Pubic Lice (Crabs) - Treatment

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How Are Pubic Lice Treated?

A lice-killing lotion containing 1% permethrin or a mousse containing pyrethrins and piperonyl butoxide can be used to treat pubic ("crab") lice. These products are available over-the-counter without a prescription at a local drug store or pharmacy. These medications are safe and effective when used exactly according to the instructions in the package or on the label.

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.

Malathion* lotion 0.5% (Ovide*) is a prescription medication that can kill lice and some lice eggs; however, malathion lotion (Ovide*) currently has not been approved by the U.S. Food and Drug Administration (FDA) for treatment of pubic ("crab") lice.

Ivermectin has been used successfully to treat lice; however, ivermectin currently has not been approved by the U.S. Food and Drug Administration (FDA) for treatment of lice.

How to treat pubic lice infestations: (Warning: See special instructions for treatment of lice and nits on eyebrows or eyelashes. The lice medications described in this section should not be used near the eyes.)

  1. Wash the infested area; towel dry.
  2. Carefully follow the instructions in the package or on the label. Thoroughly saturate the pubic hair and other infested areas with lice medication. Leave 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.
  3. Following treatment, most nits will still be attached to hair shafts. Nits may be removed with fingernails or by using a fine-toothed comb.
  4. Put on clean underwear and clothing after treatment.
  5. To kill any lice or nits remaining on clothing, towels, or bedding, machine-wash and machine-dry those items that the infested person used during the 2-3 days before treatment. Use hot water (at least 130F) and the hot dryer cycle.
  6. Items that cannot be laundered can be dry-cleaned or stored in a sealed plastic bag for 2 weeks.
  7. All sex partners from within the previous month should be informed that they are at risk for infestation and should be treated.
  8. Persons 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.
  9. Repeat treatment in 9-10 days if live lice are still found.
  10. Persons with pubic lice should be evaluated for other sexually transmitted diseases (STDs).

Special instructions for treatment of lice and nits found on eyebrows or eyelashes:

  • If only a few live lice and nits are present, it may be possible to remove these with fingernails or a nit comb.
  • 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 2-4 times a day for 10 days is effective. Regular Vaseline* should not be used because it can irritate the eyes if applied.

*Use of trade names is for identification purposes only and does not imply endorsement by the Public Health Service or by the U.S. Department of Health and Human Services.

Return to Pubic Lice (Crabs)

See what others are saying

Comment from: cdm1729, 45-54 Female Published: November 28

Don't know how I got it and my husband doesn't have this. He is adamant he hasn't cheated. He says I'm always petting animals and that's how I got it. He could of had this by cheating and cleaned up before I realized I had it. Now I'm using Rid-X and different oils - (5 drops each), lavender, eucalyptus, peppermint, tea leaf in 1/3 of olive oil. Have this for several weeks and still haven't gotten rid of this. I use two times a day now.

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Comment from: cherie, 45-54 Female (Patient) Published: January 11

I was infected with pubic lice many years ago after I had "made out" with someone without having intercourse and I later found out from the rumor mill that this person was infected. In an unrelated incident, while working in a shelter (years after I was infected myself), some of the residents reported being infected with pubic lice without having had intimate contact with anyone so most everyone assumed the infection was the result of sharing a bathroom. I really don't know what else it could have been and fortunately I was not infected that time. So in both cases, there was no sexual intercourse and the lesson I learned was to be very careful about touching anyone you don't know well. When I was infected, I was so horrified that I shaved my entire pubic area to remove all of my pubic hair and then I covered the entire area with Vaseline until I was sure the lice were gone. This worked for me. It was a disgusting and humiliating experience which still haunts me nearly 30 years later but the good news is that it is relatively easy to get rid of them with a little patience and time to yourself.

Was this comment helpful?Yes

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