Development of a paw paw herbal shampoo for the removal of head lice

Antiparasitic Activity of Tea Tree Oil (TTO) and Its Components against Medically Important Ectoparasites: A Systematic Review

Ectoparasites are pathogens that can infect the skin and cause immense pain, discomfort, and disease. They are typically managed with insecticides. However, the fast-emerging antimicrobial resistance and the slow rate of development of new bio-actives combined with environmental and health concerns over the continued use of neurotoxic insecticides warrant newer and alternative methods of control. Tea tree oil (TTO), as an alternative agent, has shown remarkable promise against ectoparasites in recent studies. To our knowledge, this is the first systematic review to assess preclinical and clinical studies exploring the antiparasitic activity of TTO and its components against clinically significant ectoparasites, such as Demodex mites, scabies mites, house dust mites, lice, fleas, chiggers, and bed bugs. We systematically searched databases, including PubMed, MEDLINE (EBSCOhost), Embase (Scopus), CENTRAL, Cochrane Library, CINAHL, ScienceDirect, Web of Science, SciELO, and LILACS in any language from inception to 4 April 2022. Studies exploring the therapeutic activity of TTO and its components against the ectoparasites were eligible. We used the ToxRTool (Toxicological data reliability assessment) tool, the Joanna Briggs Institute (JBI) critical appraisal tools, and the Jadad scale to assess the methodological qualities of preclinical (in vitro and in vivo) studies, non-randomised controlled trials (including cohort, case series, and case studies), and randomised controlled trials, respectively. Of 497 identified records, 71 studies were included in this systematic review, and most (66%) had high methodological quality. The findings of this review revealed the promising efficacy of TTO and its components against ectoparasites of medical importance. Most importantly, the compelling in vitro activity of TTO against ectoparasites noted in this review seems to have translated well into the clinical environment. The promising outcomes observed in clinical studies provide enough evidence to justify the use of TTO in the pharmacotherapy of ectoparasitic infections.

Lice update: new solutions to an old problem

An estimated 6 to 12 million children are affected by lice annually in the United States.(1) Knowledge of the various treatment options for this diagnosis is essential. This paper aims to provide an overview of the myriad therapeutic options available for lice infestations in children. U.S. Food and Drug Administration-approved drugs, off-label drug therapies, over-the counter-products, and herbal remedies are all discussed in detail. Clinicians may use this information to teach patients and families about the latest available care for the eradication of head lice in pediatric patients.

Tocopheryl acetate 20% spray for elimination of head louse infestation: a randomised controlled trial comparing with 1% permethrin creme rinse

Background

Tocopheryl acetate is viscous oily fluid used in a range of preparations for skin and scalp care in Italy. Observational and in vitro data have suggested a high level of efficacy against head louse infestation. The purpose of this investigation was to confirm the activity of tocopheryl acetate in a clinical setting in comparison with a standard widely used preparation.

Methods

A spray formulation containing tocopheryl acetate 20% in cyclomethicone was compared with permethrin 1% creme rinse for treatment of head louse infestation in a randomised, assessor blind, trial. Forty-five people were treated on two occasions 7 days apart. The spray was applied to dry hair for 20 minutes then washed. Participants treated with permethrin washed their hair and towel dried it before treatment for 10 minutes. Assessments were made by dry detection combing 1, 6, 9, and 14 days after first treatment.

Results

The tocopheryl acetate 20% spray was significantly (p = 0.033) more effective than permethrin 1%, using intention to treat worst case analysis, in which there were 13/23 (56.5%) successful treatments for tocopheryl acetate compared with 5/22 (22.7%) for permethrin. After unprecedented issues of re-infestation within households had been taken into account the underlying cure rate was 17/23 (73.9%) for tocopheryl acetate compared with 5/22 (22.7%), Odds Ratio 9.63 (95% CI, 2.46 to 37.68) (p < 0.001).

Conclusions

The tocopheryl acetate spray was significantly more effective than the permethrin product, was cosmetically acceptable, and not affected by current problems with resistance.

Trial registration

Current Controlled Trials ISRCTN45553737.

Assessment of the efficacy and safety of a new treatment for head lice

Infestation with head lice is a widespread, persistent, and recurring issue leading to serious health problems if untreated. We are facing resistance phenomena to usual pediculicides and questions about their direct or cumulative toxicity. The aim of this trial was to assess the efficacy of a new product, free of chemical insecticides but with a physical effect. This product contains components whose antilice efficacy has already been demonstrated, as well as Andiroba oil which asphyxiates the lice and Quassia vinegar which dissolves the chitin of the nits (they are then inactivated). 30 patients with head lice infestation, aged 3–39 years, applied the treatment one to three times, 5 days apart. Cure was defined as the absence of live lice after 5, 10, or 14 days, and symptoms are usually associated with infestation. Easiness and safety of the treatment were assessed by the patients and/or their parents. Overall cure rates were 20% on D5 after one treatment, 37% on D10 after two treatments, and 90% on D14 after three treatments. Symptoms such as itch, scalp dryness, redness, and flakiness rapidly diminished. This treatment seems to be a beneficial addition or a valuable alternative to existing treatments, considering the total absence of chemical insecticides, the absence of drug-resistance induction in head lice, the absence of major toxicological risks compared with usual pediculicides, and the favourable patient use instructions.

Characterization of n-Hexane sub-fraction of Bridelia micrantha (Berth) and its antimycobacterium activity

Background

Tuberculosis, caused by Mycobacterium tuberculosis (MTB), is the most notified disease in the world. Development of resistance to first line drugs by MTB is a public health concern. As a result, there is the search for new and novel sources of antimycobacterial drugs for example from medicinal plants. In this study we determined the in vitro antimycobacterial activity of n-Hexane sub-fraction from Bridelia micrantha (Berth) against MTB H₃₇Ra and a clinical isolate resistant to all five first-line antituberculosis drugs.

Methods

The antimycobacterial activity of the n-Hexane sub-fraction of ethyl acetate fractions from acetone extracts of B. micrantha barks was evaluated using the resazurin microplate assay against two MTB isolates. Bioassay-guided fractionation of the ethyl acetate fraction was performed using 100% n-Hexane and Chloroform/Methanol (99:1) as solvents in order of increasing polarity by column chromatography and Resazurin microtiter plate assay for susceptibility tests.

Results

The n-Hexane fraction showed 20% inhibition of MTB H₃₇Ra and almost 35% inhibition of an MTB isolate resistant to all first-line drugs at 10 μg/mL. GC/MS analysis of the fraction resulted in the identification of twenty-four constituents representing 60.5% of the fraction. Some of the 24 compounds detected included Benzene, 1.3-bis (3-phenoxyphenoxy (13.51%), 2-pinen-4-one (10.03%), N(b)-benzyl-14-(carboxymethyl) (6.35%) and the least detected compound was linalool (0.2%).

Conclusions

The results show that the n-Hexane fraction of B. micrantha has antimycobacterial activity.

In vitro efficacy of over-the-counter botanical pediculicides against the head louse Pediculus humanus var capitis based on a stringent standard for mortality assessment

Infestation of the head louse Pediculus humanus var capitis DeGeer (Phthiraptera: Pediculidae) is an important public health problem in Australia, with up to a third of children infested in some primary schools. Insecticide resistance and inadequate attention to the application instructions of topical pediculicides are common reasons for treatment failure. This study evaluated six popular Australian over-the-counter products against head lice, primarily comprised of different botanical extracts, and compared them with permethrin 1% (Quellada) and a non-treatment control in order to assess their in vitro efficacy. We also assessed commonly used criteria for evaluating pediculicide efficacy in vitro. All tested products failed to demonstrate high levels of efficacy with the exception of Tea Tree Gel((R)), which outperformed 1% permethrin. Permethrin had a high level of efficacy, but using stringent criteria 18% of lice were not dead at 3 h, indicating some resistance to Quellada. Commonly used less stringent criteria were shown to overestimate mortality of head lice as a result of the protective phenomenon of stasis or sham death observed in exposed lice that may recover after some time. Using two different levels of stringency resulted in different rankings of efficacy for most products, with the exception of the first ranked product, Tea Tree Gel. Rankings of efficacy also varied over time, even within the different assessment criteria. Government regulatory agencies should require standard in vitro tests using stringent mortality criteria, with an observation period of >or= 6 h, to determine the efficacy of new pediculicides, and only products that cause a minimum mortality rate (e.g. 80%) in head lice collected from the target population should be licensed for sale.

Paw paw and cancer: annonaceous acetogenins from discovery to commercial products

Extracts of paw paw ( Asimina triloba, Annonaceae) are among the most potent of the 3500 species of higher plants screened for bioactive compounds in our laboratories at Purdue University. The paw paw is a small tree native to eastern North America; its edible fruits (sometimes referred to as "Indiana Bananas") have nurtured mankind for centuries. Activity-directed fractionation of the paw paw extracts, using the brine shrimp lethality bioassay, led to the isolation and molecular characterization of over 50 unique annonaceous acetogenins. Fractionation of extracts from related species resulted in the identification of over 150 additional acetogenins. The annonaceous acetogenins are derivatives of long-chain (C32 or C34) fatty acids. They are potent inhibitors of mitochondrial (complex I) as well as cytoplasmic (anaerobic) production of adenosine triphosphate (ATP) and the related nucleotides. The powerful cytotoxicity, in vivo antitumor, pesticidal, antimalarial, anthelmintic, piscicidal, antiviral, and antimicrobial effects indicated a myriad of potentially useful applications. Commercial development of these compounds uses natural mixtures of active components, incorporated into pesticidal, topical, and dietary supplement products. Successful applications and commercial products include a shampoo, highly effective in treating infestations of head lice, fleas, and ticks; a series of pesticidal sprays, which protects host plants against a diversity of pests; and an ointment for treatment of oral herpes (HSV-1) and other skin afflictions. The extract (in capsule form) enhances a mixture of natural anthelmintics. In addition, an encapsulated extract has been effectively used by certain cancer patients as a botanical supplement product.

In vitro pediculicidal and ovicidal activity of an extract and oil from fruits of Melia azedarach L

BACKGROUND

Head louse infestation is difficult to control because of increasing lice resistance to synthetic pediculicidal drugs.

OBJECTIVE

To test the activity of extract and oil obtained from fruits of Melia azedarach L. against the head louse Pediculus humanus capitis.

METHODS

A filter paper diffusion bioassay was carried out in order to determine the pediculicidal and ovicidal activity of extract and oil from M azedarach L. fruits.

RESULTS

Both vegetable products, tested either individually or in combinations, showed high levels of mortality on adult lice, with values ranging between 62.9% and 96.5%. The highest mortality rate was obtained with a combination of 20% ripe fruit extract with 10% ripe fruit oil. A formulation made with both extract and oil at 10% plus the addition of emulsifier and preserving agents showed 92.3% pediculicidal activity. The products were also successful in delaying or inhibiting nymph emergence, with the formulation being the most effective, with a complete inhibition of emergence.

LIMITATIONS

Because adult lice are sensitive to starvation and therefore control mortalities are often higher than 20% in tests with field specimens, the results may not reflect the direct effect of the extract.

CONCLUSIONS

These results demonstrate the possibility of using Melia products for controlling head lice, which are difficult to control because of their resistance to the currently used anti-louse agents.

A review of the toxicity of Melaleuca alternifolia (tea tree) oil

The essential oil of Melaleuca alternifolia, also known as tea tree or melaleuca oil, is widely available and has been investigated as an alternative antimicrobial, anti-inflammatory and anti-cancer agent. While these properties are increasingly well characterised, relatively limited data are available on the safety and toxicity of the oil. Anecdotal evidence from almost 80 years of use suggests that the topical use of the oil is relatively safe, and that adverse events are minor, self-limiting and occasional. Published data indicate that TTO is toxic if ingested in higher doses and can also cause skin irritation at higher concentrations. Allergic reactions to TTO occur in predisposed individuals and may be due to the various oxidation products that are formed by exposure of the oil to light and/or air. Adverse reactions may be minimised by avoiding ingestion, applying only diluted oil topically and using oil that has been stored correctly. Data from individual components suggest that TTO has the potential to be developmentally toxic if ingested at higher doses, however, TTO and its components are not genotoxic. The limited ecotoxicity data available indicate that TTO is toxic to some insect species but more studies are required.

A new shampoo based on neem (Azadirachta indica) is highly effective against head lice in vitro

Because topical compounds based on insecticidal chemicals are the mainstay of head lice treatment, but resistance is increasing, alternatives, such as herbs and oils are being sold to treat head lice. To test a commercial shampoo based on seed extract of Azadirachta indica (neem tree) for its in vitro effect, head lice (n=17) were collected from school children in Australia and immersed in Wash-Away Louse shampoo (Alpha-Biocare GmbH, Germany). Vitality was evaluated for more than 3 h by examination under a dissecting microscope. Positive and negative controls were a commercially available head lice treatment containing permethrin 1% (n=19) and no treatment (n=14). All lice treated with the neem shampoo did not show any vital signs from the initial examination after immersion at 5-30 min; after 3 h, only a single louse showed minor signs of life, indicated by gut movements, a mortality of 94%. In the permethrin group, mortality was 20% at 5 min, 50% at 15 min, and 74% after 3 h. All 14 head lice of the negative control group survived during the observation period. Our data show that Wash-Away Louse is highly effective in vitro against head lice. The neem shampoo was more effective than the permethrin-based product. We speculate that complex plant-based compounds will replace the well-defined chemical pediculicides if resistance to the commonly used products further increases.

In vitro and in vivo killing of ocular Demodex by tea tree oil

AIMS

To compare the in vitro killing effect of different agents on Demodex and to report the in vivo killing effect of tea tree oil (TTO) on ocular Demodex.

METHODS

Survival time of Demodex was measured under the microscope. Sampling and counting of Demodex was performed by a modified method.

RESULTS

Demodex folliculorum survived for more than 150 minutes in 10% povidone-iodine, 75% alcohol, 50% baby shampoo, and 4% pilocarpine. However, the survival time was significantly shortened to within 15 minutes in 100% alcohol, 100% TTO, 100% caraway oil, or 100% dill weed oil. TTO's in vitro killing effect was dose dependent. Lid scrub with 50% TTO, but not with 50% baby shampoo, can further stimulate Demodex to move out to the skin. The Demodex count did not reach zero in any of the seven patients receiving daily lid scrub with baby shampoo for 40-350 days. In contrast, the Demodex count dropped to zero in seven of nine patients receiving TTO scrub in 4 weeks without recurrence.

CONCLUSIONS

Demodex is resistant to a wide range of antiseptic solutions. Weekly lid scrub with 50% TTO and daily lid scrub with tea tree shampoo is effective in eradicating ocular Demodex.

Acaricidal properties of the essential oil of Melaleuca alternifolia Cheel (tea tree oil) against nymphs of Ixodes ricinus

The aim of the study was to examine the acaricidal effect of essential oil of Melaleuca alternifolia (tea tree oil, TTO) at different doses (4, 6, 8 and 10 microl) and for different exposure times (30, 60, 90 and 120 min) on nymphs of Ixodes ricinus. A dose of 8 microl TTO was lethal for more than 70% of ticks when inhaled and this effect was enhanced when the dose was increased to 10 microl (> 80%). The effect was correlated with the duration of exposure of ticks to TTO, with a significant effect being observed after 90 min exposure. The findings show that TTO has acaricidal properties and could be extremely useful in controlling ticks that are efficient vectors of pathogens.

Ectoparasites--the underestimated realm

CONTEXT

Ectoparasitoses (infestations with parasites that live on or in the skin) can cause considerable morbidity. Whereas pediculosis and scabies are ubiquitous, cutaneous larva migrans and tungiasis (sand-flea disease) occur mainly in hot climates. The prevalence of ectoparasitoses in the general population is usually low, but can be high in vulnerable groups. Scientific knowledge on how to deal best with parasitic skin diseases in different settings is scanty, and evidence-based measures for control are not available. For head lice and scabies the situation is daunting, because resistance of Pediculus humanus capitis and Sarcoptes scabiei to insecticides is spreading and unpredictable.

STARTING POINT

J Hunter and S Barker reported different patterns of resistance in schoolchildren in Brisbane, Australia: full resistance to malathion, permethrin, and pyrethrum in two schools, whereas head lice were susceptible to malathion and, to a lesser extent, to pyrethrums in three other schools (Parasitol Res 2003; 90: 476-78). K Yoon and colleagues found different resistance patterns in the USA and Ecuador (Arch Dermatol 2003; 139: 994-1000). Head lice from Florida were less susceptible to permethrin than those from Texas, and parasites from Ecuador were susceptible to both insecticides tested. WHERE NEXT? The occurrence of resistant pediculosis and scabies is expected to increase numerically and geographically. Clinicoepidemiological studies are urgently needed to identify the factors which govern the emergence and spread of strains of P humanus capitis and S scabiei that are resistant to insecticide or acaricide. Oral treatment with ivermectin could substitute for topically applied compounds, particularly in resource-poor communities where polyparasitism is common. A better understanding of local epidemiology is required to develop control measures. This knowledge has to be applied in combination with environmental sanitation, health education, and culturally acceptable interventions that are affordable by the underprivileged.

Inhibitory effects on mitochondrial complex I of semisynthetic mono-Tetrahydrofuran acetogenin derivatives

Modifications in the terminal alpha,beta-unsaturated gamma-methyl-gamma-lactone moiety or in the alkyl chain that links this terminal gamma-lactone with the alpha,alpha'-dihydroxylated THF system of the natural mono-tetrahydrofuranic acetogenins, annonacin and annonacinone, led to the preparation of eight semisynthetic derivatives. Their inhibitory effects on mitochondrial complex I is discussed and compared with that of the classical complex I inhibitor, rotenone.