Initial Treatment Options for Lice

Lice, head

Malathion 0.5% lotion

Apply to dry hair and scalp, wash and rinse in 8–12 hours, shampoo scalp, and remove nits

May repeat in 7–9 days if live nits (nits closer than a 1/4 inch away from the scalp) are seen

Highly effective but not 1st-line treatment because of flammability and unpleasant odor

Permethrin (eg, 1% lotion or cream rinse), other pyrethroid or pyrethrin lotions*

Wash hair and apply to wet hair, behind ears and on nape; wash off in 10 minutes

May repeat in 7 days if live nits (closer than a 1/4 inch away from the scalp) are seen

Contraindicated in patients sensitive to the chrysanthemum family of plants

Spinosad 0.9% topical suspension

Apply to dry scalp and rub in until scalp is moistened, then apply to dry hair, completely covering the scalp and hair; leave on for 10 minutes then thoroughly rinse off with warm water

If live lice are seen after 7 days, a second treatment should be done

For use in patients ≥ 4 years of age

Contains benzyl alcohol and derivatives; avoid in neonates and those younger than 6 months of age because of potential toxicity and in patients with sensitivity to benzyl alcohol

May cause eyelid redness and swelling; avoid contact with eyes

Ivermectin 0.5% lotion

Apply lotion to dry hair to coat the hair and scalp. Rinse after 10 minutes with water

Single-use application

For use in patients > 6 months of age

Wet combing with a metal nit comb

Should be combined with all of the therapies

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Lice, body

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Treatment of pruritus and secondary infection

Topical measures not used because body lice are found in clothing

Wash clothes and linens and dry them at 65° C (149° F)

Dry cleaning or ironing clothes

Lice, pubic

Permethrin 1% (60 mL) cream

Same as for head lice

Must repeat in 10 days

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Pyrethrins* with piperonyl butoxide (60 mL) shampoo

Apply to dry hair and skin, leave on for 10 minutes, rinse, and repeat in 7–10 days

Cannot be applied more than twice in 24 hours

Lice, eyelashes

Fluorescein drops 10–20%

Applied to the eyelids

Provides immediate pediculicidal effect

Petrolatum ointment

Apply 3–4 times a day for 8–10 days

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