Neem as a Low-risk Alternative Treatment for Head Lice

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By: Markus Sommer, M.D.

Der Merkurstab | 5 5. Jahrgang | 2002 | Heft 6

Judging by the fourth plague called down upon the Egyptians (Exodus 8:17), lice appear to be an ancient affliction of humanity. At that time their appearance was expected to bring about a change of heart (unsuccessfully), while in our times we are primarily concerned with external measures for ridding ourselves of them. By wintertime at the latest in our practice, we can expect to be asked what we recommend for treating head lice, which are so prone to spreading. Cloakrooms at schools and kindergardens, where woolen caps hang side by side, are one of their favorite spots; hence it is school doctors who are most often confronted with the problem. Despite the social stigma still often attached to cases of lice, numerous studies indicate that head lice—unlike body lice or, in my opinion, genital lice—are not associated with poor hygiene or low social status. However, there do appear to be great racial differences in susceptibility. Extensive investigations have shown conclusively that the incidence of lice is far lower among Blacks. Studies in the United States involving about 15,000 students found lice 36 times less frequently among African-Americans than among Whites (1), a phenomenon that may be related to differences in hair type.

In order to kill lice, insecticides are generally used. Most of these are not specifics, but are neurotoxins whose injurious actions primarily affect the parasites on the scalp by taking advantage of their unfavorable surface area to body mass ratio. In certain cases, however, they can also have damaging effects on the human being, as I have demonstrated in detail in this journal (1994), citing a panoply of literature, some of it quite disturbing(2). Instead of repeating this here, let me point to some unproblematic alternatives based our present state of knowledge. Two harmless but not always feasible physical measures are cutting the hair short and applying heat. The latter method can be effectively carried out with a hairdresser's drying hood, since head lice die when exposed to temperatures over 45 °C for extended periods. Care should be taken not to exceed 53 °C, as this could damage the hair as well. Since these creatures flee heat and will seek shelter in clothing and on the patient's body, a thin bathing cap should be worn. Dampening the hair with vinegar water (1 Tbs. vinegar to 1/2 – 1 liter water) will quell these ectoparasites’ biting urge, which is excited by heat. Small and very restless children cannot receive the drying hood treatment, as the minimum time for it is one hour.

No matter which of the suggested methods is chosen, it is essential that the children's surroundings be thoroughly cleaned and clothing, sheets, etc. washed at over 50 °C. Stuffed animals and other objects that cannot be subjected to such high temperatures can be made louse-free by deep freezing for at least 3 days at –15 °C or colder. When no other approach is possible, it should also suffice to completely isolate the infested object from human contact for more than 10 days: Nits hatch after a gestation period not exceeding 8 days and once hatched, the animals cannot live beyond a maximum of 2 days without nourishment—of which human blood is essentially their only source (3).

Another safe approach is to treat the child’s head with an oil that clogs the insects' breathing pores. Unfortunately, the commercially available preparations contain problematic additives (especially synthetic musk aroma, which is reputed to have a carcinogenic action) (4). Instead of these ready-made preparations, one can proceed safely by emulsifying sunflower or olive oil with a standard shampoo and massaging it into the hair, or else using warmed coconut oil as is commonly done in India (although its effectiveness in combatting lice is less certain). Spots from dripping oil can be prevented by carrying out the treatment in the bathtub or wrapping the head in a large towel for protection. To ensure that the lice are killed, the oil must be allowed to act for several hours. In addition, the treatment must be repeated 3 and 10 days later in order to reach animals newly hatched from nits. Furthermore, in all recommended methods, nits must be carefully removed using a nit comb. They will come loose more easily if the hair is first dampened with vinegar water. The recommended combing direction is from the tips to the roots of the hair. The areas usually most heavily affected are the back of the head and around the ears. Sections of hair already searched can be marked with a hairgrip and set aside.

In the article published 8 years ago we drew attention to the Neem tree, which is used in Southeast Asia in combatting lice and other insect pests as well as for internal treatment for worms, gastritis, rheumatic complaints and skin ailments. Twigs from the Neem tree are also widely used as “toothbrushes.” Chewing on the end of a twig produces a bundle of fibers that is well suited for tooth cleaning, as it gives off aromatic–tasting and anti-inflammatory substances that promote oral hygiene. Because of their toxicological safety, low production cost, favorable eco-toxicological properties and the ease of cultivating the tree in the tropics (Azadirachta indica), Neem preparations are now used across the globe to fight migratory locusts and other insect pests (5). In our latitudes as well, a purified Neem extract (NeemAzal) has been successfully tested on a great number of plant pests (6) and has been authorized in Germany as a plant protection agent (7). NeemAzal preparations have also been successfully used in combatting clothes moths and other textile pests (8), as well as in home environment treatment to prevent dust mite allergies. The preparation Milbiol, made by Biocur, has been licensed for this use based on its success in long-term studies.

What is particularly remarkable about Neem extracts is their highly specific insectistatic action, which operates essentially by influencing the insects’ molting process. This is why death of the insects does not ensue immediately (and the discovery of living lice after application is no sign of failure), but only at the next molting of the growing animal. There is however an inhibiting effect on the animals’ eating and biting behavior even before molting, so that complaints such as itching of the scalp mostly recede after the initial application. In vitro tests with Neem extract demonstrated that its inhibiting effect on cell growth is approximately 106 times more powerful on insect cells than on the three different mammalian cell lines included in the study (9). Reports from India refer to cases of poisoning after oral intake of Neem oil by children, who developed symptoms reminiscent of Reye Syndrome (10). It is assumed however that the intoxication was due not to the Neem oil itself but to mycotoxin impurities (aflatoxins B and G) (11). The Trifolio-M company of Lahnau, which works intensively with organic approaches to pest control, has produced a purified and certified aflatoxin-free Neem extract in shampoo form suitable for louse control, although it is officially marketed as a “hair care product for lice control.” The NeemAzal extract contained in it has been thoroughly tested in animal tests, and very minimal toxicity was found with oral application (no cases of lethality, only temporary apathy and bristling of fur in rodents at extremely high concentration). No symptoms similar to those of Reye Syndrome mentioned above were observed; hence it can be assumed that the substance responsible for the isolated cases of acute toxicity of non-purified Neem oil was eliminated in the extraction and purification process (12). Dermal compatibility was very good: Long-term studies revealed no indications of carcinogenic action and genotoxicity tests in bacteria, mammalian cells and mice gave negative results (13). The results of two-generation feeding studies with rats showed no indications of reproductive impairment with oral administration (N.B.: in vaginal application, Neem extracts have been successfully tested as a spermicide in India); nor have any teratogenic effects been observed.

Niemann and Hilbig of the Bundesinstitut für gesundheitlichen Verbraucherschutz (7) summarize as follows: “Based on the available data from valid toxicological studies, Neem Azal-T/S can be assumed to pose no health risk to the applier or user.”

At the pediatric clinic of Iserlohn a clinical study (14) was conducted on a product now available in pharmacies under the name of “Neem-Extrakt FT-Shampoo” (generally the manufacturer must be indicated as well). In this study, children were treated both for head lice and scab mites (for which tests are now in process). With head lice, the treatment was particularly successful when the hair was shampooed on the 1st, 3rd and 10th day. The shampoo should be allowed to act for at least 10-20 minutes. Undesirable side effects were rarely observed: Out of 160 patients, 8 found the smell offensive, 3 developed itching of the scalp, 2 reported that the shampoo burned their eyes, and one patient with neurodermatitis exhibited “poor compatibility” for the product.

Neem tree at the edge of the Thar Desert in India.
Leaves of the Neem tree.
Careful grooming of the hair is the basis of successful louse control.
The nit comb, fashioned in a simple manner in India, remains an important tool in louse control.

In the pediatric practice of Georg Soldner and in my own practice, by now about 80 patients have been treated with this preparation, which is available in a 60-ml bottle for individual use and a 200-ml container for family treatment. With correct use, the complaints rapidly disappeared. At the end of the application period no lice could be detected and we observed no side effects at all (even in patients with skin sensitivities). In addition, Neem Hair Lotion (Wala) appears to be suitable as a preventive measure against lice. Unlike the product discussed above, it is made from the leaves, not the seeds, of the Neem tree. There is also an insect repellent action that has been described in Neem preparations, independent of their insectistatic action,and this appears to be responsible for their prophylactic effect. According to personal communications from parents, use of the hair lotion has protected their children from contracting lice even when fellow students (in developing countries) were subject to heavy infestation.

Altogether, Neem preparations appear to offer a genuine, low-risk alternative treatment for head lice, assuming caution is taken in using only products of good pharmaceutical quality that have been tested for aflatoxins. The Neem tree exemplifies very well a statement made by Rudolf Steiner: Plants which are subject only to pathologies stemming from external causes such as pests possess an over-abundance of etheric forces, which provides them with resistance (15). This is especially true of the Neem tree, which is why it is remarkably free of insect pests. Its curative actions can also be used for the benefit of human beings when the need arises to resist external parasites. It should not be concealed that in individual cases there are repeated recurrences, and these require treatment of the deeper inner causes. The therapy will be quite individual and may have to consider a variety of aspects. A situation involving astral tension, for example, seems to have an attractive action on the parasites. The therapy may range from administration of potentized sulphur (which apparently reduces perspiration favorable to parasites) to resolving burdensome family and social situations or prescribing curative eurythmy. In many cases of recurrent infestation with parasites - including oxyuria and others -the “big A" exercise is effective, which Rudolf Steiner spoke of as “working against the animal nature in man” (16).

Markus Sommer
Praxisgemeinschaft der Ärzte
Korselt, Soldner, Sommer
Josef-Retzer-Straße 36
D-81241 München

Literature and Notes

  1. Jurannek DD. Epidemiologic investigations of pediculosis captitis in school children. Scabies and Pediculosis,168 – 173, Philadelphia1977
  2. Sommer M. Kopflausbehandlung – nur mit dem Risiko Neurologischer Schäden? Merkurstab 47 (1994) 484 – 486
  3. Busvine E. Pediculosis: Biology of the parasites. in: Orkin M. et al.: Scabies and pediculosis. 143 – 152, Philadelphia 1977
  4. Ökotest, Heft 25, 1998
  5. Ketkar CM, Ketkar MS. Different uses of neem (Azadirachta indica . Juss). in: Kleeberg H. (ed.): Practice oriented results on use and
    production of neem ingredients and pheromones, Lahnau 1993
  6. Hummel E, Kleeberg H. Neue Ergebnisse zur praktischen Anwendung von NeemAzal-Formulierungen. Mitteilungen der Deutschen Gesellschaft für allgemeine und angewandte
    Entomologie. 11 (1997) 331 – 335
  7. Niemann L, Hilbig V. Die gesundheitliche Bewertung des Einsatzes von Naturstoffen im Pflanzenschutz am Beispiel von Neemkernextrakten. Gesunde Pflanzen 52 (2000) 135 – 141
  8. Kleeberg H, Hummel E,Troß R, Schlicht A. Laboruntersuchungen zur Anwendung von NeemAzal-Formulierungen im Textilienschutz
    gegen Kleidermotten Tineola bisselliella (Lep.,Tineidae) und Polsterwarenkäfer Anthrenus vorax (Col., Dermestidae) in: Practice
    Oriented Results on Use and Production of Neem-Ingredients and Pheromones, Proceedings of the 6th workshop, Lahnau 2000
  9. Jabbar A, Strang RHC. A comparison of the effects of Azadirachtin A on cultured insect and mammalian cells. In: Kleeberg H. (ed.): Practice oriented results on use and production of Neem-ingredients and pheromones. Proceedings of the 7. workshop. Lahnau 1998
  10. Sinniah D, Baskaran G. Margosa oil poisoning as a cause of Reyes syndrome. Lancet (1981), 487 – 489
  11. Niemann L, Hilbig B. Die gesundheitliche Bewertung des Einsatzes von Naturstoffen im Pflanzenschutz am Beispiel von Neemkernextrakten. Gesunde Pflanzen 52 (2000) 135 – 141
  12. Niemann L.Toxikologie und Rückstandssituation bei niem- und pyrethrinhaltigen Pflanzenschutzpräparaten. Berichte aus der
    Biologischen Bundesanstalt für Land- und Forstwirtschaft. Heft 76, 2001, 68 – 76
  13. A survey of these findings is found in Niemann und Hilbig (l.c.), who are active at the Bundesinstitut für gesundheitl. Verbraucherschutz und Veterinärmedizin.

  14. Knust FJ.NEEM – Therapie der Pediculosis capitis und der Scabies im Kindesalter. Arzt und Umwelt, 11 (1998) 319 – 322

  15. Steiner R. Manifestations of Karma, lecture 3 of May 18, 1910. GA120. Rudolf Steiner Verlag Dornach 1992

  16. Steiner R. Curative Eurythmy, lecture 2 of April 13, 1921. GA 315. Rudolf Steiner Verlag Dornach 1981. A good overview is also found in: National Resaerch Council. Neem: A tree for solving
    global problems. Washinton 1992; Schmutterer H. The Neem tree,
    Weinheim 1995

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