How should lice infestations be treated?

Head and pubic lice infestations are treated similarly. Due to resistance and safety, a 5% permethrin cream is applied 8 to 12 hours overnight, the treatment is repeated in one week (with occlusion), and the scalp (within ¼ inch) is observed for viable nits. Ovide (malathion 0.5%) is applied 8 to 12 hours (approved for individuals over 6 years of age) and the treatment is repeated in 7 days. Finally, oral ivermectin 200 to 250 mg/kg is given on day 1 and day 8. As with scabies, children should get less than 15 kg, and pregnant/lactating women should probably not get oral ivermectin. Removal of the nits with a specially designed, fine-toothed comb ensures that the infestation is clear. All close contacts should also be treated. Body lice are eliminated by thorough cleaning of the clothes or changing them for new ones. The patient needs symptomatic relief only and a fresh change of clothes.

Elston DM: Drugs used in the treatment of pediculosis, J Drugs Dermatol 4:207– 211, 2005.