What is the treatment for body lice infestation?

Treatment of Body Lice (Pediculosis Corporis)

Machine washing all infested clothing, bedding, and linens in hot water with hot-cycle drying or dry-cleaning is the cornerstone of treatment and often sufficient without medication. 1

Primary Treatment Approach: Environmental Measures First

Body lice live on clothing and bedding, not on the human body, making environmental decontamination the most critical intervention:

• Wash all infested clothing, bedding, and linens in hot water and dry using the hot cycle, or dry-clean them - this is often sufficient without any medication 1
• Remove items from body contact for at least 72 hours if immediate washing is not possible, as body lice cannot survive off clothing for more than 2-3 days 1, 2
• Fumigation of living areas is not necessary 1, 2
• At least once-weekly bathing and laundering of clothing and bedding is essential for prevention 3

When to Add Pharmacologic Treatment

Medication should be added when environmental measures alone are insufficient or when there is extensive body surface area involvement:

First-Line Medication: Permethrin 1% Cream Rinse

• Apply permethrin 1% cream rinse to affected body areas and wash off after 10 minutes 1
• This is the CDC's treatment of choice when medication is needed 1
• Permethrin has extremely low mammalian toxicity and superior efficacy compared to alternatives 2, 4

Alternative First-Line Option: Pyrethrins with Piperonyl Butoxide

• Apply to affected areas and wash off after 10 minutes 1
• This is an acceptable alternative to permethrin 1

Second-Line Option: Lindane 1% (Use Only When Other Treatments Fail)

• Apply thinly to all body areas from the neck down and wash off after 8 hours 1
• Avoid in pregnant or lactating women and children under 2 years due to neurotoxicity and seizure risk 1, 5
• Should not be used following a bath or in persons with extensive dermatitis 1
• Only indicated for patients who cannot tolerate or have failed other approved therapies 5

Special Populations

Pregnant and Lactating Women

• Treat with permethrin or pyrethrins with piperonyl butoxide only 1
• Absolutely avoid lindane due to neurotoxicity risk 1

Homeless or High-Density Urban Populations

• Body lice prevalence ranges from 4.1% to 35% among persons experiencing homelessness 3
• Suspect body lice in patients with poor hygiene and pruritus who do not change or wash clothing regularly 6
• Treatment requires addressing social drivers of health, including housing status and living environment 3

Critical Pitfalls to Avoid

• Do not rely on medication alone - environmental decontamination is essential and often sufficient by itself 1
• Do not use lindane as first-line treatment due to neurotoxicity concerns 1, 5
• Caregivers applying lindane should wear gloves less permeable to lindane (nitrile, latex with neoprene, or sheer vinyl) and avoid natural latex gloves 5
• Body lice can transmit infectious diseases and cause secondary iron-deficiency anemia with extensive involvement, unlike head or pubic lice 7

Emerging Treatment Options

• Oral ivermectin (12 mg at 7-day intervals for 3 doses) has shown dramatic reduction in body lice burden, though effects may not be sustained long-term 8
• Growing patterns of treatment resistance necessitate development of new strategies, with oral medications serving as a promising option 7