Quick tip: How do you clean a lice comb?

Wipe it with toilet paper or paper towel.  If something is stuck between the teeth, never pry them apart. Clean it out with dental floss.  If you want to sterilize the comb between users, put it in a cup. Pour boiling water over it and let it sit for a couple of minutes.

Why I still say wet combing is a clear choice even when the research is murky.

When I was doing head lice consultations, I never recommended any commercial "shampoos" or pesticidal treatments to deal with the infestation.  I always recommended wet combing.

But does using only wet combing really work?

Earlier this year, I read a literature review that can be found on  the Canadian Paediatric Society website, among other places. It reviews the research on different methods and products for eliminating head lice infestations.  It mentions wet combing and says that "There is little evidence to support wet combing as a primary treatment for head lice."

In this report, there are two studies mentioned, both from 2002.  In one study, wet combing got rid of the lice in only 38% of the people treated.  In the other study, adding wet combing to those treated with permethrin seemed to offer no benefit.  I couldn't find the studies mentioned in the article.

This would be discouraging to me if I didn't also know of other studies where wet combing shows effectiveness:

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 (Bug busting is just a commercial wet combing kit.)

Tebruegge M, Runnacles J. Is wet combing effective in children with pediculosis capitis infestation? Arch Dis Child 2007;92:818–20.

Of course, in my own experience time and time again with head lice, wet combing works. Period.

But wet combing is not a chemical solution that you dose out. It is a technique and no two people are going to do it exactly the same way or use the same lice combs.  We should expect to get different results between studies.

What makes wet combing the most effective for me though is that you can do it again and again.  This alone increases its effectiveness in my book. If you buy a good comb, it is there for you to use whenever you need it.  No running out in the middle of the night to find a open drugstore to buy a "shampoo".  You just grab your comb and start combing.  I can do a combing whenever I want and as often as I want (unlike with pesticides which can have side effects and where there is a limit to how much and often you can use them.)

And wet combing is just so much cheaper.  A good comb costs less than the "shampoo" needed for one treatment. I used to feel so bad for families who thought they were finally rid of their head lice only to get it months later when it started going around their child's classroom again. They would always be stressed out about the anticipated costs of buying all those products.  I was always happy to tell them that they didn't have to spend oodles of money if they did wet combing.  (The comb in the picture is a good one at Walmart.  It's $10.47 CAD.)

Wet combing does take some time but that time will decrease each time you do it.  And again, most commercial 'shampoos' still recommend combing and multiple treatments so you aren't really saving time by using them. (Another great reusable tool in the fight against head lice is your hair dryer.)

Check out other posts for how to wet comb.  Worry less about perfecting a technique and just get combing.

If you can't be with the comb you love, use the comb you're with.

I've recommended specialty lice combs on this blog because combs designed for the task of lice and nit picking - combs with long, rigid, tight metal teeth - save you a lot of time.  But what if you don't have access to an actual metal lice comb?  Grab the comb you do have. If it has teeth that are narrow and close together (i.e. not a hair pick), it can still have some effectiveness. The more rigid the teeth the better. Wet, condition, and detangle the hair. Then start combing.  If  you have large egg-laying bugs on your head, you should still be able to comb out a lot of them out.  This is still progress. Get the better comb when you can but for now, just get busy.

Hair Conditioner - fights more than split ends!

If you have ever had head lice, and I am assuming that you are acquainted with it since your reading this blog, then you know that nits are a pain to remove.  Lice eggs and egg shells are cemented to the hair so well that they can be stuck on the hair long after the lice are gone.  This is one reason why I dislike no-nit policies - they don't take this into account. I am sure that many a child has been sent home from school because a nit was seen when no actual lice were present.  The only way to be sure you have head lice is to actually find one on the head.  I have gone into homes where parents found some nits but no lice - and I didn't find any lice either.  The nits were usually a few inches away from the hair shaft, indicating that they had been laid long ago,  and I then had the good fortune to tell the parents the child had lice at one point but for some reason doesn't any more.

This problem of cemented nits has spawned an small industry of products claiming to dissolve the substance that glues the nits to the hair shaft.  Sprays, rinses, creams - you can find many that claim to loosen or remove nits.  Probably the most common home remedy that I have seen people use for nit removal is vinegar.  Have you ever had vinegar in your eyes?  The kids whose parents gave them a vinegar rinse are not usually appreciative of this technique. 

As you may know, I feel the best way to remove lice, eggs, and shells is manually.  I recommend using a good metal lice comb (with very rigid teeth, such as the Licemeister or the Nit Free Terminator).  But I also recommend wetting the hair and slathering it in cheap hair conditioner.  This process of wet combing is proven to greatly increase your chances of lice detection and it is a non-pesticidal and effective way to remove lice and nits.  The conditioner helps the hair remain wet (slowing down the lice), makes it easier for the hair to stay detangled, and allows the comb to glide through the hair more smoothly.  I always recommend the cheapest conditioner because you may need a lot of conditioner and beating head lice should never break your budget.

Interestingly, hair conditioner was part of a head lice study that came out this past spring.  The study was called "Efficacy of Products to Remove Eggs of Pediculus humanus capitis (Phthiraptera: Pediculidae) from the Human Hair". You can read the study's abstract here. In other words, it compared different products that made claims that they removed lice eggs from the hair shaft. The conclusion? Egg removal was significantly helped with just water and hair conditioner.  Specialty products were no more effective than these simple tools and some substances had no effect at all. 

So, join me in buying that vat of generic conditioner from your local dollar store. This is just one more example of how effective does not have to mean expensive.

Video Link - How to use your lice comb.

As I have said many times before on this blog, the most helpful tool to have in your fight against head lice is a proper, metal lice comb. I have also said that not all combs are created equal. This includes metal combs. There are a lot of combs on the market with metal teeth that are positively useless. If the teeth can easily bend or separate, then they will still comb around the nits instead of scraping them out. The three combs I recommend are the Licemeister, the Nit-Free Terminator, and the lovely inexpensive generic purple duel-sided comb found at Walmart. For information about these combs, click here.

There is a video on YouTube about the Licemeister comb and how to use it. The techniques apply to any proper lice comb. I will provide the link to the video in a moment, but if you go to watch it, promise you will come back and read my comments about the video. Will you read the rest of this blog post? You will? Ok, then click here for the link.

I like this video because

Please, please, please get a proper lice comb!

The solution to dealing with head lice is very simple, but that doesn't mean it is easy. It is easy to say, "Just simply remove all eggs and bugs from the hair" but it is another thing altogether to actually get it done. It requires time and persistence over days or even weeks depending on the magnitude of the problem.

I know that you want to deal with head lice quickly - that's why people purchase the chemical treatments. These treatments claim to deal with head lice in less than a half hour! But, they simply don't work. I'm so sorry - I wish they did, but they don't.

But proper combs are effective. I have seen people spend dollar after dollar on treatments, but they don't want to spend the money on getting a proper lice comb and I don't understand this. Maybe these people think that one comb is just like another or that the comb that comes with the chemical treatment is sufficient. I'm not sure, but I do know that getting a proper comb will drastically cut the time spent on lice removal. And, it is of great value because you can use it again and again for years to come. I have gone to homes where the client is sure they have picked out every egg and bug, and then I take a look and also see no signs of active lice infestation. But then I comb through the hair with a proper metal lice comb and teeny live bugs are found.

So please, do yourself a favour. Get a proper metal comb such as the Licemeister (available in Edmonton at Split Enz Hair, 780-406-8181), the Nit Free Terminator, or the excellent purple dual sided lice comb that is selling so cheaply at Walmart. (The other combs at Walmart - the metal one with the blue handle, the all metal one, or the plastic combs - will NOT do.) Stop buying the chemical treatments and do something that really works. Once you get the right comb, follow the steps for picking lice out of someone else's hair, or the steps for picking lice out of your own hair.

If you have purchased one of these combs, I thank you. If you use it properly and regularly, your neighbours thank you, your kid's teachers thank you, and your co-workers thank you. Well done.

Lice: 1, Nix:0

As I have mentioned in previous posts, ALL of my business comes from people who have already used some sort of lice "shampoo" or treatment with little success. Doctors, pharmacists, and Alberta Health Services almost always recommend a permethrin based-treatment such as Nix or R&C. Once again, I recommend against the use of such treatments, and not just because permethrin is a pesticidal neurotoxin. I recommend against them because, in my experience, they don't work well.

I just came from yet another home that where a treatment was used on the child about 4 days before my visit. The parents thought that they had solved their child's lice problem, but they wanted me to check through the hair just in case.

Sometimes 'effective' can also be 'inexpensive'.

Never underestimate a decent lice comb. And I'm not talking about the plastic comb that comes in the Nix package. A proper metal lice comb is an extremely wise investment as it can cut your nit picking in half. I have always recommended the Licemeister, which is a great comb, but the cost is prohibitive for some. Then a client told me about a good comb that she found at Wal-Mart - the Pharmasystems dual-sided lice comb (see the blurry picture). It is a pretty generic comb, but I tried it and have found it to be both effective and inexpensive. I bought mine at Wal-Mart for around $9. You may have to ask the pharmacist where the lice combs are located as they are not stocked beside the regular brushes and combs. I don't think this comb is as durable as the Licemeister, but it can still be boiled and is good for multiple uses. On the back of the package, it tells you to "shampoo with pediculicide". As you know, I don't think this is necessary or beneficial. Just use the comb regularly. If you want to clean out the comb between strokes, dip it in water and wipe with toilet paper or a paper towel. If you want to clean between the teeth, do not pry the teeth apart - just clean between them with dental floss.

Not All Combs Are Created Equal

When I first got into picking head lice, I would read about the "lice comb". I mistakenly thought that those little green combs that you find in the lice "shampoo" boxes were real lice combs. I was very discouraged as these combs didn't remove any nits, and only removed the occasional bug. This "lice comb" was no better than a traditional comb. Then I was told that metal combs were the answer. I went to my local drug store and bought a metal comb. It pulled out the nits - but it also pulled out the hair! It was horribly painful to use! Because of this, I gave up on ever finding that perfect lice comb. I thought I would be hand picking nits forever.

Then I met my dream comb: The LiceMeister. Sigh. The first time you use it you are astonished. (You never forget your first time!) The comb removes so many eggs and it catches lice, too. While I still had to do hand picking, it reduced my nit/lice picking time immensely. And it was on CSI too, so it is trés cool! It is very durable and boilable. It comes with comprehensive instructions and a comb cleaner(though you can easily clean it with wax-free dental floss). I tend to use it on wet hair first, do hand picking, and then go through the hair one more time with the comb. Just be sure to comb from root to tip in one continuous motion. You can do a quick cleaning of the comb between strokes by dipping it in water and wiping it on toilet paper or paper towel. Don't worry too much about eggs that are still in the comb - just check it to make sure that no bugs are stuck in it before you do the next stroke of the comb.

If you want more info about this great lice removal tool, contact me at www.thenicelicelady@live.com It is a must-have if your lice are a recurring don't-want.