Expanding treatment options for skin infections

The age of the “selfie” has increased the age of the patient who may come into your practice presenting with head lice.

Because selfies are often taken with more than one person leaning their heads together for that perfect moment with friends or family, head lice have the freedom to move from head to head. , which means it was once traditionally a problem reserved for children, has expanded the according to Theodore Rosen, MD, who is a professor of dermatology at Baylor College of Medicine in Houston, Texas, and discussed lice treatments and d other issues at the Florida Society of Dermatology Physician Assistants New Wave Dermatology Conference being held this week in Coral Gables, Florida.1

According to the CDC’s website, “Although reliable data on the number of people in the United States who get head lice each year are not available, an estimated 6 to 12 million infestations occur each year in the United States. United in children from 3 to 11 years old.

The good news, Rosen said, is that there is an over-the-counter ivermectin lotion that was approved in October 2020 that can treat patients older than 6 months. He noted that although the retail price is in the hundreds of dollars, there are online coupons that can be found that can lower that price significantly for patients in need of this treatment.

Discussing other parasitic skin infections, Rosen said scabies is becoming less and less responsive to therapies, citing a report in the Review of the European Academy of Dermatology and Venereology that noted of 155 patients in an Italian study, only 34 responded to permethrin.2

Despite declining response rates to some treatments, new options are now available, he said, noting that spinosad (Natroba; ParaPRO) received FDA approval roughly a year ago. , on April 28, 2021. According to a press release from the company, spinosad has been approved. for head lice in 2011, and the approval for scabies was based on more recent data from randomized multicenter phase 3 trials. He noted the convenience of this drug, as it is a single application and is indicated for patients over 4 years of age.

Another area where resistance is observed is in oral antifungals. Citing a study in the British Journal of Dermatology who demonstrated limited efficacy of 4 major oral antifungals, fluconazole, griseiofulvin, itraconazole and terbinafine in the current epidemic of impaired dermatophytosis in India.3

In this study of 200 patients with microscopically confirmed ringworm, “all drugs were equally ineffective, with cure rates of 8% or less (P = 0 42). At 8 weeks, the numbers of cured patients were as follows: fluconazole 21 (42%), griseofulvin 7 (14%), itraconazole 33 (66%) and terbinafine 14 (28%) (P

On the bright side, however, Rosen said, is that there are a number of potential antifungals in various stages of development, and one that’s currently approved that attacks the cell membrane. He said seeing this research developed gives hope to patients battling these troublesome skin conditions.


  1. Rosen T. New anti-infectives and why we need them. Presented at: New Wave Dermatology Conference. April 28-May 1, 2022. Coral Gables, Florida.
  2. Balestri R. Scabies becomes less responsive to permethrin treatment J European Academy of Derm Ven. July 26, 2021.
  3. Singh S, Chandra U, Anchan VN, et al. Limited efficacy of four oral antifungal drugs in the current epidemic of impaired dermatophytosis in India: results of a pragmatic randomized trial. Br J Dermatol. 2020, 183(5):840-846.