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Treating lice during breastfeeding

Published
Topics: Cyclomethicone + Isopropyl myristateDimeticoneIsopropyl alcohol · MalathionPermethrinSafety in BreastfeedingSkin disorders ·

Wet combing, dimeticone, malathion or permethrin can be used during breastfeeding; choice will depend on the indication. Other treatments can be considered.

Contents

  1. General considerations
  2. Recommendations
    1. Head Lice
    2. Pubic Lice
  4. Clinical considerations
  5. Specific Recommendations
    1. Wet combing
    2. Dimeticone
    3. Malathion
    4. Isopropyl myristate + cyclomethicone
    5. Isopropyl myristate + isopropyl alcohol
    6. Permethrin
  7. Patient Information
  8. Contact us
  9. About our recommendations
  10. Bibliography

General considerations

It is important to complete an individual risk assessment (SPS page) for your patient and to apply the principles of prescribing in breastfeeding (SPS page) when looking at the available information and making treatment decisions.

This article includes the most commonly used head and pubic lice treatments. Other treatment options are available, and may need to be used for more specialist situations. Contact our specialist service, UK Drugs In Lactation Advisory Service (UKDILAS) (SPS page), for further advice.

Recommendations

Different treatments are used depending on whether it’s head lice or pubic (crab) lice infestation. Choice of preparation should therefore primarily be directed at adequately treating the condition first and preference of application method.

Head Lice

Wet combing or dimeticone are the preferred choices to treat head lice in breastfeeding.

Malathion may also be used as an alternative.

Other preparations (isopropyl myristate/cyclomethicone or isopropyl myristate/isopropyl alcohol) can be considered after other treatment options have failed.

Pubic Lice

Malathion and permethrin can be used to treat pubic lice in breastfeeding.

Clinical considerations

Lice are parasitic insects that infest human hairs. Head lice and pubic lice are different and infest different areas. Any hair on the body can become infested.

Some of the commonly-used products for lice (e.g. Vamousse ®, Derbac M Liquid ®, Full Marks Solution® Lyclear® Dermal Cream) also contain additional ingredients. However, due to treatment being topical, and minimal systemic absorption, transfer into breast milk is not expected. They are therefore considered compatible with breastfeeding when used in the short-term.

Keep hair short or tied up to prevent infant from sucking hair during treatment.

Specific Recommendations

Wet combing hair with a fine toothed comb and normal hair conditioner to remove head lice and their eggs is preferred due to successful eradication without the use of parasiticidal agents.

Dimeticone (e.g. Hedrin 4% lotion®) is a preferred choice treatment in breastfeeding for head lice.

Infant monitoring

No specific infant monitoring is required.

Further information

No evidence is available for the use of dimeticone in breastfeeding. However, it is not absorbed through the skin, therefore transfer into breast milk is not expected.

Dimeticone is likely to be less irritant than other chemical treatments. They are also used extensively in cosmetic formulations and in certain food applications. It is generally regarded as a relatively nontoxic and non-irritant product.

Malathion (e.g. Derbac M 0.5% Liquid®) is a preferred choice treatment in breastfeeding for pubic lice. It can also be used for treating head lice.

Infant monitoring

No specific infant monitoring is required.

Further information

No evidence is available for the use of topical malathion in breastfeeding. Limited evidence suggests that malathion absorbs through the skin in small amounts, which is then rapidly metabolised and excreted. Therefore, it is highly unlikely that any will pass through into breast milk.

Isopropyl myristate / cyclomethicone (e.g. Full Marks Solution®) can be used during breastfeeding for treatment of head lice.

Infant monitoring

No specific infant monitoring is required.

Further information

No evidence is available for the use of topical Isopropyl myristate or cyclomethicone in breastfeeding.

Isopropyl myristate is absorbed through the skin but it is unknown if it transfers into breastmilk.

Cyclomethicone is not thought to absorb through the skin.

Both isopropyl myristate and cyclomethicone are used in cosmetics and topical pharmaceutical formulations and generally regarded as non-toxic and non-irritant.

Isopropyl myristate / isopropyl alcohol (e.g. Vamousse®) can be used during breastfeeding for treatment of head lice.

Infant monitoring

No specific infant monitoring is required.

Further information

No evidence is available for the use of topical isopropyl myristate or isopropyl alcohol in breastfeeding.

Isopropyl alcohol may slowly absorb through intact skin and prolonged skin application may potentially reach systemic circulation and result in side-effects. However, the short application required for treating head lice is highly unlikely to lead to side-effects occurring or clinically significant amount being transferred into breast milk

Both isopropyl myristate and isopropyl alcohol are widely used in cosmetics and topical pharmaceutical formulations and generally regarded as non-toxic and non-irritant.

Permethrin can be used during breastfeeding for treating pubic lice.

Infant monitoring

No specific infant monitoring is required.

Further information

No evidence is available use of topical permethrin during breastfeeding.

However, only very small amounts of permethrin are absorbed in to systemic circulation through topical treatment. It is rapidly metabolised and excreted. Therefore, it is highly unlikely that any will pass through into breast milk.

Patient Information

The NHS website provides advice for patients on head lice and pubic lice.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS) (SPS page), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • the infant is unwell or premature
  • other lice infestations need to be treated
  • the medicine in question is not included in our advice
  • you need further advice

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.

Bibliography

References are available on request.