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Snapshot
  • A 5-year-old girl comes home from school reporting itching. Her mom notices that she is scratching her hair. She finds out that other children at the school are suffering from similar symptoms. They present to the pediatrician's office, where a careful examination shows viable nits 0.5 cm away from base of the hair shaft. She is prescribed topical permethrin. (Pediculus capitis infection)
Introduction
  • Drugs
    • permethrin
      • topical as lotion or shampoo
    • malathion
      • topical as cream or shampoo
    • lindane
      • topical as lotion, cream, or shampoo
  • Clinical use
    • Sarcoptes scabiei (scabies)
    • Pediculus capitis (lice)
    • Pthirus pubis (lice)
Permethrin
  • Mechanism of action
    • inhibits deactivation of sodium channels, leading to neuronal membrane depolarization and paralysis in the louse or mite
  • Adverse effects
    • skin irritation
    • burning sensation
Malathion
  • Mechanism of action
    • inhibits acetylcholinesterase
  • Adverse effects
    • hypersensitivity
    • skin irritation
Lindane
  • Mechanism of action
    • inhibits GABA channels, leading to neurotoxicity in the louse or mite
  • Clinical use
    • not indicated in crusted scabies
    • typically not used as a first-line agent
  • Adverse effects
    • skin irritation
    • anxiety
 

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