Posted by Librarian on 4/2/2002, 12:19 pm

Treatment. To date, no treatment applied has been able to bring about complete eradication of the mites. However, many substances used on the scalp and elsewhere on the body have afforded welcome even though temporary relief from the annoying sensation produced by the mites. It would seem that a certain number of the substances employed have actually killed some or all of the adult mites, but have had no effect on the ova. Any substance used on the scalp was applied with sterile cotton or with a pipette, usually being then well rubbed in with the finger tips. Twenty-four to 48 hours was the usual length of time between the application of any one substance and its removal by means of a shampoo, although some substances were left on the scalp for at least a week. The scalp was always shampooed as a preliminary to the application of any substance, and no other substance was used until the preceding one had been thoroughly washed out. After the use of certain of these compounds, a period of two to three months often elapsed before renewed symptoms indicating the presence of the mites were apparent. On circumstantial evidence this might be taken to indicate that the length of time required for the maturation and hatching of a young mite from the ovum is approximately two to three months. There is always the possibility, however, that the young mites may not make their presence felt at once, and that the growth period is really somewhat shorter. Attempts at control have continued actively from 1943 up to the present time. Many substances employed as a possible means of control proved useless for that purpose. Among these may be mentioned: DDT powder, 10% used as for pediculosis; kerosene emulsion with vinegar; Seargant's Mange Cure, which had been of value in treating mange on two pet cats some years before, but was of no help in the present situation; ethyl, normal butyl and isopropyl alcohols, used separately and in varying strengths from 70 to 100%; ether, applied to the scalp a few drops at a time; 3% phenol, also as used for pediculosis. The following chemicals have proved of value in bringing relief, sometimes of a very temporary nature, from the activities of the mite: Sulphur ointment, 15% USP, applied to the scalp or other parts of the body. This could be left on for several days after application. It is one of the most helpful substances employed to date. In the early treatment of mites on the body, a stronger preparation of sulphur was used, made by mixing flowers of sulphur with Crisco or Spry. The exact percent of the sulphur so used was never determined. At one time only during the period of acute symptoms was any sensitivity to sulphur noticed. The ointment used at that time was made up in lanolin. This sensitivity soon disappeared and no indication of it has been felt since that time. Mites treated with sulphur seem to die in situ. Gentian violet, 2 to 5% aqueous solution. This, if left on any affected part of the body for a week or 10 days, and if constantly augmented by additions of the same every few days, proved completely effective in eradicating the small colonies already mentioned, on wrist, knee, fingers and below one ear. Unfortunately it was never feasible to leave this dye on the scalp for more than two days at the most, as it is by no means desirable to go about with one's scalp and hair painted purple. There is also some question as to whether or not gentian violet would prove as effective over areas in which the mites were more deeply located or where they had been "at home" for a considerable period of time. Lysol, a relatively strong solution (4 teaspoonfuls to the pinte, or even somewhat stronger) has proved to be one of the most effective methods of killing the adult mites. It can be used, at this strength, on small areas only. It has the disadvantage of possessing a strong odor and is also hard on the skin. The epidermis usually peels off from any area so treated some time after the use of this solution. In a weaker solution it has been used over the entire scalp following a shampoo, usually being rinsed off in a few hours. It is also by the use of lysol solution that some of the mites have been captured, as noted below. Zemo, both regular and extra strength solutions, has proved of value in reducing the irritation caused by the mites' activities, and may even have killed some of the adult mites. Germicidal soap, 1% mercuric-iodide, used as a shampoo, appears to be quite effective against the mites, but does not eliminate all of them, nor does it appear to have any effect upon the ova. This soap is used quite regularly as a shampoo, and since no ill effects have followed its use except at one period of acute symptoms, it seems evident that this soap cannot have been the causative substance which precipitated the acute attack. No evidence of sensitivity to this soap has been noted. It often causes the mites to migrate, however, which is not desirable if the migration is toward eyes or ears. Zinc oxide ointment. This has been used at times alone or in combination with sulphur ointment, as is sometimes recommended, to alleviate itching on areas of the face and neck. Painted around each eye, it served to prevent the entrance of many mites into the eyes, as they could be felt moving up to this barrier but going no further. In addition, certain other compounds known to be of value in the control of sarcoptic and other forms of mange, have been employed. Of these, the first two were suggested by Dr. Gaines W. Eddy, who has recently published the results of a series of experiments with some new synthetic organic compounds as scabicides (Jour. Investig. Dermatology 12(2): 117-123, 1949). He likewise sent me samples of several of these substances, enough for two or more treatments with each. It seems quite possible at the present writing that one or both of these new chemicals may eventually prove effective in the eradication of our mites. Benzyl salicylate. An aqueous solution of salicylic acid and benzyl ester 10%, in 2% of Tween 20, is the first of these two drugs. Samples of the Tween 20 were kindly donated by the Atlas Powder Company of Wilmington, Del. This has been used on my own scalp for several different doses during the past two months. After each such use, the symptoms were temporarily eliminated, but migration of the mites was quite noticeable. It has recently been employed in the treatment of one of the members of my family, but living mites are still present on her scalp. 2-phenylcyclohexanol 10%, and Tween 20, 2% as an aqueous solution, is the second chemical recommended by Dr. Eddy. The Dow Chemical Company of Midland, Mich., was kind enough to provide me with samples of this compound. It has recently been used on my own scalp. As yet, the results are inconclusive, but again the symptoms are temporarily alleviated. Migration of mites occurs after its use. Ultimate success might be achieved by the frequent repetition of this substance to the scalp and other affected areas, if used repeatedly over a sufficient period of time so as to kill all newly hatched larvae before they reach maturity. Benzyl benzoate. This has been employed in two forms: first as a liquid, and second as an emulsion, the Wellcome brand, which was much used by British scientists during World War II in the treatment of human scabies. Some relief was obtained from its use, particularly when the emulsion was employed. It seemed especially effective against those mites which had located in the pinna of the ears. Migration of the mites after the use of this compound was most pronounced. Recently, the emulsion has been used on small areas of the scalp at double the strength recommended. Some migration has been caused, but many of the mites seem to have been killed in situ. As it is probably unwise to use benzyl benzoate at double strength except on very limited areas, and as it fails to effect complete cure even when so used, this drug cannot be relied upon to control the mite under consideration. Tetraethylthiuram monosulphide. Another remedy much used, and with good success according to the literature on the subject, against human and animal scabies. Used as an alcoholic solution as recommended, it has not proved as useful in the treatment of our mite as have several other substances. It is stated to give excellent control against Sarcoptes and Notoedres, but it seems not to be the answer when used against Dermatophagoides. Gamma isomer of hexachlorocyclohexane. This was used in the form of an ointment sold under the commercial name of KWELL. Ticks and mites are reported to be killed readily by this substance, but not so the mite Dermatophagoides. It was left on the scalp for several days before removal with a shampoo, and almost immediately thereafter the mites could be felt moving about in their accustomed places. 40% aqueous hypo (sodium hyposulfite). This was allowed to dry on the scalp, and was followed by a second application, which was also allowed to dry. Sometimes hypo was used alone, or again was followed by 5% HCl after the second application was thoroughly dry. Both methods often brought relief for several days, even for a week or more. But again the ova were evidently not destroyed. Although this treatment has been repeated many times during the past four years, the mites are still with us. However, it did give temporary relief, and caused only a moderate amount of migration on the part of the mites.