最近剛好有衛生局關心關於頭蝨的治療除了"必去蝨"以外的選擇?
突然想起自己在幾年前也有講過關於這部份的教育訓練:
http://tw.classf0001.urlifelinks.com/css000000011634/cm7kfile-1158810016-7688-2431.ppt
在搜尋過關於最近的變化之後,將一些心得與大家分享並作為紀錄:
1. http://www.skintherapyletter.com/2000/5.1/1.html 稍微摘要一下
Scabies and lice have afflicted man since ancient times. Permethrin is generally the treatment of choice for head lice and scabies, because of its residual effect. Toxicity and absorption are minimal. Ivermectin should be reserved for cases where permethrin fails.
百滅寧 Nix (permetherin 1%) 仍是目前治療頭蝨與疥蟲的首選,其毒性與吸收都很輕微.
Ivermectin (口服) 則是作為百滅寧無效時的選擇.
關於台灣常用的"必去蝨 (Lindane)" : 仍有90%以上成功率, 但有permethrin 40倍以上的經皮吸收,故有癲癇等中樞神經系統副作用,切勿於使用前洗澡,以避免吸收過多.
(For lice, lindane has a 90% success rate, but there are concerns about side effects involving the central nervous system if improperly used.
Seizures secondary to this medication have been reported, particularly when this medication was applied to wet skin or to skin altered by inflammatory changes that cause easy absorption. The absorption rate may be ≥ 40 times that of permethrin, leading to a significant potential for toxicity. Bathing prior to application should be avoided. Hair should be washed with plain shampoo and dried thoroughly before applying lindane. Children should not apply lindane without adult supervision)
2. Spinosad 0.9% (Natroba)
美國FDA 核准用於4歲以上的頭蝨用藥
根據2011發表的數據顯示, spinosad 0.9% 使用一次且不需梳掉蟲卵的療效與 permethrin 治療兩次相當;且使用兩倍的濃度時,血液中仍偵測不到濃度,可證明其經皮吸收屬於較低; 主要副作用在於使用時對眼睛與皮膚的刺激. 單一次的治癒率約85%
目前台灣治療仍是以"必去蝨" Lindane 為主,因其毒性問題仍是需要積極尋求其他安全可靠的治療.
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