Implications for clinical practice

Although combing may seem an attractive, simple and safe treatment method, there is no real evidence that it is effective, especially when practised by carers who may have little skill in the method. What little evidence is available indicates that insecticide-based products are more likely to be effective if applied twice with an interval of 2 weeks, even in areas where insecticide resistance has developed. No doubt the success of currently used insecticides will diminish with time but combing requires better evidence of success before it will replace chemical treatments for the majority of patients.

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