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Wet combing: head lice

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        13. Wet combing: head lice
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First published: October 2013
Last updated: February 2021


Introduction

Infestations of head lice are common, particularly in school-aged children, occur worldwide and affect people of all ages and socioeconomic groups. Half of the people infested with lice do not scratch. All people in contact with an affected person should be manually checked for lice.

Intervention

Manual (condition and comb or wet comb) removal using a head lice comb. The wet comb method has been shown to be as effective as a 1-week or 2-week course of 1% permethrin lotion.1

Indication

Half of the people infested with lice do not scratch. All people in contact with an affected person should be manually checked for lice.

Figure 1.

Figure 1.

Head lice (Pediculosis capitis)

 

 

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Figure 2.

Figure 2.

Lice egg attached to hair shaft

Attribution: Wabeggs, CC0, via Wikimedia Commons
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Suitable for insecticide resistant infestations.

Suitable for pregnant and breastfeeding women, babies, people with allergies or open scalp wounds and asthma.

Good alternative for people who are reluctant to use insecticides.

Precautions

None

Adverse effects

No serious adverse effects have been reported.

Availability

Wet comb with a head lice comb is a low-cost way of removing head lice.1

Nit combs are available from pharmacies and some supermarkets. The teeth of the comb should be just wider than the hair. More than one comb may be necessary, starting with a wide-toothed comb and then moving to fine-toothed combs.

Description

How to perform wet combing:

  1. Using a wide-toothed comb, comb out any tangles from the hair.
  2. Apply a generous amount of conditioner to all of the dry hair, making sure to cover the hair roots.
  3. Place a fine-toothed headlice comb flat against the scalp and draw the comb through each section of hair from the roots to the ends.
  4. Check the comb for lice after each stroke, and remove them by wiping onto a paper towel or tissue or rinsing the comb.
  5. Comb each section of hair at least five times.
  6. Wash the hair as usual.
  7. Clean the combs with an old toothbrush and hot soapy water to remove any eggs or lice, and rinse with hot water.
  8. Importantly, repeat the wet combing method every second day to remove any newly hatched lice, for 10 days

Tips and challenges

  • This treatment does not prevent recurring head lice infestations.
  • Any members of the family with head lice should also be treated at the same time to break the infestation cycle.
  1. Sunkar S, Dwinastiti YA, Haswinzky RA, Irmawati FP, Wardhana AW, Sudarmono P, et al. Effectiveness of wet combing compared with 1% permethrin lotion for the treatment of pediculosis capitis. International Journal of Applied Pharmaceutics 2019; 11(6):108-110.
  2. Tebruegge M, Runnacles J. Is wet combing effective in children with pediculosis capitis infestation? Arch Dis Child 2007;92:818–20.
  3. Hill N, Moor G, Cameron M, Butlin A, Williamson M, Bass, C. Single blind, randomised, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom. BMJ 2005;331:84.
  4. Queensland Health. Head lice
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