Efficacy and Safety of a Mineral Oil-Based Head Lice Shampoo: A Randomized, Controlled, Investigator-Blinded, Comparative Study

PLoS One. 2016 Jun 10;11(6):e0156853. doi: 10.1371/journal.pone.0156853. eCollection 2016.

Abstract

Background: Due to increased resistance and safety concerns with insecticide-based pediculicides, there is growing demand for head lice treatments with a physical mode of action. Certain mineral oils kill lice by blocking spiracles or by disrupting the epicuticular wax layer. The present study was performed to evaluate efficacy and safety of a mineral oil-based shampoo.

Methods: This randomized, controlled, investigator-blinded, monocentric study (EudraCT registration no. 2014-002918-23) was performed from October 2014-June 2015 in Germany. A mineral oil shampoo (Mosquito® Med Läuse Shampoo 10 in Germany, Paranix or Silcap shampoo elsewhere), registered as medical device, was compared to a conventional, locally reimbursed, pyrethroid-based pediculicide (Goldgeist® Forte solution). In total, 107 patients (>1 year) with confirmed head lice infestation were included (test arm: n = 53; control arm: n = 54). All subjects received two applications of either test or control product at day 0 and day 7, according to the instructions for use. Efficacy and safety was evaluated directly, 1h and 24h after first application, before and after second treatment, and at day 10. The main objective was demonstrating a cure rate for the test product, being superior to 70% at day 10.

Results: Cure rates at day 10 (corrected for re-infestation) for the test product (96.1%) and control (94%) significantly exceeded the pre-defined target (70%) (p < 0.001, 2-sided, 1-sample, chi-square test) with confirmed non-inferiority for the test product. Over all visits, cure rates were consistently higher for the test product, whereas more initially-cured subjects remained lice-free until end of study (78%; control: 60%). Both products were safe and well tolerated, offering good esthetical effects.

Conclusion: This study showed that substance-based medical devices (including the tested mineral oil shampoo) can be safe and effective alternatives for insecticide-based pediculicides, with less risk for development of resistance because of the physical mode of action.

Trial registration: German Clinical Trials Register (DRKS) DRKS00009753 and EudraCT database 2014-002918-23.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Administration, Topical
  • Adolescent
  • Adult
  • Animals
  • Child
  • Child, Preschool
  • Female
  • Hair Preparations / administration & dosage*
  • Hair Preparations / adverse effects*
  • Humans
  • Insecticides / administration & dosage
  • Insecticides / adverse effects
  • Lice Infestations / drug therapy*
  • Male
  • Middle Aged
  • Mineral Oil / administration & dosage*
  • Mineral Oil / adverse effects*
  • Pediculus / drug effects*
  • Scalp Dermatoses / drug therapy
  • Treatment Outcome
  • Young Adult

Substances

  • Hair Preparations
  • Insecticides
  • Mineral Oil

Grants and funding

Funder of the study was Oystershell Laboratories who is also the manufacturer of the test product. The co-authors Bart Russel and Frank Eertmans are company members of Oystershell Laboratories. The sponsor was involved in the study planning as well as in the decision to publish, but was not involved in data collection, data analysis and data interpretation. Oystershell Laboratories engaged the CRO CardioSec Clinical Research GmbH to design and perform the study. First author MD Doerte Wolf is managing director of CardioSec Clinical Research. She was the principle investigator of the study and responsible for study design as well as data collection. Co-author Luise Wolf is employed by CardioSec Clinical Research GmbH. Co-author Els Adriaens is an independent self-employed statistician who performed the post hoc analyses on behalf of Oystershell Laboratories. Planned statistical analysis was performed by Dr. Thomas Keller, ACOMED Statistik, who is a self employed statistician acting in this study on behalf of the CRO. The specific roles of these authors are articulated in the ‘author contributions’ section.