lice + warts

What is the brand name for Cyrotherapy- Dimethyl ether?

Wartner Wart Removal, Compound W/ Freeze Off, Dr. Scholl’s Freeze Away

What are the application steps of Dimethyl ether?

Apply once. If after 14 days the wart is still present, apply another treatment, up to 4 treatments max→ 12 weeks

What is the MOA for Cryotherapy?

1. Keratolytic: destroys wart by freezing tissue. As tissue freezes, microthrombi form, leading to ischemic necrosis and destruction of the HPV-infected cells.

2. Irritant: local irritation and inflammation that may clear wart through immune response

How long do you apply a cryotherapy product for?

Plantar wart: 40 sec, Common wart: 20 sec

What are the side effects of cyrotherapy?

pain (goes away within an hour), blistering and black dots, scarring/hypo/hyperpigmentation, tendon/nerve damage, kill healthy tissue around wart

Is cryotherapy safe in preg/bf? What are the age restrictions?

Yes; 4+

What are two cautions associated with cryotherapy?

Flammable; pts who lack sensitivity, diabetes, etc.

What is the brand name for cryotherapy- nitrous oxide?

Compound W Nitrofreeze

How do you apply nitrofreeze?

Apply once for 10-40 seconds, depending on wart size and location. May treat again in 14 days if wart is still present, can do this up to three times total.

Which cryotherapy is stronger?

Nitrous oxide has a stronger freeze than dimethyl ether products

What does 40% salicylic acid treat? What does 17% salicylic acid treat?

Plantar warts; common warts

What are the name brands for 40% salicylic acid?

Compound W Pads, Curad Mediplast, Dr. Scholl’s clear strips/plantar discs/ultra thin disks, Duofilm Patch for kids, PediFex Wart Stick

What are the 20% Salicyic acid procducts?

Compound W Fast Acting Gel/Liquid, Dr. Scholl’s liquid, Duofilm liquid

How do you apply salicylic acid?

Apply every 24-48 hours depending on the product up to 6-12 weeks

Is salicylic acid safe in preg/bf? What is the age limit?

Yes; 3+

What is the MOA for salicylic acid?

1. Keratolytic: acid slowly destroys the virus-infected cells

2. Irritant: local irritation and clears the wart through an immune repsonse

What are the side effects for salicylic acid?

Skin color changes, potential systemic toxicity, can kill healthy tissue

Is salicylic acid painful?

No

What are the cons for salicylic acid?

Adherence, slow onset of 6-12 weeks, flammable

What are the cautions with Salicylic acid?

Avoid with ASA allergy, pts with lack of sensitivity

What are the steps of using silver duct tape?

1. Apply to wart and leave in place for 6 days

2. Remove duct tape on day 6 in the evening

3. On the next morning, soak wart in warm water for 5 mins, remove top layer of skin with disposable emery board and place a new piece of duct tape to wart

4. Repeat process up to 2-3 months or until the wart is resolved (4-12 weeks)

What is the patient education for Pyrethrins shampoo (piperonyl butoxide 2-4%)

1. apply to dry hair, behind ears and back of neck

2. Leave in for 10 min

3. Rinse hair

4. Comb for lice afterwards to remove eggs

5. Retreat at day 9. Do not apply more than 2x/day

What is the MOA for pyrethrins?

Block nerve impulse transmission to paralyze and kill lice, only works on live adult lice

What is the MOA of piperonyl butoxide?

inhibits breakdown of pyrethin

What does pyrethrin shampoo/piperonyl butoxide treat?

Head and pubic lice

What are the side effects of Piperonyl butoxide?

Irritation, erythema, itching, swelling

What is the age restriction for Piperonyl butoxide? If it safe in preg/bf?

2+; safe in bf, safer options available for preg

What are two cons associated with Piperonyl butoxide (Rid)?

Excessive contact time may increase absorption, resistance common in superlice

What are two cautions with Piperonyl butoxide?

Avoid contact with eyes, avoid in pts with pyrethrin/chrysanthemum/ragweed allergy

What is the brand name for pyrthrins (piperonyl butoxide) and permethrin?

Pyrethrin: Rid shampoo, Permethrin: Nix cream rinse

What does Nix treat? What is the age range?

Head lice; 2 months+

What is the patient education for Permethrin (Nix)?

1. wash hair with shampoo and no conditioner

2. Apply cream to hair, behind the ears, and back of neck

3. Leave in for 10 min then rinse hair

4. Comb for lice afterwards to remove eggs and help kill lice

5. Due to resistance, recommend retreat at day 9, do not apply more than 2x/day

What is the MOA for permethrin?

synthetic pyrethroid; block nerve impulse transmission to paralyze and kill lice, only works on live adult lice

What are the side effects of Nix?

Greasiness, transient pruritus, burning, stinging, irritation

Which can be used with ragweed/pyrethrin/chrysanthemum allergy?

Permethrin cream rinse

How long does Nix last?

10 days

Which is more effective? Pyrethrins or permethrin?

Permethrin is more effective with one treatment, but both are similar with 2 treatments

Is Nix safe in preg/bf?

Preg: safe but better options exist, bf: safe

Why can you not use conditioner with permethrin?

Conditioners impair permethrin adherence to the hair shaft, reducing its residual effect

Can lice be resistant to permethrin?

Yes

What is a caution with permethrin?

avoid eyes/mucus membranes

What are the brand names for Ivermectin 0.5% Lotion? What is the age limit?

Sklice, Rid one and done; 6 months+

What is the patient education for Sklice?

1. Apply contents of 1 tube to dry hair and thoroughly coat scalp and hair close to scalp

2. Let sit 10 min

3. Rinse lotion out with water

4. Do not wash hair with shampoo for 24-48 hours

What are the side effects of Sklice?

Rare: conjunctivitis, ocular hyperemia, eye irritation, dandruff, dry skin, skin burning sensation

How many applications are required of Ivermectin lotion/Sklice?

One→ also recommended to comb through

Does Sklice work on lice resistance?

May work

Is sklice safe in preg/bf?

Avoid, there are safer products

What is the con for Sklice?

More expensive than pyrethrins/permethrins

What is the patient education for Nix Ultra (dimethicone)?

1. Apply solution to dry hair

2. leave for 10 min

3. rinse and shampoo

4. use nit comb

5. Do not apply conditioner, most people need 2 doses (7-9 days) apart

What is the MOA for Nix Ultra?

Silicone oil that physically clogs breathing holes and prevents the excretion of water. Also lubes hair to aid in removal of nits and lice. Affects adult lice which have breathing holes, nits need to be combed out with a nit comb

What are the side effects for Nix Ultra?

Greasy, slippery, rare: scalp erythema, irritation, flaking

What are the pros for dimethicone solution?

Potentially more effective, less irritation, easier to comb nits out of

Is Nix Ultra safe in preg/bf? What is the age limit?

yes; 2+

What are the cons of Nix Ultra?

Not FDA approved, kills live lice better than eggs

What product is used in the Nuvo method? What is the age limit? Is it safe in preg/bf?

Cetaphil cleansing lotion; any age; safe in preg/bf

What are the patient education points for Nuvo method?

1. apply to dry hair

2. dry the lotion with a hair dryer

3. Leave on overnight or at least 8 hours

4. Wash hair out next day

5. Repeat weekly 3-4 total treatments

What is the MOA for cetaphil?

covers breathing holes to suffocate lice, and after heated acts to continue suffocation like a shrink wrap film, works on adult lice and nymphs with breathing hole

What is the side effect from nuvo method?

Scalp irritation

What is the pro for nuvo method?

One study found it to be more effective than permethrins/pyrethrins

What are the non pharm options for lice?

Air Alle electronic nit comb; LiceMeister Comb

What is Air Alle MOA?

Air Alle: applies heat to dehydrate and kill the lice and nits, but expensive and requires a tech

Do nymphs have a CNS?

No

What is the MOA for Sklice?

Binds selectively and with high affinity to glutamate-gated chloride channels in invertebrate nerve and muscle cells, which leads to an increase in the permeability of the cell membrane to chloride ions with hyperpolarization of nerve or muscle cell, which results in paralysis and death of the parasite