Treatment for Head Lice - Only At Risk of Neurological Damage?

(Original title: Kopflausbehandlung – Nur mit dem Risiko neurologischer Schaeden? Der Merkurstab 12994; 47: 484-6.
English by A.R Meuss, FIL, MTA.) 

Head lice are becoming a real plague in schools and nurseries. General practitioners and school doctors are facing the difficult problem of fighting the creatures without harming the humans. The usual drugs used against ectoparasites derive from plant protection, among them the organophosphate malathion or lindane. Anyone in favor of biodynamically grown vegetables is unlikely to want to have such substances on the heads of their children. Yet it seems that even "harmless" alternatives such as pyrethrum extracts or pyrethroids, i.e. chemical derivatives of natural pyrethrins with extended half life and in some cases greatly increased toxicity, are not entirely safe.

My attention was drawn to the problem by observations made on a child and a woman who, after application of Goldgeist, showed long- term deterioration of general health, adynamia (asthenia), problems with concentration and (in the case of the adult patient) painful hepatomegaly. A local symptom was a prickling sensation, possibly indicative of mild neuropathy. The child also developed diffuse alopecia, as did another child, which, however had no systemic symptoms. Years ago, it had taken numerous investigations before I was able to establish that the paraparesis of a 12-year-old was due to one occasion of inhaling Paral (an insecticide containing malathion) and some solvents. In the present case, intoxication was given earlier consideration, with appropriate investigations instituted.

Pyrethrin and pyrethroids are essentially neurotoxic. Depending on the experimental conditions they may either enhance or block neural responses.(1) Insects are relatively sensitive to them, and in the 1970s it was still believed that they were not toxic to humans.(2) However, chronic toxicity experiments on dogs using pyrethroids in combination with alcohol or caffeine showed a noticeable increase in mortality.(3) Ten years later reports were published showing human intake of relatively large amounts to result in anesthesia (which today must be regarded as due to pyrethroid-mediated polyneuropathy), headaches, tinnitus, lack of coordination, spasms and stupor.(4) In 1991 Prof. Mueller-Mohnsen (Society for Radiation and Environmental Research) explicitly stated that irreversible neurologic damage may be sustained, making special reference to potential chronic toxicity.(5) The German health authority has, among others, denied the existence of chronic damage,(6) but a recent report also refers to the neurotoxicity of natural pyrethrins and undesirable side effects of Goldgeist forte.(7) In a personal conversation. Prof. Mueller- Mohnsen said he had collected ca. 500 cases of intoxication following "correct" use of products for the treat- ment of head lice. A detailed analysis will be made as part of a doctorate thesis, but the following is already established. 50% of cases involve children, most of them initially misdiagnosed as suffering from atypical encephalitis. Intoxication was often only considered because no causal organism was found and the condition was unduly prolonged. It is also certain that only a small proportion of cases have been reported to Prof. Mueller-Mohnsen.

Clearly this is only the tip of the iceberg. Older people were particularly badly affected, and it is important for geriatricians to consider the possibility when dealing with indefinite neurologic symptoms. But even those in the middle of life were unable to work for 8 months on average! When large areas were treated for scabies, the dangers were, of course, even greater; and, like Hahnemann, we have to realize that some chronic conditions are due to previous treatment for scabies. It is reported that fatal poisoning occurred in a woman aged 86 who had been treated with Jacutin Emulsion for scabies. The lindane concentrations in her blood were the highest so far determined in Germany.

All in all, it has to be accepted that the risks are considerable. Two additional sources of danger also merit brief mention: small vaporizers in electrical plugs used in children's rooms disseminate pyrethroids - to combat midges and mosquitoes - and insect sprays are also dangerous. Prof. Mueller-Mohnsen refers to the case of a child who lost consciousness for a week after receiving a single puff of Paral in the face.

In the case of the patients described initially, the side effects were relatively minor. The alopecia appears to be fairly persistent, but general well-being returned to normal in ca. 3 months with "derivative" treatment using Berberis 6x, Okoubaka 6x and Kidney Tonic (Wala).

Fortunately there are safer means of dealing with parasites. The simplest method is to put individuals with head lice under a hair dryer for an hour. Lice and nits die off at temperatures above 45 degrees C. Unfortunately the method cannot be used with restless young children. In their case, help can come from the neem tree. In India, neem (margosa) extracts have been used for centuries to treat acne, pruritus and infected wounds and to combat parasites.(9) A number of different constituents of the plant affect the insect endocrine system,(10) especially the molting hormone," among other things inhibiting chitin synthesis. Unlike the nonspecific neurotoxins, neem is an "insect-specific biocidal agent - an insecticide worthy of the name.(7) Insects are no longer able to bite, suck and reproduce following the application of neem, but they may continue to live for a time (it is important not to interpret this as lack of efficacy of neem preparations) and the term "insectistatic" has been suggested.(12) Animal experiments with mammals have shown the substance to be harmless even in high concentrations.(11) Theoretically, therefore, and in the light of centuries of tradition, including internal use, use in human medicine appears to be safe.

Initially many experiments with neem extracts as plant protectives showed extraordinarily good effectiveness. The product is easy to manufacture and offers great hope for protection of food plants from insect depredations in developing countries, and to combat arthropods capable of transmitting diseases.(12) Neem has also proved highly successful in dealing with ectoparasites of sheep in biodynamic agriculture, with no indication of toxicity for the mammals.(13)

H. Kleeberg has developed a neem-based shampoo that has proved effective against head lice at a number of nurseries and schools. No parasites were found after a maxi- mum of 3 shampoos at 3-day intervals. The preparation is not yet licensed. Colleagues who are interested and frequently have to deal with the problem (e.g. school doctors) may obtain the shampoo on a trial basis if prepared to provide records. The author will be pleased to establish the necessary contacts if required.

There is also another way: neem has been used in anthroposophic pharmacy for decades, e.g. in the Wala Neem Essence, a product which until now has attracted little attention. It was originally developed to balance sebum production in the scalp and strengthen the hair. Trials are in progress that should tell us of potential usefulness in dealing with lice. Until now the essence has only been used after the insects were killed using other products. It immediately stopped the pruritus which tends to persist for some time. Considering the risks attached to the usual products, its use at an earlier stage may be indicated. The author would be pleased to receive any reports.

Markus Sommer, M.D.
Parkstr. 16a
D-82194
Groebenzeu Germany

References

1 Camougis G. Mode of action of pyrethrumon arthropod nerves. Pyrethrum. The natural insecticide. New York 1973.

2 Barthel WF. Toxidty of pyrethrum and its constituents to mammals. Pyrethrum. The natural insecticide. New York 1973.

3 Bond HW, DeFeo ]J. Toxicity of pyrethrum in combination with certain common chemicals and drugs. Report of the University of Rhode Island to Kenya Pyrethrum Co. 1969. Quoted by Barthel.

4 Moeschlin S. Klinik und Therapie der Vergiftungen. Stuttgart 1980.

5 Mueller-Mohnsen H. Deutsches Aerzteblatt 1991.

6 Appel KE. Kontroversen zur Toxizitaet von Pyrethrum und Pyrethroiden. Intemistische Praxis 1994; 34:2229-30.

7 Mueller-Mohnsen H. Kontroversen zur Toxizitaet von Pyrethrum und Pyrethroiden. Intemistische Praxis 1994; 34:2231-32.

8 Arzneimittelkommission der Deutschen Aerzteschaft. Fall Nr. 6293.

9 Ketkar CM, Ketkar MS. Different uses of neem (Azadirachta indica A. Juss). Practice-oriented results on use and production of mem ingredients, Kleeberg H. ed. Lahnau 1993.

10 Rembold H, Subrahmanyam B, Mueller R. Corpus cardiacum - a target for azadirachin. Experientia 1989; 45:361-3.

11 Schmutterer H. Kontroversen zur Toxizitaet von Pyrethrum und Pyrethroiden. Intemistische Praxis 1994; 34:232-33.

12 Kleeberg. Personal communication.

13 Leupholz W. Versuch der Ektoparasitenbekaempfung bei Milchschafen. Practice-oriented results on
use and production of neem ingredients, Kleeberg H. ed. Lahnau 1992.