Alcohol-based head lice products
The potential hazards of alcohol-based head lice treatments should be understood, including the risk that they may trigger asthma in susceptible people. Alcoholic lotions should not be used for people with asthma and young children as inhalation of alcohol fumes may precipitate bronchospasm. Nor should they be used for patients with eczema as alcohol may cause inflammation and stinging. The British National Formulary (March 2005) advises, in relation to alcoholic formulations, that “…aqueous formulations are preferred in severe eczema, for patients with asthma, and small children.” The manufacturers of Electric Blue Natural Head Lice products would like to confirm that their products contain no alcohol. Since inception back in 1999, the product label has stated so to enable consumers to make an informed choice, & to distinguish Electric Blue products from others which may not be suitable for vulnerable groups of people.

Asthma and eczema
Alcohol based lice treatments should not be used for asthmatics or  young children. Although not widely appreciated, alcoholic fumes may inflame the airways that line the lungs. This may trigger bronchospasm that causes an asthma attack. Alcohol based formulations should also not be used for people with eczema as alcohol may cause inflammation and stinging of the skin. 

Children, and pregnant or lactating women
There is no data to assert safety of headlice lotions or creams on children under 2 years old, nor in pregnant or lactating women. Therefore for such people, headlice applications should be used only with medical advice. Otherwise, treatment should involve removal of nits, nymphs (immature adult lice), and adults by hand or nit comb.

Sassafras Oil
In a State Health Department’s educational pamphlet, sassafras oil (together with olive and tea tree oils) is described as ‘alternative remedies’ for headlice, without any qualification on whether it should be diluted or used ‘neat’. Sassafras oil was traditionally used and is listed in the British Herbal Pharmacopoeia for headlice treatment. However, we need to be aware of its potential hazards. Small doses of  sassafras oil, if consumed, are toxic to both the nervous system and to the liver. Two to 3 millilitres (just over half a teaspoonful) accidentally consumed by a child is sufficient to cause respiratory paralysis. The oil is absorbed through intact skin, and is widely recognised to be a cancer causing substance. For more information, please read Dr Eggspert's explanation of the distinction between a “non-poison” and a “harmless substance”.

Western Australia
In literature quoting results from an overseas University School of Pharmacy, Australian manufacturers of an alcohol-based product containing tea tree oil and lavender oil described it as "safe and effective" and "non-irritating and non-sensitizing". A product containing the same ingredients was cited by the Therapeutic Goods Administration (TGA) as having numerous reports of "adverse dermal events". The TGA subsequently estimated an incidence of adverse dermal events "of the order of 0-3%."

United States of America
A well-known multinational U.S.A. manufacturer of head lice products described its product as "safe" even though its own records disclosed safety problems in people with allergies, and the risk of irritation to eyes and other mucous membranes. The same manufacturer also mislead customers into thinking a lice infestation could be cured with a single application. A U.S. State Attorney General directed that the company be required to re-label its packaging to advise that a second application is required. The same manufacturer also claimed 100% efficacy for its egg removal comb, based on laboratory tests conducted by trained testers! The Company was disciplined by the New York State Attorney General and agreed to amend or desist from such misleading advertising. However the same company manufactures the same product in Australia with the offending claims on the label.

Lindane
Around the same time, the Ketorac Company wrote to the National Health & Medical Research Council (NH&MRC) advising concerns about the safety and effectiveness of treatments available at that time. Particularly, the use of lindane and malathion in the NH&MRC's (then) recommendations for treatment.

Malathion
Even though public health codes ban statements suggesting that pesticides are safe, an Australian Public Health agency is on record stating that malathion is safe. In fact, the particular health department wrote "I can assure you that the Health Department considers malathion a very safe and effective treatment for head lice infestation." The same health department also states that "the Medical Entomology Centre at the University of Cambridge England" continues to recommend malathion for head lice.

Let's dissect the health department's statements and compare them with the facts. The Medical Entomology Centre (in a private communication to this writer) advised that it never had any link with the University of Cambridge!

On safety
The Medical Entomology Centre advises that "malathion absorption averaged around 3% of the applied dose, (and)… the toxicological effects will depend on the purity of the insecticides - the more impurities the more toxic." Furthermore, "…the malathion ingredient in the most popularly promoted Australian product is considerably less stable than the material used in the UK so it will always have more impurities when it reaches the consumer.

On effectiveness
The Centre advised that "Malathion…is not a particularly effective treatment because it has little ovicidal activity". In fact, it killed only 35% to 37% of the eggs, no matter what the label claimed! Nonsense is nonsence - no matter who puts it out!

Use in children
Because 3% to 8% is absorbed through intact skin, the Ketorac Company questions the wisdom and ethics of using malathion on children - a very vulnerable group which bears most head lice infestations. The difficult issue on safety of organophosphates (including malathion) is the possibility that chronic exposure to low doses may produce neuropsychiatric disease without the warning cholinergic symptoms (dry mouth, blurred vision, nausea, confused thinking). It is well established that exposure to organophosphates depletes the neurotransmitter 'acetylcholine' and produces symptoms of illness. What is in doubt is whether long-term exposure to much smaller doses (that cause no immediate symptoms) may have the same effect! Look out for updates on these malathion notes.