Gamma Benzene Hexachloride 1% Lotion (Lindane)
Introduction
Gamma Benzene Hexachloride, in short GBH, is an organochlorine insecticide. It has been used topically in a concentration of 1% for scabies and head lice.
However, it is no longer favoured due to
- The rare neurologic adverse effects
- Reported resistance
- It has been classified as carcinogenic to humans in 2015.
In fact, Lindane use is banned in California, United Kingdom, Australia and many Western countries.
Dosing
The recommended duration of GBH 1% lotion application differs, depending on the indication:
- Scabies: Apply a thin layer of lotion and massage it on skin from the neck to the toes; after 8-12 hours, bathe and remove the drug; most patients will require 30 ml; larger adults may require up to 60 ml. Do not re-treat. Do not leave on for more than 12 hours. CDC STD guidelines recommend an 8 hour application.
- Head lice, crab lice: Apply shampoo to dry hair and massage into hair for 4 minutes; add small quantities of water to hair until lather forms, then rinse hair thoroughly and comb with a fine tooth comb to remove nits. Amount of shampoo needed is based on length and density of hair; most patients will require 30 ml (maximum: 60 ml). Do not re-treat.
Precautions
Seizures and death have been reported following lindane use with repeat or prolonged application, but also in rare cases following a single application used according to directions.
- Lindane should be used with caution in infants, children, elderly patients, individuals with other skin conditions, and those who weigh <50 kg, as they may be at risk of serious neurotoxicity.
External Links
- Malaysia CPG - Guideline for management of scabies in adults and children, 2015
- Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States, 2002
- Outcomes of the California ban on pharmaceutical lindane: clinical and ecologic impacts, 2008
- Lindane toxicity: a comprehensive review of the medical literature, 2012
- CDC Sexually Transmitted Diseases Treatment Guidelines, 2015
- Carcinogenicity of lindane, DDT, and 2,4-dichlorophenoxyacetic acid, 2015
What about GBH 0.1%? I got confused between these two concentrations, for what indication and to which population (adult or paeds)
ReplyDeleteMOH formulary 2022 and Topical Preparations Counselling Guide for Pharmacist 2018 suggested GBH 0.1% is indicated for head lice (by leaving on the hair for 4 minutes before rinsing). I personally felt this is probably a misinformation.
DeleteThe lindane concentration highlighted in Lexicomp, Micromedex and Martindale for head lice or scabies is 1%. Even so, the use of lindane 1% is now restricted by resistance and neurotoxicity.
Means we use the same concentration of GBH 1% for adult and children for both scabies and head lice?
DeleteAlthough FDA approved, lindane is not recommended as a treatment option for head lice in pediatric patients <50 kg due to the risk of serious neurotoxicity and use should be avoided if possible. On the other hand, may consider permethrin (5% for scabies or 1% for head lice) for children.
Delete