Chen Jacqueline, Mei Angela, Jacques Angela, Ricciardo Bernadette, Bowen Asha
Department of Dermatology, Sir Charles Gairdner Hospital, Perth, Washington, Australia.
Department of Dermatology, Perth Children's Hospital, Perth, Washington, Australia.
PLOS Glob Public Health. 2025 Jul 17;5(7):e0004841. doi: 10.1371/journal.pgph.0004841. eCollection 2025.
Pediculosis capitis is a worldwide prevalent public health issue, mostly involving children. Resistance has been increasingly identified with conventional treatments such as permethrin or malathion. We aimed to evaluate the therapeutic potential of plant-based therapies for pediculosis capitis. PubMed, MEDLINE, Embase, EmCare, Web of Science, Cochrane, and ScienceDirect were searched for studies. Google Scholar was used to identify relevant gray literature from inception until 30th July 2023. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) in English language evaluating a plant-based head lice treatment were considered for inclusion. This review was registered with the International Prospective Register of Systematic Reviews (CRD42023428674). Study characteristics, detection method, outcomes including final cure rate at 1-14 days following last treatment and adverse events were identified. Statistical analysis was performed with one sample t-test and linear mixed models. Random effects meta-analysis using forest-plots were used to describe intervention odds ratio. From 881 records, 20 studies were included comprising 13 RCTs and 7 NRCTs. All 20 studies were qualitatively analyzed and 9 RCTs were quantitatively analyzed. Based on RCT data, certain plant-based interventions may offer improved cure rates with overall higher mean final cure rate 0.86 (95% CI 0.73, 0.99) compared to conventional treatment 0.60 (95% CI 0.25, 0.95), however findings were limited by study heterogeneity (I2 = 83.2%) and methodological constraints. Local cutaneous irritation was the most frequent adverse event. Several limitations were identified, including confounding variables (e.g., inconsistent combing technique and variable plant-based interventions with multiple active ingredients and formulations), small sample sizes and lack of blinding. The risk of bias was high for NRCTs, while RCTs had some concerns. In conclusion, results should be interpreted cautiously in the context of study limitations. Further research is required to elucidate the efficacy and clinical role of plant-based therapies in PC.
头虱病是一个在全球范围内普遍存在的公共卫生问题，主要影响儿童。人们越来越多地发现，诸如氯菊酯或马拉硫磷等传统治疗方法存在耐药性。我们旨在评估基于植物的疗法对头虱病的治疗潜力。检索了PubMed、MEDLINE、Embase、EmCare、Web of Science、Cochrane和ScienceDirect等数据库中的研究。使用谷歌学术搜索从数据库建立至2023年7月30日的相关灰色文献。纳入以英文发表的评估基于植物的头虱治疗方法的随机对照试验（RCT）和非随机对照试验（NRCT）。本综述已在国际前瞻性系统评价注册库（注册号：CRD42023428674）登记。确定了研究特征、检测方法、结局（包括最后一次治疗后1至14天的最终治愈率）和不良事件。采用单样本t检验和线性混合模型进行统计分析。使用森林图进行随机效应荟萃分析以描述干预比值比。从881条记录中，纳入了20项研究，包括13项RCT和7项NRCT。对所有20项研究进行了定性分析，对9项RCT进行了定量分析。基于RCT数据，某些基于植物的干预措施可能具有更高的治愈率，总体平均最终治愈率为0.86（95%CI 0.73，0.99），高于传统治疗的0.60（95%CI 0.25，0.95），然而研究结果受到研究异质性（I2 = 83.2%）和方法学限制的影响。局部皮肤刺激是最常见的不良事件。确定了几个局限性，包括混杂变量（如梳理技术不一致以及基于植物的干预措施多样，含有多种活性成分和剂型）、样本量小和缺乏盲法。NRCT的偏倚风险较高，而RCT也存在一些问题。总之，鉴于研究局限性，对结果的解释应谨慎。需要进一步研究以阐明基于植物的疗法在头虱病治疗中的疗效和临床作用。
