Background: This study evaluates a herbal shampoo containing Gharaghorot, vinegar, and Ajwain for managing head lice, particularly in resource-limited settings.

Methods: The herbal shampoo formulation constituted 100% final solution, composed of: 28.85% Gharaghorot extract (prepared from sour yogurt juice), 67.31% apple cider vinegar, 2.88% Ajwain (Trachyspermum ammi) essential oil, and 0.96% xanthan gum (a biocompatible thickening agent). Cell toxicity and sterility were assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and fluid thioglycollate and soybean casein digest media, respectively. Irritation and sensitization tests were conducted on rabbits and guinea pigs, respectively. A ran­domized controlled trial with 114 patients compared the herbal shampoo to standard Permethrin treatment (Permethrin shampoo 1%). Participants applied the shampoo daily for one hour over seven days, with efficacy evaluated by counting live lice and nits before treatment, three days in, and seven days post-treatment.

Results: The herbal shampoo exhibited no significant cytotoxicity at concentrations of 10% or lower. The shampoo did not cause sensitization, edema, or erythema. Microbial contamination analysis showed no detectable levels of aerobic or anaerobic bacteria or fungal spores. In the human study, the intervention group showed a 0% prevalence of live lice by the seventh day, compared to 50% in the permethrin group (P= 0.021), and a significant reduction in lice eggs to 42% versus 100% in the permethrin group (P= 0.025).

Conclusion: The herbal shampoo demonstrated safety, microbiological purity, and notable efficacy in reducing live head lice and partial effectiveness against nits (42% egg viability post-treatment).

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