Head lice infestations, while not a health hazard or indicative of poor hygiene, can cause considerable anxiety and are a familiar problem, especially among children. Effective management involves a combination of strategies, with nit removal combs playing a crucial role. This article explores the effectiveness of nit removal combs, their proper usage, and their place in an integrated approach to head lice control.
The head louse, Pediculus humanus capitis, is a wingless insect that lives on the human scalp, feeding on blood. Adult lice are about the size of a sesame seed, ranging in color from beige to gray. They crawl but cannot hop, fly, or jump. Lice eggs, called nits, are oval and tiny (about 0.8 mm), camouflaged to match the host's hair pigment. Female lice glue nits to hair shafts close to the scalp, and these eggs hatch in 7 to 10 days.
Nit removal combs are designed to physically remove lice and nits from the hair shaft. A lice comb can help detect lice and remove both the lice and their nits (eggs). The use of a fine comb for removing lice from the head of the human host is a relevant tool both in the diagnosis of infestations and as part of an integrated control strategy of head lice. Don't overlook the value of nit combing. "Combing works," says Dr. Claire McCarthy, a pediatrician at Harvard-affiliated Boston Children's Hospital. "It takes patience and perseverance, but not only does it get rid of both live lice and eggs, it's completely nontoxic and without side effects.
Young lice or adults may be seen or collected with a comb. The fine-toothed comb, called a nit comb, is used from the scalp to the end of the hair. Guidelines suggest looking at wet hair that's coated with hair conditioner or other products.
To kill head lice and lice eggs, you can use a few methods. Wet combing, smothering or dehydrating are ways to kill head lice. Or you can use medicine available with or without a prescription. The medicine may not kill the newest eggs. So a second treatment at the right time to kill nymphs may be needed. Wet Combing Combing wet hair with a fine-toothed nit comb may remove lice and some nits. You can do this after treatment of the scalp with a medicine or in place of a medicine. Start by wetting the hair or coating it with hair conditioner or other products that can slow lice. Some options are products with dimethicone, mayonnaise, or petroleum jelly.
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The effectiveness of a fine comb depends, in part, on the design and material they are built. A high-quality lice comb has long, fine, metal teeth that are very close together. Some experts say not to bother with plastic combs or the ones that come in the lice medicine packages. The best combs are available online (or possibly at your local drugstore) and from lice salons. You may see or hear about electronic combs, but according to Richard Pollack, a lice expert at the Harvard School of Public Health, the electronic versions probably offer no advantage over a traditional, well-designed lice comb.
Studies have found that a lice comb is the best tool for finding live lice.
The aim of one study was to compare in vivo the efficacy of metal and plastic combs that are currently used in the removal of head lice and eggs worldwide. The assays were performed comparing the combs in pairs: (a) KSL® vs. NOPUCID® plastic combs, (b) KSL® vs. ASSY® metal combs and (c) KSL® plastic comb vs. ASSY® metal comb. The most effective plastic comb was KSL®, removing a higher number of individuals of all stages. The most effective metal comb was ASSY®, removing more insects of all stages (except adults).
To properly use a lice comb, follow the wet-combing method:
A lice comb is a good diagnostic device, too. Even if you’re determined to not use an OTC lice treatment, though, or lice treatments have failed you, combing can eradicate a lice infestation.
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While combing can be a highly effective method if you're very careful and consistent about doing it, it's important to consider it as part of an integrated strategy. Lice combing can be done in addition to applying lice treatments such as permethrin or pyrethrin, or on its own.
If you decide to use an over-the-counter (OTC) lice treatment product, follow all directions carefully. Avoid washing your hair for 2 days after applying the product to allow the medication to work, but continue using a lice comb daily.
If the correct use of a treatment you get without a prescription has failed, your healthcare professional may suggest prescription treatments. Spinosad (Natroba). Spinosad is for adults and children age 6 months and older. Apply to dry hair. Leave on for 10 minutes. Rinse with warm water over a sink to keep the lotion from getting on the skin. Don't shampoo hair for 24 to 48 hours. Repeat in seven days if you see lice. Malathion. Malathion is for adults and children age 6 years and older. Put the lotion on the hair and leave it on for 8 to 12 hours. Then rinse it out using warm water over a sink to keep it from getting on the skin. Don't shampoo hair for 24 to 48 hours. Repeat in seven days if you see lice. This medicine is flammable, which means it can cause fires. Don't use it with a hair dryer or curling iron or near an open flame. Ivermectin (Stromectol). This is a prescription that you take by mouth. You can give it to children who weigh more than 33 pounds (15 kilograms) if topical treatments don't rid the scalp of head lice. You can repeat it in 7 to 10 days if needed.
The FDA approved ivermectin for head lice in February 2012. That decision was based on two trials that included a total of 765 adults and children older than six months. Both were randomized, double-blind, placebo-controlled trials. That means people with head lice, or their caregivers, were given a coded 4-ounce tube to use. The contents of the tube were applied to dry hair and the scalp, left on for 10 minutes, then rinsed off with water. No one was supposed to use a comb to remove nits (juvenile lice) attached to hair strands. A clinician checked the person's head two days later, then again one and two weeks later. On day two, 95% of those who used the ivermectin lotion were louse free, compared to 31% of those who used the placebo lotion. Some people in the study experienced side effects, which include eye irritation, a burning sensation in the skin, and skin redness. The trials compared ivermectin with a placebo, not another head lice treatment known to be an effective way of treating head lice and nits.
If your child's hair is too hard to comb - too fine or long or thick or curly to get a comb through over and over again - you're going to have a hard time getting the lice out using a comb. Though it's pricey, a lice removal service can be a great option, saving you time and worry. These salons and individuals are skilled at comb-outs and topical treatments, and they know how to keep kids occupied. Look online for one in your area or ask at school for a recommendation. Another option worth considering is cutting your child's hair. A shaved head means an instant end to head lice, but this solution is usually only acceptable to boys. For girls, you may be able to save yourself and your child a lot of time and frustration by cutting her hair short (so it's easier to comb out) or shaving the back of her neck (a key place for lice to hide and lay their eggs). You'll have to do it yourself, of course, since you can't take a child with lice to a hair salon.
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If lice are an ongoing problem in your area, try combing out hair once a month. "Regular comb-outs are the best prevention," says one mom whose daughter had lice twice. "The minute I see one of those lice warning notes from school, I sit my daughter down for a combing. I also comb her hair out after sleepovers or other outings where the kids are close together. We haven't had lice since." With school back in session, I’ll probably do preventative combing of my kids’ hair every few weeks, just to be sure they haven’t caught any bugs from friends.
While you may be able to effectively treat lice at home with combing and OTC medications, contact a doctor if you or another member of your household experiences reinfestation. They may recommend a prescription product instead, which is available for children as young as 6 months old. You should also consider speaking with a doctor before using home remedies for lice. Kitchen items such as olive oil, butter, and mayonnaise may temporarily make lice less active, but research on their effectiveness to kill lice is lacking.
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