Trends in Pediculicide Usage in Turkey

Abstract

Aim: Head louse infestation caused by Pediculus humanus capitis is a serious public health problem all over the world. Increased prevalence of infestations over the years causes an increase in treatmentrelated costs and the development of resistance to pediculicides. In this study, it was aimed to evaluate the sales of pediculicides in Turkey, the treatment trends, the preference for given products, and the possible development of resistance over a 5-year period (2015-2019). Methods: Data regarding products which were sold with prescription and with the permission of the Ministry of Health of the Republic of Turkey, were formally requested from the IQVIA-Turkey Office/Intercontinental Medical Statistics (IMS) database and the relevant companies. Annual sales units of pharmacologically (permethrin, sumithrin, and pyrethrin plus piperonyl butoxide) and physically (dimethicone) active pediculicides were included (, but not products based on plant extracts and which do not have the permission to be sold as pediculicides). A cost-analysis was made according to sale prices in a given year. Results: In 2015, a total of 2,452,846 units of pediculicides were sold, while their sales decreased to 2,146,856 units in 2019. With 4,365,578 units (38.7%) sumithrin-based products were the most sold pediculicides, followed by dimethicone-based ones with 4,034,141 units (35.7%), and pyrethrins plus piperonyl butoxide with 342,083 units (3%). While the consumption of pyrethrin-, permethrin- and sumithrin-based pediculicides decreases over the years, the consumption of physically acting products containing dimethicone has increased. The overall price of pediculicides for the consumer during the last five years increased by 2.27 times, mainly due to the high inflation rate in the country. Conclusion: Since pediculosis is not reportable in Turkey, the prevalence of head louse infestation, the treatment modalities and the effectiveness of these products are poorly known. There are many indications that local lice became resistant to pyrethrin- and pyrethroid-based products, which would explain the decrease in their sales, while dimethicone based products are gaining popularity and there are reasons to believe that this trend will continue also in the future.