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Public concern about the use of insecticides on children has led some observers to promote mechanical removal of head lice. In this randomized, controlled trial, which involved 167 U.K. schoolchildren from an area with intermediate resistance to malathion, mechanical removal by wet combing was compared with malathion treatment. In the wet-combing group, fine-toothed combs were used every 3 to 4 days for 2 weeks; in the malathion group, 2 applications of 0.5 percent lotion were used, a week apart (with instructions not to use nit combs).
Because there was a low rate of compliance with therapy, only 72 children were included in the analysis. The primary outcome measure was the presence or absence of live lice 1 week after the end of treatment:…