Treatment of Body Lice (Pediculosis Corporis)
The primary treatment for body lice is thorough laundering of all infested clothing, bedding, and linens in hot water with hot dryer cycle or dry-cleaning, which is often sufficient without medication. 1
Environmental Decontamination (First-Line Treatment)
Machine washing and drying is the cornerstone of treatment and frequently eliminates the infestation without requiring topical medications. 1
- Wash all infested clothing, bedding, and linens in hot water (above 54°C/130°F) and dry using the hottest dryer setting for at least 20 minutes 2, 3
- Items that cannot be immediately washed should be removed from body contact for at least 72 hours 4, 1
- Dry-cleaning is an acceptable alternative for items that cannot be machine washed 4, 1
- Fumigation of living areas is not necessary 4, 1
Critical pitfall: Body lice live in clothing seams, not on the body itself, so environmental measures are essential—topical treatment alone will fail if clothing is not properly decontaminated 2, 5
Topical Pharmacologic Treatment (When Needed)
When medication is required (typically in heavy infestations or when hygiene measures alone are insufficient):
First-Line Medication
- Permethrin 1% cream rinse applied to affected body areas and washed off after 10 minutes 4, 1
- Alternative: Pyrethrins with piperonyl butoxide applied to affected areas and washed off after 10 minutes 4, 1
Second-Line Options
- Malathion 0.5% lotion applied to affected areas and washed off after 8-12 hours (for treatment failures or documented resistance) 4
- Ivermectin 250 μg/kg orally, repeated in 2 weeks (alternative regimen) 4
Avoid in Certain Populations
- Lindane 1% should be avoided in pregnant or lactating women and children under 2 years due to neurotoxicity risk (seizures, aplastic anemia) 1, 4
- Lindane should not be used immediately after bathing or in persons with extensive dermatitis 4, 1
Special Populations
Pregnant and Lactating Women
- Treat with permethrin or pyrethrins with piperonyl butoxide—these are safe options 4, 1
- Avoid lindane due to association with neural tube defects and accumulation in breast milk 4
Follow-Up and Monitoring
- Evaluate after 1 week if symptoms persist 4
- Re-treatment may be necessary if lice are found or if eggs are observed at the hair-skin junction 4
- If no clinical response to first-line treatment, switch to an alternative regimen 4
Important Clinical Context
Body lice are distinct from head and pubic lice—they live in clothing seams and only move to the body to feed. 2, 5 This infestation is associated with poverty, overcrowding, and poor hygiene, and is seen more commonly in cold climates 5. Body lice can transmit serious bacterial infections including epidemic typhus, relapsing fever, and trench fever 3, 5, making prompt treatment important not just for symptom relief but for public health.