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Is wet combing effective in children with pediculosis capitis infestation?

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A 6-year-old boy presents to the paediatric emergency department complaining of pruritus affecting his scalp. On examination you notice several nits attached to his hair as well as a few adult head lice. You are considering treatment with pediculocides, but his mother is rather reluctant to use “chemicals”. You consult the BNF for children, which apart from listing three classes of pediculocides – carbaryl, malathion and pyrethroids (permethrin and phenothrin) – outlines the option of using wet combing as an alternative. You wonder whether there is good evidence to support the sole use of this intervention in head lice infestation.

Structured clinical question

In a child with pediculosis capitis infestation [patient], is wet combing alone [intervention] effective in eradicating the parasites [outcome]?

Search strategy and outcome

Cochrane Library using the search terms “head lice” and “pediculosis capitis”: one relevant Cochrane review.1 However, the article dates back to 2001.

PubMed (1950–to date/no limits set) using the search terms “head lice and combing”: 33 articles of which only five articles were relevant,26 which are summarised in table 1. PubMed search using the terms “pediculosis capitis and combing”: 11 articles, all already identified. MeSH database search using the heading “lice infestations” produced no further relevant results.

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Table 1 Treatment for pediculosis capitis infestation

EMBASE database (1974–to date) using the same set of search terms as employed in the PubMed search: 24 results – no additional relevant articles identified.

TRIP database using the same set of search terms as in the PubMed search: 22 results – no further relevant article identified.

Search of multiple trials registers using the same search terms including ISRCTN, NHS, NIH and MRC: eight results – four unrelated to pediculosis, three trials investigating new pediculocides, one investigating “suffocation-based” treatment – thus none relevant. The Cochrane Central Register of Controlled Trials using the same …

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