Lindane Shampoo for Head Lice Treatment among Female Secondary School Students in Jeddah, Saudi Arabia: An Interventional Study

Background: We aimed to determine the prevalence of head lice infestation, effectiveness of over-the-counter treatment options, and the effectiveness and safety of lindane shampoo among female Saudi Arabian secondary school students.
Methods: This study was conducted in October-November 2016 in two secondary schools each from the northern and southern parts of Jeddah. Investigators completed a standardized questionnaire. Students’ hair and scalps were examined manually for head lice or scalp lesions. Students with head lice infestation were asked to use 1% lindane shampoo.
Results: Of the 337 students examined, 106 (31%) were infested with live lice and eggs; 55% and 45% were from northern and southern schools, respectively (P=0.02). Among students who shared a comb and those who did not, the prevalence rates of head lice were 67% (n=28) and 33% (n=14), respectively. A history of head lice was more prevalent among students with positive head lice test results (49%) than among those with negative results (40%; P<0.04). A significantly lower number of students with head lice infestation had dark skin color (2/106; 1.9%) than light skin color. Moreover, 70/106 students used over-the-counter pyrethrin-containing pediculicide shampoos (22 [31%] responders, 48 [69%] non-responders). Furthermore, 93/106 (88%) responded to lindane shampoo whereas 13/106 (12%) did not (P ≤ 0.05), with no neurotoxicity reported.
Interpretation: Pediculicide shampoo resistance is common among Saudi Arabian students, and lindane shampoo is a safe and effective treatment.