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Publications

Updated: 19 April 2017

Appropriate Use of Head Lice Treatments

Prescriber Update 38(1): 14-15
March 2017

Key Messages

  • Head lice treatments should only be used if the presence of live lice are confirmed.
  • Serious side effects are rare with head lice treatments but are more common when treatment is applied more frequently or in higher doses than recommended.
  • Healthcare professionals should advise consumers that Para Plus is potentially flammable and should not be applied close to a naked flame (eg, cigarette or candle) or an external heat source (eg, heater or hairdryer).


Head lice treatments are widely used in New Zealand. Products with a range of active ingredients, including insecticides and essential oils, are available (Table 1). PHARMAC currently funds Para Plus aerosol spray* and Parasidose shampoo.

Table 1: Examples of head lice treatments available in New Zealand (this is not an exhaustive list)

Active Ingredient(s) Type of product Brand/Product Sponsor
Permethrin Insecticide Lice Clear Scalp lotion AFT Pharmaceuticals Ltd
Quedella Head Lice Treatment Scalp lotion Orion Laboratories (NZ) Ltd
Phenothrin/ pyrethrin/ pyrethrum Insecticide Parasidose Shampoo, Extra strength Multichem NZ Limited
Malathion/ permethrin/ piperonyl butoxide Insecticide Para Plus aerosol spray Orion laboratories
Eucalyptus oil/ Lemon tree oil Suffocant Moov head lice solutions Douglas Pharmaceuticals Ltd
Benzyl alcohol Suffocant Neutralice Wilson Consumer Products


Despite the high use of head lice treatments, adverse drug reactions (ADRs) are rarely reported in New Zealand. Since 2006, the Centre for Adverse Reactions Monitoring (CARM) has received a total of 12 ADR reports associated with head lice treatments.

The majority of these cases were non-serious and included reactions such as pruritus, rash, dermatitis and application site reaction, consistent with the known safety profile of head lice treatments1,2. However, three of the reports were serious.

One of the serious reports concerned a child who suffered burns to the face when Para Plus ignited during application (although no source of ignition was identified). The report noted that Para Plus was being used frequently. No other reports of ignition of Para Plus were identified in New Zealand or internationally, which suggests that this is an extremely rare adverse effect. The product packaging of Para Plus includes a warning not to use near a naked flame (eg, cigarette or candle) or an external heat source (eg, heater or hairdryer) due to presence of flammable hydrocarbons (butane and propane) in the aerosol.

Healthcare professionals should advise consumers on the appropriate use of head lice treatments, including frequency of use and amount to be applied. Insecticide based head lice treatments should only be used if live lice are present. Head lice treatments are not recommended as preventatives. Do not use medicated treatments more frequently than recommended by the manufacturer’s instructions. If head lice persists, alternative treatment is required.

* Para Plus aerosol spray was delisted from the Pharmaceutical Schedule effective 1 January 2017.

References
  1. Hartley M. 2010. Insecticides and the skin. URL: dermnetnz.org/topics/insecticides-and-the-skin/ (accessed 01 February 2017).
  2. Goldstein A, Goldstein B. 2015. Pediculosis capatis. UpToDate. URL: uptodate.com/contents/pediculosis-capitis?source=search_result&search=Pediculosis%20capitis&selectedTitle=1~37#H9 (accessed 01 February 2017).
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