What is the treatment for body lice (pediculosis corporis)?

Treatment for Body Lice (Pediculosis Corporis)

The first-line treatment for body lice is permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes, combined with proper hygiene measures and washing of all clothing and bedding in hot water. 1, 2

Diagnosis

• Body lice infestation should be suspected when symptoms of generalized pruritus occur in persons with poor hygiene or those who do not regularly change or wash clothing 3
• Unlike head lice, body lice live primarily in the seams of clothing and only move to the skin to feed 3
• Examine the seams of clothing for live lice and nits (eggs) 4

Treatment Options

First-Line Treatments:

1. Topical Pediculicides:

   • Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes 1
   • Pyrethrins with piperonyl butoxide applied to affected areas and washed off after 10 minutes 1

2. Alternative Treatments:

   • Lindane 1% shampoo applied for 4 minutes and thoroughly washed off 1
     • Caution: Not recommended for pregnant or lactating women, children under 2 years, or persons with extensive dermatitis due to risk of seizures and aplastic anemia 1
   • Malathion 0.5% lotion for patients who fail permethrin treatment 2

Essential Hygiene Measures:

• Clothing and Bedding Decontamination:

  • Machine wash all clothing, bedding, and linens in hot water (at least 130°F/54°C) 1, 3
  • Dry items using the hottest setting for at least 20 minutes 2
  • Items that cannot be washed should be removed from body contact for at least 72 hours 1

• Personal Hygiene:

  • Regular bathing and changing into clean clothes 3
  • Environmental treatment is necessary for complete eradication 3

Follow-Up

• Evaluate patients after 1 week if symptoms persist 1
• Re-treatment may be necessary if live lice are still found 1
• If not responding to initial treatment, retreat with an alternative regimen 1

Management of Close Contacts

• Both sexual and close personal or household contacts within the last month should be examined and treated 1
• People who live and work in close proximity to infested individuals may acquire lice even with good hygiene 5

Special Considerations

Pregnant Women and Children:

• Pregnant and lactating women should be treated with permethrin or pyrethrins with piperonyl butoxide 1
• Children under 2 years should not be treated with lindane 1

Symptom Management:

• Pruritus may continue even after successful treatment due to allergic reaction to bites 5
• Over-the-counter cortisone creams or calamine lotion may help relieve itching 5

Resistance Concerns:

• Growing patterns of treatment resistance necessitate consideration of alternative strategies 6
• Pyrethroid permethrin when applied to clothing is highly effective and can retain toxicity even after multiple washings 5

Complications and Prevention

• Body lice can transmit serious infectious diseases including epidemic typhus, epidemic relapsing fever, and trench fever 5, 7
• Regular inspection of individuals in high-risk settings (homeless shelters, refugee camps) is recommended 5
• Secondary bacterial infections and iron-deficiency anemia can occur with severe infestations 6

Body lice infestations primarily affect people living in crowded conditions with poor hygiene, including homeless populations 6, 4. Successful treatment requires both medication and addressing the environmental factors that contribute to infestation.