Key points

• Permethrin, malathion and synergised Pyrethrins are probably effective against head lice, provided resistance is not present. There is limited evidence for older insecticides like lindane, which have now been withdrawn in most countries. All trials had methodological flaws.

• There is insufficient evidence of the effectiveness of combing alone or in comparison with insecticide treatment for either removing lice or nit combing.

• There is no evidence on the effects of herbal treatments and essential oils as alternative treatments for head lice.

• Combing with a plastic detection comb appears to be the most effective method for finding live lice, but methods for diagnosing louse infection have been little studied.

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