Raising the standard of the labelling and instruction leaflets of treatments for head lice
The National Health Service (NHS) seeks to promote self-care for
minor ailments such as head lice, with health professionals in a
supporting role. Burgess, Brown and Lee suggest the problem of under-
dosing in the community with formulated products could be improved with
“better instructions for use and improved information at the primary care
level” (1). We agree and furthermore we consider that inadequate
labelling and product instructions, running in tandem with guidelines for
health professionals (2, 3) which give conflicting advice, are a major
obstacle to successful eradication. This rebounds on health professionals
at a huge cost to the NHS (4).
Failure to base treatment recommendations on an accurate knowledge of
the life-cycle of the head louse (5) compounds the confusion. It must be
acknowledged that there is no formulated product available which kills
eggs with certainty, and some perform so poorly against hatched lice that
“they potentially expose users to repeat applications without any
important reduction in infestations” (6). The situation is illustrated by
a report to the Welsh Assembly in 2003 of an 8.3% prevalence rate of head
lice in primary school children, double that reported in 2000 (7). Across
the UK distress and anger prevail among parents whose expectations of a
solution are raised by promises on product labelling e.g. “a single
application ... will kill head lice and their eggs”, “for
the fast effective treatment of head lice and their eggs” and then dashed.
In the interest of the public health and fairness to product users,
evidence should be produced by clinical evaluation in the UK community
where parents follow the manufacturers’ instructions. Information on the
quantity to use, the time to leave it on the head, and the number of
applications is required. The practicality of the application and removal
methods should be assessed. Realistic statements such as “Enough for one
application to shoulder length hair”, “X minutes/hours application time”
and “X number of applications required to complete treatment” should
appear on a product label. For products containing insecticides to which
lice become resistant, the date of the last clinical evaluation should be
displayed with the percentage success rate. An accurate statement on the
incubation period of head louse eggs, the consequent need to make a
thorough check for lice 5 and 12 days after treatment applications, and
the appropriate practical tips about product use should always be included
in the instructions.
We call for an open debate of these issues which places the
regulatory framework in the public domain.
Joanna Ibarra, Programme Co-ordinator,
Frances Fry, Development Worker,
Clarice Wickenden, Health Education Adviser,
Jane Lesely Smith, Assistant Development Worker
Community Hygiene Concern, Reg Charity No: 801371, Manor Gardens
Centre, 6-9 Manor Gardens, London N7 6LA
References
(1) Burgess IF, Brown CM, Lee PN. (2005)Treatment of head louse
infestation with 4% dimeticone lotion: randomised controlled equivalence
trial. BMJ 330: 1423-5 (Full text Online first, BMJ,
doi:10.1136/bmj.38497.506481.8F(10 June 2005)
(2) Joint Formulary Committee. British National Formulary, entry
13.10.4, Parasiticidal preparations. London: British Medical Association
and Royal Pharmaceutical Society of Great Britain, 1981- (updated March
and September each year)
(3) Aston R, Duggal H, Simpson J, advised by Burgess I, Medical
Entomology Centre, Cambridge. Head lice. Report for Consultants in
Communicable Disease Control (CCDCs) 1998 (www.fam-
english.demon.co.uk/phmeghl.htm)
(5) Buxton P A. The Louse. An account of the lice which infest man,
their medical importance and control. London: Edward Arnold & Co,
1947
(6) Hill N, Moor G, Cameron MM, Butlin A, Preston S, Williamson MS,
Bass C. Single blind, randomised, comparative study of the Bug Buster kit
and over the counter pediculicide treatments against head lice in the
United Kingdom. BMJ 2005; 311: 384-6 (Full text Online first, BMJ,
doi:10.1136/bmj.38537.468623.EO (5 August 2005)
(7) Roberts RJ, Casey D, Morgan DA, Petrovic M. Comparison of wet
combing with malathion for treatment of head lice in the UK: a pragmatic
randomised controlled trial. Lancet 2000;356: 540-4
Competing interests:
Community Hygiene Concern is a charity, part-funded by sales of the Bug Buster Kit on a non-profit making basis.
Competing interests:
No competing interests
04 April 2006
Joanna Ibarra
Programme Co-ordinator
Frances Fry, Clarice Wickenden and Jane L. Smith
Community Hygiene Concern, Manor Gardens Centre, London N7 6LA
Rapid Response:
Raising the standard of the labelling and instruction leaflets of treatments for head lice
The National Health Service (NHS) seeks to promote self-care for
minor ailments such as head lice, with health professionals in a
supporting role. Burgess, Brown and Lee suggest the problem of under-
dosing in the community with formulated products could be improved with
“better instructions for use and improved information at the primary care
level” (1). We agree and furthermore we consider that inadequate
labelling and product instructions, running in tandem with guidelines for
health professionals (2, 3) which give conflicting advice, are a major
obstacle to successful eradication. This rebounds on health professionals
at a huge cost to the NHS (4).
Failure to base treatment recommendations on an accurate knowledge of
the life-cycle of the head louse (5) compounds the confusion. It must be
acknowledged that there is no formulated product available which kills
eggs with certainty, and some perform so poorly against hatched lice that
“they potentially expose users to repeat applications without any
important reduction in infestations” (6). The situation is illustrated by
a report to the Welsh Assembly in 2003 of an 8.3% prevalence rate of head
lice in primary school children, double that reported in 2000 (7). Across
the UK distress and anger prevail among parents whose expectations of a
solution are raised by promises on product labelling e.g. “a single
application ... will kill head lice and their eggs”, “for
the fast effective treatment of head lice and their eggs” and then dashed.
In the interest of the public health and fairness to product users,
evidence should be produced by clinical evaluation in the UK community
where parents follow the manufacturers’ instructions. Information on the
quantity to use, the time to leave it on the head, and the number of
applications is required. The practicality of the application and removal
methods should be assessed. Realistic statements such as “Enough for one
application to shoulder length hair”, “X minutes/hours application time”
and “X number of applications required to complete treatment” should
appear on a product label. For products containing insecticides to which
lice become resistant, the date of the last clinical evaluation should be
displayed with the percentage success rate. An accurate statement on the
incubation period of head louse eggs, the consequent need to make a
thorough check for lice 5 and 12 days after treatment applications, and
the appropriate practical tips about product use should always be included
in the instructions.
We call for an open debate of these issues which places the
regulatory framework in the public domain.
Joanna Ibarra, Programme Co-ordinator,
Frances Fry, Development Worker,
Clarice Wickenden, Health Education Adviser,
Jane Lesely Smith, Assistant Development Worker
Community Hygiene Concern, Reg Charity No: 801371, Manor Gardens
Centre, 6-9 Manor Gardens, London N7 6LA
www.chc.org
bugbusters2k@yahoo.co.uk
References
(1) Burgess IF, Brown CM, Lee PN. (2005)Treatment of head louse
infestation with 4% dimeticone lotion: randomised controlled equivalence
trial. BMJ 330: 1423-5 (Full text Online first, BMJ,
doi:10.1136/bmj.38497.506481.8F(10 June 2005)
(2) Joint Formulary Committee. British National Formulary, entry
13.10.4, Parasiticidal preparations. London: British Medical Association
and Royal Pharmaceutical Society of Great Britain, 1981- (updated March
and September each year)
(3) Aston R, Duggal H, Simpson J, advised by Burgess I, Medical
Entomology Centre, Cambridge. Head lice. Report for Consultants in
Communicable Disease Control (CCDCs) 1998 (www.fam-
english.demon.co.uk/phmeghl.htm)
(4) Board NJ. Professional carer experience.
http://bmj.bmjjournals.com/cgi/eletters/331/7513/384 (20 November 2005)
(5) Buxton P A. The Louse. An account of the lice which infest man,
their medical importance and control. London: Edward Arnold & Co,
1947
(6) Hill N, Moor G, Cameron MM, Butlin A, Preston S, Williamson MS,
Bass C. Single blind, randomised, comparative study of the Bug Buster kit
and over the counter pediculicide treatments against head lice in the
United Kingdom. BMJ 2005; 311: 384-6 (Full text Online first, BMJ,
doi:10.1136/bmj.38537.468623.EO (5 August 2005)
(7) Roberts RJ, Casey D, Morgan DA, Petrovic M. Comparison of wet
combing with malathion for treatment of head lice in the UK: a pragmatic
randomised controlled trial. Lancet 2000;356: 540-4
Competing interests:
Community Hygiene Concern is a charity, part-funded by sales of the Bug Buster Kit on a non-profit making basis.
Competing interests: No competing interests