Wet combing to eradicate head lice

Dr Vander Stichele and his colleagues (July 2002 JRSM¹) make a welcome contribution to the debate on the merits of wet combing for the detection and treatment of head lice. The comb they have tested is the Bug Buster comb². This forms part of the kit now available in the UK on NHS prescription to assist parents who are encouraged to remedy head lice at home. However, the Belgian researchers do not seem to have tested the full Bug Busting method. In our experience, dry and damp lice move swiftly away from disturbance created by combing, thus evading detection. We find that it is important to shampoo and rinse the hair before applying conditioner. This takes moisture (which temporarily immobilizes lice) to the hair roots, their main habitat. The omission of shampooing in the Belgian study produces a protocol which is easier for school screening, but not the most effective.

Moreover, the Bug Busting wet combing method consists of combing sessions on days 1, 5, 9 and 13. At each session the hatched lice on the head are removed, leaving the eggs, which take a maximum of 10 days to hatch. It is therefore expected that lice which hatched on day 10 will be found during the fourth session. The cure rate should be measured at a further, fifth, session; by doing this at the fourth session, Vander Stichele and colleagues may have counted possible successes as failures.

We suggest that the Belgian protocol of wetting the hair is an improvement on spraying only where hair-washing cannot be carried out. It is definitely an advance on applying conditioner to dry hair. Wetting the hair may prove to be the most sensitive protocol that is feasible in mass screening. It should be tested against the full Bug Busting method.