Treatment for Body Lice (Pediculosis Corporis)
The primary treatment for body lice is improved personal hygiene and laundering all infested clothing, bedding, and linens in hot water, with topical permethrin applied to the body only if medical treatment is needed for large-scale infestations. 1, 2
Key Distinction: Body Lice Live in Clothing, Not on the Body
Body lice differ fundamentally from head and pubic lice—they live in the seams of clothing and bedding, not on the body itself, only moving to the skin to feed. 2, 3 This biological fact makes body lice primarily a hygiene and environmental problem rather than a medical one.
First-Line Treatment: Environmental Measures (Essential)
Machine wash all infested clothing, bedding, and linens in hot water and dry using the hot cycle, or dry-clean them. 4, 5 This is the cornerstone of treatment and often sufficient without medication. 1, 2
Remove items from body contact for at least 72 hours if washing is not immediately possible. 4
Fumigation of living areas is not necessary. 4
Regular bathing and changing into clean clothes are essential for successful eradication. 2, 3
Medical Treatment: When Pediculicides Are Needed
Topical pediculicides are only required for large-scale infestations or when environmental measures alone are insufficient. 1
Recommended Regimen
Permethrin 1% cream rinse applied to affected body areas and washed off after 10 minutes is the treatment of choice when medication is needed. 4, 5
Alternatively, pyrethrins with piperonyl butoxide can be applied to affected areas and washed off after 10 minutes. 4
Lindane 1% lotion can be applied thinly to all body areas from the neck down and washed off after 8 hours, but should be avoided in pregnant/lactating women and children under 2 years due to neurotoxicity risk. 4
Special Populations
Pregnant and lactating women should be treated with permethrin or pyrethrins with piperonyl butoxide, avoiding lindane. 4, 5
Lindane should not be used following a bath or in persons with extensive dermatitis. 4
Clinical Context and Associated Conditions
Body lice are associated with poverty, overcrowding, poor hygiene, and cold climates. 1, 6
Body lice can transmit serious bacterial infections including epidemic typhus, epidemic relapsing fever, and trench fever. 1, 6 This makes prompt treatment important for public health.
Patients typically present with pruritus and pyoderma in clothing-covered areas. 1
More generalized symptoms (fever, headaches, diffuse rash, fatigue, myalgias) may appear weeks to months after infestation begins. 1
Common Pitfalls to Avoid
Do not treat body lice the same as head lice—the emphasis must be on clothing/bedding decontamination rather than repeated topical applications to the body. 2, 3
Itching may persist after successful treatment due to lingering allergic reaction to bites; over-the-counter corticosteroid creams or calamine lotion can help. 6
People working in close contact with infested individuals should be periodically inspected even with good personal hygiene. 6
Resistance to various pediculicides has been reported, making environmental control even more critical. 6