touch when applied.
used to calculate differences between groups.
Because naturally infested hosts have eggs of Mullens, & Clark, in press), we had determined different ages, our second experiment examined that adult females and males were the most likely whether home remedies affected hatching propor- to transfer to a new host. Therefore, we chose to tions or hatch rates. Hair tufts (n = 5– 6) with EC focus on females for the first experiment, because eggs (n = 12– 42 eggs/hair tuft, or 71–137 eggs/ of their larger size and ability to lay eggs; if a treatment) of various ages were treated as de- home remedy product could adversely affect scribed above for live females. After treatment, females, then it would probably be just as effective tufts with eggs were placed on filter paper and against other stages. Groups of five freshly fed maintained in the incubator without washing or rinsing until the experiment was terminated (9–10 replicates of each; 40 lice tested total) were placed days after application treatment). Two outcome on a clean hair tuft (c150–200 human hairs glued measures were documented: (1) the proportion of together at one end and cut to 1.25 cm length).
eggs hatching (observed by microscope) and (2) After all females were attached to the hairs, lice the proportion of first instar nymphs that were able were treated with one of six home remedies to open the egg but unable to exit (partial-hatch).
(experimental variable) or water (control). Hair Hatching and partial-hatch proportions were arc- tufts with lice were submersed into the liquid home sine (square root)-transformed before comparison Table 1. Survivorship and Fecundity (F Standard Error of the comparison; the Tukey means separation test was Mean) of Reproductively Active Females (n = 40 per Group) All EC and PA lice treated with water (control) for 8 hr survived with no observed ill effects. Only lice treated with petroleum jelly had significantly less survival (38%, 15/40) when compared with all other types of home remedies (75–98%) ().
In all groups, 28– 43% of the lice (n = 11–17 individuals) survived 24 hr following treatment despite starvation, and survival did not significant- Note: Significance was determined at p b .05.
ly differ between lice treated with water and licetreated with any home remedy, F(6, 18) = 0.17, p =.98, data not shown. Eggs laid by lice treated with by ANOVA. A comparison of means test (Tukey) vinegar (9.1 F 0.07 days), isopropyl alcohol (10.0 F 10.0 days), olive oil (9.0 F 0.0 days), and mayonnaise (8.6 F 0.17 days) required a significantly longer period to hatch than eggs laid by water-treated females treated with water (8.0 F In the final experiment, we investigated the 0.1 days), F(6, 24) = 11.91, p b .0001, data not probability of drowning the lice, based on time shown. None of the home remedies affected submerged in water. Preliminary research indicated reduced the hatching rate, compared with water, that the survival of lice submersed for 6 hr and F(6, 18) = 1.62, p = .20, data not shown.
surviving at 24 hr (from t0) was comparable to lice starved for 24 hr (Takano-Lee, unpublished observations). Therefore, we used the 6-hr sub-mersion time as our survival baseline (control) and Eggs treated with olive oil, mayonnaise, and compared louse survival against four other sub- petroleum jelly were less likely to hatch than those treated with water (). Petroleum jelly was Groups of recently fed adult male and female the most effective home remedy, allowing only 6% lice (n = 4 –5; total of 8–55 lice treated per of eggs to hatch, compared with an 87% hatch rate microcentrifuge tube containing 1 ml of deionized significant difference in the proportion of eggs that water. Tubes were gently agitated until all licewere completely submerged and resting at thebottom. Lice were submerged for periods of 6, 8, Table 2. Proportions (F Standard Error of the Mean) of Eggs 10, 12, or 16 hr and remained undisturbed at room Hatching After a 5-s Immersion in Home Remedies temperature (22–238C). At the end of the submer- sion period, lice were removed from the water, placed on filter paper in Petri dishes, and permitted to recover until survival was docu- mented at 24 hr (8, 12, 14, 16, or 18 hr later).
Outcome measures recorded were female fecundi- ty and the proportion of lice functionally viable, based on the ability of lice to demonstrate normal motor coordination without twitching, lurching, or convulsing. Proportions of surviving lice were arcsine (square root)-transformed before ANOVA Note: Significance was determined at p b .05.
Table 3. Proportion (F Standard Error of the Mean) of Adult during treatment overnight might increase louse Lice Alive After Water Submersion at Room Temperature mortality, but is unlikely to affect eggs. Loose shower caps may not contain all of the hair overnight and would allow some lice to recover.
Like chemical pediculicides, no home remedy is It appears to be nearly impossible to drown lice on a host. Lice must be unable to respire for at least 8 hr continuously before significant mortality occurs, and such conditions are difficult to meet on a naturally infested host. However, if an Note: Significance was determined at p b .05.
overnight home remedy treatment is completelyremoved, it may be possible for lice to recover,even after 12 hr. Contaminated articles, such as partially hatched between any treatments, F(5, clothing or linens, must be laundered at high 25) = 1.85, p = .14, data not shown.
temperatures to kill lice, because drowning for Treating hairs did not interfere with egg laying, as Following prolonged water submersion, only combing, because they can temporarily immobilize lice submerged for 6 hr were able to lay eggs, or slow down lice and may suffocate some. For an although egg-laying was reduced (data not shown); oily remedy to be effective, however, multiple therefore, no statistical analyses were performed.
treatments and a great deal of combing are required Most lice submerged for 6 hr (n = 15) and surviving at 24 hr were functional (), but The fact that these experiments could not be survival significantly decreased as submersion performed on a naturally infested host was the main limitation of this study, because the impact ofcontinuous blood-feeding is unknown. Most likely,mortality rates would have been reduced because blood ingestion would have boosted energy levels and restored life functions. However, by performing No home remedy killed 100% of lice or eggs the experiments in the laboratory setting, we were after 24 hr, but petroleum jelly killed more lice than able to use suitably large sample sizes under any other treatment. In fact, many lice survived past 24 hr in all treatments, suggesting that lice are rather We recommend that future studies explore the hardy. In addition, keeping home remedy products utility of bnaturalQ substances, such as the essential on the hair for extended periods, or getting them off, oils, noting with caution that such substances may can be time-consuming, uncomfortable, and stress- be harmful if not administered properly. Other alternative strategies that physically stress lice, such Although eggs laid by lice treated by a home as elevated temperatures, occlusive compounds, remedy exhibited delayed hatching rates, the differ- dessicating agents, or even commercial pediculi- ence probably was not biologically important.
cides, could be used in combination with each other Remedies with high viscosity (i.e., olive oil, to control louse infestations or disinfect contami- mayonnaise, and petroleum jelly) tended to reduce egg hatch, but nothing completely stopped it.
It is unfortunate that these simple and relatively Perhaps by sealing the eggshell opening, they safe home remedies were not more effective, but deprive the egg of oxygen. In addition, the doctors and nurses should discourage their use befficacyQ of these viscous materials should be because they clearly fail to eliminate louse infesta- cautiously interpreted, because they were permitted tions. In addition, patients should be informed that to remain on hairs for 9–10 days; most people would some home remedies are toxic or dangerous to wash their hair within hours after a treatment, apply. Alternative approved pesticides and manual thereby cleansing the hair and nits and allowing combing are currently the only good options when eggs to hatch. A tight-fitting swimming cap worn treatment failure occurs. They should be combined with a thorough cleaning of the home environment The authors thank the school nurses within the San Bernardino City Unified School District andDr. David Taplin and Terri Meinking, FieldEpidemiology Survey Team (FEST), University of Miami, School of Medicine, Miami, FL, for Funding for this project was provided by the their generosity in collecting head lice for our National Institutes of Health grant R01AI45062.
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(1999). Evidence for double resistance to permethrin and Pollack, R. J., Kiszewski, A., Armstrong, P., Hahn, C., Wolfe, malathion in head lice. British Journal of Dermatology, 141, N., & Rahman, H. A., et al. (1999). Differential permethrin susceptibility of head lice samples in the United States and Frankowski, B. L., & Weiner, L. B., et al. the Committee on Borneo. Archives of Pediatrics & Adolescent Medicine, 153, School Health, the Committee on Infectious Diseases (2002).
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