Head lice can be controlled without application of insecticide lotions

Editor—Dawes et al’s evidence based case report about treatment for head lice was interesting as an exercise in evidence searching, but the authors failed to ask the right question in the first place.¹ A more useful research question would have been, “In children attending primary care with head lice, what is the most effective intervention that will keep the problem under control?”

Head lice are most prevalent in primary school children, and the average number of adult lice per child is only 8-10.² This does not constitute a major health hazard, and there is little evidence of an association with impetigo as quoted in the article. Insecticide lotions are effective in killing head lice if used correctly, but what is the point of using repeated applications of chemicals on schoolchildren? The children may be cleared of head lice by insecticide lotion one day, only for them to be reinfected on their return to school the next day. Extensive and expensive campaigns in the past, with entire communities being treated with insecticide lotion, have shown that reinfection from outside sources occurs quickly.

Wet combing (combing through wet, well conditioned hair with a fine toothed nit comb), if done correctly and repeated every three days, will control the problem by physical removal of the lice.³ A plastic nit comb, a short teaching session with the Community Hygiene Concern’s training video (160 Inderwick Rd, London N8 9JT), and support from health professionals will enable parents to take control of the problem of head lice in their children. In the long term, surely this is more effective and environmentally friendly than repeat prescribing of insecticide lotion.