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Background  Treatment of head lice using physically acting preparations based on silicones is currently replacing insecticide use due to widespread resistance to neurotoxic agents. It has been postulated that some products act by asphyxiation, although the limited experimental evidence and the anatomy of the louse respiratory system suggest this is unlikely.    Results  Observation over several hours of lice treated using 4% high molecular weight dimeticone in a volatile silicone base showed that, although rapidly immobilised initially, the insects still exhibited small movements of extremities and death was delayed. One common effect of treatment is inhibition of the louse's ability to excrete water by transpiration through the spiracles. Inability to excrete water that is ingested as part of the louse blood meal appears to subject the louse gut to osmotic stress resulting in rupture. Scanning electron microscopy coupled with X-ray microanalysis to detect silicon showed dimeticone lotion is deposited in the spiracles and distal region of the tracheae of lice and in some cases blocks the lumen or opening entirely.    Conclusion  This work raises doubts that lice treated using dimeticone preparations die from anoxia despite blockage of the outer respiratory tract because movements can be observed for hours after exposure. However, the blockage inhibits water excretion, which causes physiological stress that leads to death either through prolonged immobilisation or, in some cases, disruption of internal organs such as the gut.

The mode of action of dimeticone 4% lotion against head lice, Pediculus capitis