From the Guidelines
Treatment for Pediculosis (Lice Infestation)
The most effective treatment for pediculosis is topical permethrin 1% cream rinse, applied to the hair and scalp for 10 minutes before rinsing, with a repeat treatment in 7-10 days 1.
- First-line therapy: Permethrin 1% cream rinse is recommended due to its low mammalian toxicity and effectiveness in killing lice and nymphs.
- Application: The hair should be shampooed with a nonconditioning shampoo, towel-dried, and then the permethrin cream rinse applied for 10 minutes before rinsing.
- Repeat treatment: A second treatment is necessary in 7-10 days to kill any newly hatched nymphs, as permethrin does not kill all eggs 1. Alternative treatments include:
- Topical pyrethrin 0.33% shampoo: Applied to the hair and scalp for 10 minutes before rinsing, also with a repeat treatment in 7-10 days 1.
- Oral ivermectin: 200-400 mcg/kg, given as a single dose, may be considered in cases of treatment failure, with a repeat dose in 7-10 days if necessary 1. It is essential to note that resistance to permethrin and pyrethrins has been reported, and in such cases, alternative treatments like malathion or ivermectin lotion may be considered 1.
From the FDA Drug Label
For the treatment of Head Lice, Pubic (Crab) Lice and Body Lice A second treatment must be done in 7-10 days to kill any newly hatched lice eggs (nits) Treat apply thoroughly to dry hair or other affected area. Remove lice and their eggs (nits) use a fine-tooth or special lice/nit comb
The treatment for pediculosis (lice infestation) is to apply pyrethrin (TOP) thoroughly to dry hair or other affected area, and then remove lice and their eggs (nits) using a fine-tooth or special lice/nit comb. A second treatment must be done in 7-10 days to kill any newly hatched lice eggs (nits) 2.
- Head Lice: apply behind ears and to back of neck, allow product to remain for 10 minutes, then rinse and comb out tangles.
- Pubic (Crab) Lice: treat simultaneously with sexual partners to avoid reinfestation.
- Body Lice: disinfect clothing by machine washing in hot water and using the hottest dryer setting. If infestation continues, see a doctor for other treatments 2.
From the Research
Treatment for Pediculosis (Lice Infestation)
The treatment for pediculosis, also known as lice infestation, typically involves the use of pharmacologic and non-pharmacologic methods.
- First-line pharmacologic treatment for pediculosis is permethrin 1% lotion or shampoo 3, 4.
- Permethrin 1% lotion or shampoo has been shown to be effective in eradicating head lice, with a study demonstrating that 1% permethrin shampoo for 1 hour is more effective in eradicating head lice within the first week of treatment and in relieving scalp itching during the second week 5.
- Other treatment options include topical ivermectin 0.5% lotion, which has been shown to be safe and efficacious for head lice treatment, although it is typically reserved as a third-line treatment due to its high cost and limited clinical experience 6.
- Non-pharmacologic treatments, such as wet combing, can also be effective in treating pediculosis 4.
- In addition to treating the individual, it is also important to wash and dry clothing and bedding in hot water to prevent re-infestation 3, 4.
Treatment for Specific Types of Lice Infestations
- For head lice, treatment typically involves the use of permethrin 1% lotion or shampoo, or topical ivermectin 0.5% lotion 5, 3, 6.
- For body lice, treatment typically involves improving hygiene and washing and drying clothing and bedding in hot water 7, 3, 4.
- For pubic lice, treatment typically involves the use of permethrin 1% lotion or shampoo, and may also involve evaluation for other sexually transmitted infections 3, 4.