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Infection Prevention and Control – Pediculosis (Body and Pubic Lice)
Strength of Evidence Level: 3
PURPOSE:
To prevent transmission of and eliminate infestations of
body and pubic lice (crab) and associated infections.
CONSIDERATIONS:
1. Contact the local public health department for
additional guidance and resources regarding body
lice or crab lice.
2. Types:
a. Body lice: Pediculus humanus corporis (body
louse, clothes louse) Adult body lice are 2.3-3.6
mm in length. Body lice live and lay eggs on
clothing and only move to the skin to feed.
(1) Transmission: Body lice infestations are
spread most commonly by close person-toperson contact but are generally limited to
persons who live under conditions of
crowding and poor hygiene.
(2) Diagnosis: Signs are intense itching and
rash. Intense itching leads to scratching
which can cause sores and secondary
bacterial infection of the skin. When body
lice infestation is long lasting, heavily bitten
areas of the skin can become thickened
and darkened, particularly in the midsection of the body. This condition is called
“vagabond’s disease.”
(3) Body lice are known to transmit diseases
such as epidemic typhus, trench fever and
epidemic relapsing fever.
b. Pubic (Crab) lice: Pthirus pubis ("crab" louse,
pubic louse). Adult pubic lice are 1.1-1.8 mm in
length. Pubic lice typically are found attached to
hair in the pubic area but sometimes are found
on coarse hair elsewhere on the body (e.g.
eyebrows, eyelashes, beard, mustache, chest,
armpits, etc.).
(1) Transmission: Pubic lice usually spread
through sexual contact. All sex partners
within the previous month should be
informed that they are at risk for infestation
and should be treated. Persons with pubic
lice should be evaluated for other sexually
transmitted diseases.
(2) Diagnosis: Itching (“pruritus”) in the pubic
and groin area is the most common
symptom of pubic lice infestation. Intense
itching leads to scratching which can cause
sores and secondary bacterial infection of
the skin. Visible lice eggs (“nits”) or lice
crawling or attached to pubic hair, or less
commonly other hairy areas of the body are
also signs of pubic lice infestation.
[Note: Pubic lice on the head (eyelashes or
eyebrows) of a child may be an indication of sexual
exposure or abuse. Report immediately.]
3. Medications for pubic and body lice:
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[Note: The lice medications described in this section
should not be used near the eyes.]
a. CDC recommended: A lice-killing lotion
containing 1 percent permethrin or a mousse
containing pyrethrins and piperonyl butoxide
can be used to treat pubic (“crab”) lice and are
available without a prescription.
b. CDC not recommended: Lindane shampoo is a
prescription medication that can kill lice and lice
eggs. However, lindane is not recommended as
a first-line therapy. Lindane can be toxic to the
brain and other parts of the nervous system; its
use should be restricted to patients who have
failed treatment with or cannot tolerate, other
medications that pose less risk. Lindane should
not be used to treat premature infants, persons
with a seizure disorder, women who are
pregnant or breast-feeding, persons who have
very irritated skin or sores where the lindane will
be applied, infants, children, the elderly, and
persons who weigh less than 110 pounds.
c. Not FDA approved for crab lice: (1) Malathion*
lotion 0.5 percent (Ovide*) and (2) Ivermectin.
EQUIPMENT:
Magnifying glass
Gloves
Gown
Trash bag for receiving contaminated patient clothing
Trash bag for discarding PPE
Clean clothing for patient
Towel and wash cloth
Medication (pubic lice)
Nit comb (pubic lice)
PROCEDURE:
Body Lice:
1. Bathe or shower patient.
2. Have patient don clean clothing.
3. Have contaminated clothing laundered or discarded,
if patient agrees to latter.
4. Educate patient on maintaining good personal
hygiene and regular changes of clean clothes.
5. If patient shares infested clothing and/or remains in
an environment where body lice are present there is
a chance of reinfestation.
Pubic Lice
1. Wear gloves and gown.
2. Have patient remove contaminated clothing and bag
for laundering.
3. Wash the infested area; towel dry.
[Note: See special instructions for treatment of lice
and nits on eyebrows or eyelashes.]
Infection Prevention and Control – Pediculosis (Body and Pubic Lice)
Strength of Evidence Level: 3
a.
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If only a few live lice and nits are present, it may
be possible to remove these with fingernails or
a nit comb.
b. If additional treatment is needed for lice or nits
on the eyelashes, careful application of
ophthalmic-grade petrolatum ointment (only
available by prescription) to the eyelid margins
2 to 4 times a day for 10 days is effective.
Regular Vaseline should not be used because it
can irritate the eyes if applied.
Carefully follow the instructions in the package or on
the label. Thoroughly saturate the pubic hair and
medication on hair for the time recommended in the
instructions. After waiting the recommended time,
remove the medication by following carefully the
instructions on the label or in the box.
Following treatment, most nits will still be attached
to hair shafts. Nits may be removed with fingernails
or by using a fine-toothed comb.
Have patient put on clean underwear and clothing
after treatment.
Patient should avoid sexual contact with their sex
partner(s) until both they and their partners have
been successfully treated and reevaluated to rule
out persistent infestation.
Refer patient to public health for STD follow up, if
appropriate.
Repeat treatment in 9 to 10 days if live lice are still
found.
AFTER CARE
1. Machine wash and dry clothing, bed linens, and
other items that the infested person wore or used
during the 2 days before treatment using the hot
water (130°F) laundry cycle and the high heat
drying cycle. Clothing and items that are not
washable can be dry-cleaned.
OR
2. Seal items in a plastic bag and store for 2 weeks.
3. Soak combs and brushes in hot water (at least
130°F) for 5 to 10 minutes.
4. Vacuum the floor and furniture, particularly where
the infested person sat or lay.
[Note: the risk of getting infested by a louse that has
fallen onto a rug, carpet or furniture is very small.]
5. DO NOT use fumigant sprays; they can be toxic if
inhaled or absorbed through the skin.
REFERENCES:
CDC. (n.d.). Centers for Disease Control and
Prevention. Retrieved from
www.cdc.gov/ncicoc/dpd/parasites/index.htm
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