Treatment of Body Lice
Body lice infestation is primarily treated through improved personal hygiene and laundering of all infested clothing and bedding in hot water, with topical permethrin as an adjunct only when needed for large-scale infestations. 1, 2
Primary Treatment: Hygiene and Environmental Measures
The cornerstone of body lice treatment differs fundamentally from head lice because body lice live in clothing seams, not on the body itself. 3, 4
Essential hygiene measures include:
- Washing the affected individual thoroughly 5, 2
- Laundering all infested clothing, bedding, and linens in hot water and drying on hot cycle 3, 6
- Removing items that cannot be washed from body contact for at least 72 hours, as lice cannot survive off the human body for more than 2-3 days 7
Personal hygiene measures are essential for successful treatment and more important than topical medications. 3, 4
Pharmacologic Treatment (Adjunctive)
Topical insecticides serve as secondary treatment, primarily for large-scale infestations:
Permethrin 1% lotion or cream:
- Apply to affected skin areas 3, 6
- May help eradicate body lice but is not the primary treatment modality 3, 4
- Medical treatment with pediculicides is required mainly in large-scale infestations 2
Alternative agents for resistant cases:
- Malathion 0.5% can be considered for treatment failures 3, 4
- Oral ivermectin may serve as a promising option given growing treatment resistance patterns 5
- For lice resistant to topical agents, oral ivermectin at 200-400 μg/kg in a single dose may be used in patients weighing over 15 kg, with a second dose after 9-10 days 1
Clinical Recognition
Body lice infestation should be suspected in patients with:
- Poor hygiene and pruritus who do not change or wash clothing regularly 1, 3
- Pruritus and pyoderma of clothing-covered areas 2
- Lice found in the seams of clothing rather than on the body 3, 4
- More general reactions including fever, headaches, diffuse rash, fatigue, and myalgias appearing weeks to months after parasitism begins 2
Critical Distinctions from Head Lice
Body lice carry significantly greater morbidity than head lice:
- Greater body surface area involvement 5
- Potential for infectious disease transmission 5, 2
- Risk of secondary iron-deficiency anemia 5
- Preferentially seen in cold climates under conditions of poor sanitation and crowding 2
Common Pitfalls
Do not over-rely on topical pediculicides - unlike head lice where permethrin is first-line, body lice treatment prioritizes hygiene and environmental decontamination. 3, 2, 4
Recognize the population at risk - body lice thrive in high-density urban populations with poor hygiene, particularly among homeless individuals. 5, 2
Address the clothing reservoir - failure to properly launder or discard infested clothing will result in treatment failure regardless of topical medication use. 3, 6