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ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjI1MDEzLXRyZWF0bWVudA==\nDrugs & Diseases > Infectious Diseases\nPediculosis and Pthiriasis (Lice Infestation) Treatment & Management\nAuthor: Lyn C C Guenther, MD, FRCPC, FAAD; Chief Editor: Michael Stuart Bronze, MD more...\nPediculosis and Pthiriasis (Lice Infestation)\nSections Pediculosis and Pthiriasis (Lice Infestation)\nOcclusive and Nonpesticide Therapy\nOral Agents\nTreatment of Head Louse Infestation\nTreatment of Pubic Louse Infestation\nTreatment of Body Louse Infestation\nTreatment of Contacts\nDeterrence and Prevention\nAntiparasitic Agents\nTreatment of pediculosis has 2 aspects: medication and environmental control measures. Increasing emphasis is being placed on understanding the life cycle of lice in order to provide effective treatment.\nNot all treatment preparations are ovicidal. For weakly ovicidal or non-ovicidal pediculicides, routine retreatment is recommended typically 7-9 days after the first treatment. For strongly ovicidal pediculicides, retreatment is recommended only if live (ie, crawling) lice are still present after treatment. [4] Retreatment should ideally occur after all eggs have hatched but before new eggs are produced. [4] It is extremely important to use medications as directed to ensure total eradication of the lice through their life cycle. In addition, all infested persons in a household and their infested close contacts and bedmates should be treated at the same time.\nHead lice have been found on hats, scarves, brushes, combs, hair accessories, linens, towels, and stuffed animals. Since exposure to these fomites could result in infestation, it is recommended that such items used by the infested person within 2 days prior to pediculicide treatment be machine washed with hot water and dried with hot air since the lice and eggs are killed after 5 minutes of exposure to temperatures greater than 53.5°C (128.3°F). [4] Items that cannot be laundered can be dry-cleaned or sealed in a plastic bag for 2 weeks. [4] The floors and furniture should be vacuumed in order to remove hairs from an infested individual, which might have been shed with viable nits attached. [4] Children should also be educated not to share combs, brushes, hair accessories, and towels. [4]\nIn the treatment of body lice, medications are less essential than environmental measures. Patients with body lice should have infested clothing, bedding, and towels laundered with hot water (at least 130°F) and then dried in a dryer using a hot setting. [10] For items that cannot be washed in a washing machine, the CDC recommends dry-cleaning or sealing and storing for 2 weeks in a plastic bag. [14] If the patient maintains hygiene with regular appropriate laundering of clothing, changes into clean clothing at least weekly, and avoids the sharing of clothing, beds, bedding, and towels used by other infested individuals, pediculicides are generally not required. If hygiene cannot be maintained, treatment with a pediculicide used to treat head lice may be necessary. Fumigation or dusting with chemical insecticides is occasionally needed to control and prevent spread of louse-bourne infections. [10]\nRelated clinical guideline summaries include the following:\nBritish Association for Sexual Health and HIV -United Kingdom National Guideline on the Management of Phthirus pubis infestation [31]\nCDC: Parasites - Lice [4, 10, 14]\nVarious topical pediculicidal agents are available for the treatment of head and pubic lice. Pyrethrin shampoos and permethrin 1% are available over the counter; permethrin 5% (approved to treat scabies, but occasionally used to treat lice), malathion 0.5% (Ovide), lindane, topical ivermectin (Sklice), and spinosad are prescription agents. Pubic lice can be treated with over-the-counter permethrin 1% lotion and a mousse containing pyrethrins and piperonyl butoxide (RID foam). [14] Malathion lotion 0.5% is currently not US Food and Drug Administration (FDA) approved to treat pubic lice.\nPyrethrin and permethrin kill live lice, but not unhatched eggs. A second treatment 9 days after the first treatment is recommended in order to kill any newly hatched lice before they can produce new eggs. Pyrethrin is derived from chrysanthemums and is approved for use in children aged 2 years or older. It should not be used by individuals who are allergic to chrysanthemums or ragweed. Piperonyl butoxide has been added to pyrethrin products to enhance efficacy and to minimize the potential for resistance. [6]\nExamples of pyrethrin/piperonyl butoxide combination formulations include A200 Maximum Strength, A200 Lice Control, A-200 Lice Treatment, A200 Time-Tested Formula, A200 Lice Killing Shampoo, Good Sense Lice Killing Shampoo, Step 1, Lice Treatment gel, Lice-X, Licide shampoo, Leader Lice Solution, Medi-Lice maximum strength, Pronto Plus Lice Killing shampoo, Pronto Maximum strength, Pronto Lice Kill System, Pyrinex, Pyrinyl II, Pyrinyl Liquid Shampoo, Pyrinyl Liquid, R&C Lice Treatment Kit, RID Pediculicide, RID shampoo/spray kit, RID foam, RID gel, and Tisit shampoo.\nPermethrin is a synthetic pyrethroid similar to the naturally occurring pyrethrins from the chrysanthemum flower. Permethrin 1% lotion is approved for use in children aged 2 months or older.\nMalathion is an organophosphate that has proven to be more ovicidal than permethrin and has a higher lethal effect and decreased frequency of re-infestation, if used properly. It is approved for use in individuals aged 6 years or older. Malathion 0.5% lotion (Ovide) is flammable and should not be used in the presence of hot hair care products or near individuals who are smoking.\nLindane is an organochloride that should be reserved for treatment of individuals in whom alternative treatment has failed or is intolerable. [4, 14] Seizures may result from abnormal absorption or gross overuse of the product. It should not be used in patients with a defective cutaneous barrier, premature infants, people with seizure disorders, or pregnant or breastfeeding women. [14] Many authors recommend that it not be used in elderly persons or people who weigh less than 110 pounds. [14] Because of safety concerns, retreatment should also be avoided.\nSpinosad 0.9% suspension (Natroba) was approved by the FDA in 2011 for the treatment of head louse infestation in patients aged 4 years and older. The product is applied to dry hair as a cream rinse, left in for 10 minutes, and then shampooed out. Spinosad is derived from soil bacteria and has ovicidal activity. Retreatment is necessary only if live (ie, crawling) lice are seen 1 week after the first treatment. [32]\nIn February 2012, topical 0.5% ivermectin (Sklice) was approved in the United States as a single-dose, 10-minute application without the need for nit combing in individuals aged 6 months or older. Although it is not ovicidal, it appears to prevent nymphs from surviving. [4]\nAgents that work by clogging the respiratory spiracles of lice offer an alternative to neurotoxic pediculicides. [33, 34] This is the mechanism of action of benzyl alcohol lotion 5% (Ulesfia), which is approved by the FDA for treatment of head lice in patients aged 6 months or older; the benzyl alcohol inhibits lice from closing their respiratory spiracles, allowing the lotion to obstruct the spiracles.\nThe lotion is given in 2 applications 1 week apart for 10 minutes; it needs to be applied twice because it kills only lice, not nits. Benzyl alcohol lotion may be an easier and safer alternative to lindane and malathion. Because its mechanism of action is physical rather than chemical, development of resistance should not be a concern. In clinical studies, more than 75% of those treated with benzyl alcohol lotion became lice-free. [35]\nIsopropyl myristate (Resultz) is available in Canada and Europe, but not in the United States (it is currently in phase III clinical trials). It is a non-insecticide–based drug that contains isopropyl myristate, an ingredient commonly used in cosmetics. Its mode of action is a mechanical process that weakens the waxy shell of lice, resulting in internal fluid loss and dehydration. [36]\nOne study reported efficacy of 4% dimethicone lotion (a silicone-based lotion believed to disrupt the louse's ability to manage water) in the treatment of head lice. [37] Another study found that 4% dimethicone lotion was a significantly more effective than malathion in most patients. [38] NYDA is a Canadian-approved product that contains 92% dimethicone. In one study, it was found to be superior to 1% permethrin lotion. [39] The dimethicone in NYDA replaces the air in the breathing system of lice, nymphs, and nits (eggs) and then thickens quickly, causing suffocation and death. NYDA is approved in Canada for use in individuals aged 2 years or older. This product should eliminate head lice infestations after one application; however, the product monograph recommends a second treatment to ensure complete removal of head lice.\nOther occlusive therapy techniques, such as vinegar, mayonnaise, petroleum jelly, olive oil, butter, isopropyl alcohol, and water submersion as long as 6 hours, have been advocated, but most have not been scientifically evaluated. However, a dry-on, suffocation-based pediculicide (DSP) lotion was found to be effective in open trials. [33]\nVarious botanical agents have been used. Essential oils demonstrate variable efficacy and may be contact allergens. [40] In general, the evidence supporting their efficacy is of poor quality. [37, 41] Monoterpenoids are promising agents. [37, 42, 43]\nOral anthelmintics, including ivermectin, levamisole, and albendazole, [44, 45] have been found to be effective against head louse infestation, but are not approved by the FDA to treat lice. Oral ivermectin has also been successfully used to treat pubic lice. [14] Administration should be repeated in 7-10 days to kill lice emerging from nits that may have survived the first treatment. Trimethoprim-sulfamethoxazole was initially reported to be effective; however, controlled studies have shown only minimal efficacy.\nResistance of lice to the most commonly used medications for treatment of infestation (permethrin and pyrethrin) is increasing. [46, 47, 48, 49] Resistance has been reported in the United States as well as among countries in South America and Europe.\nA possible mechanism of resistance development includes mutations of target enzymes (eg, acetylcholinesterase) so that the enzymes no longer bind the organophosphate permethrin with the same affinity. Another possible mechanism is increasing the metabolism of the insecticides through an increase in monooxygenase enzyme activity, turning them into harmless compounds before they can cause damage. [50, 51, 52, 53]\nResistance to malathion has been reported in the United Kingdom; however, the UK formulation contains only malathion, whereas, in the US formulation, malathion is coupled with isopropyl alcohol and terpineol.\nMedicated lotions or shampoos may be used to eliminate head lice. Empiric treatment of all contacts is not needed; only contacts with confirmed infestation should also be treated; however, prophylactic treatment of bedmates of an infested individual is prudent. [4] Re-treatment after 7-10 days is recommended with many agents to eradicate any lice that hatched from nits after the initial treatment. It is important to read the instructions before applying the pediculicide to ensure that the medication has been left on for the appropriate amount of time and washed off properly.\nHair conditioner and combination shampoo/conditioner products should not be used prior to pediculicide application, and the hair should not be re-washed for 1-2 days after the pediculicide is removed. [4] Hair conditioners may prevent binding of the pediculicides to the hair shafts. After treatment, the infested individual should put on clean clothing.\nMechanical removal and shaving\nThe CDC, American Association of Pediatrics, and National Association of School Nurses recommend that school “no-nit” policies be discontinued. [4] Nits are cemented to hair shaft and unlikely to be successfully transferred to others. [4] Nonetheless, some schools still have a no-nit policy. In such cases, nits can be mechanically removed with fine-tooth combs. Soaking the hair in a solution of equal parts water and white vinegar and then wrapping the wet scalp in a towel for at least 15 minutes may facilitate removal. Commercial products include an 8% formic acid preparation (GenDerm Step 2) and an enzymatic nit remover (Clear).\nMost studies have shown that mechanical removal alone (ie, wet-combing every 2-3 days for a minimum of 2 weeks) is not as effective as mechanical removal combined with a pediculicide. [54] Proper treatment with medication is advised.\nShaving is effective but is usually not necessary or socially acceptable. However, in resistant disease, it may be a consideration.\nEnvironmental eradication\nSince head lice can sometimes be spread by sharing hats, hair bands and accessories, and towels that have been in contact with an infested person’s hair, any object that the infested child or parent has come into contact with should be considered a potential fomite. It may be beneficial to launder potential fomites (eg, towels, pillowcases, sheets, hats, toys) in hot water, followed by machine drying using the hottest cycle. Temperatures exceeding 130°F (55°C) for more than 5 minutes kill eggs, nymphs, and mature lice. Items that are not machine washable may be placed in a dryer at high heat for 30 minutes. Dry cleaning may be an effective alternative.\nBecause adult lice cannot survive for long if separated from a host and because eggs hatch in 6-10 days and nymphs die without a blood meal, carefully sealing potential fomites in plastic bags for 2 weeks can be effective. This technique works well for objects such as stuffed animals that do not tolerate laundering or dry cleaning. Vacuuming selected areas of the home, such as couches used by infested patients, is recommended by some as an adjunctive control measure.\nCombs and hair brushes can be discarded or soaked for at least 5 minutes in very hot water (>130°F [>55°C]).\nChemical insecticide sprays used in the home environment have not been shown to be effective in the control of head lice.\nProviding education to children about the sharing of hats, combs, and hair-ties is also prudent. Giving children separate areas to store their belongings in the classroom may help prevent the spread of lice. [4]\nThe same pediculicides used for head louse infestation are also used for pubic louse infestation. In addition, P pubis infestations of the eyelashes are treated with occlusive therapies.\nPubic lice can be treated with over-the-counter permethrin 1% lotion and a mousse containing pyrethrins and piperonyl butoxide (RID foam). [14]\nMalathion lotion 0.5% is currently not FDA approved to treat pubic lice.\nLindane shampoo causes neurotoxicity and should not be used as a first-line agent; it should be reserved for cases of resistance or when other medications are not tolerated. [14]\nSexual partners of a person infested with pubic lice should be informed that they are at risk for infestation and should be treated if the sexual contact occurred within a month prior to diagnosis. [14] Infested persons should avoid sexual contact until they have both been successfully treated. [14] If live lice are still found, treatment should be repeated in 9-10 days. [14] Individuals with pubic lice should also be checked for other STDs. [14]\nThe infested areas should be washed and towel dried. The instructions on the pediculicide should be read and carefully followed. The pubic hair and other infested areas (excluding eyebrows and eyelashes) should be thoroughly saturated with the pediculicide. After leaving on the pediculicide for the recommended time, it should be removed according to the package instructions. Clean clothing and underwear should be put on after treatment. Towels, clothing, and bedding used within the 2-3 days before treatment should be machine-washed in water of at least 130°F and dried in a hot dryer. [14] Items that cannot be laundered should be dry-cleaned or stored in a sealed plastic bag for 2 weeks. [14]\nOphthalmic-grade petrolatum (2-4 times a day for 10 days) is often used, with good results, as an asphyxiant for eyelash infestation. [14] The petrolatum covers the lice and their nits, preventing respiration. The dead lice are removed mechanically, usually with tweezers. Mercuric oxide ointment is also useful in the treatment of eyelash infestation with P pubis. If only a few live lice and nits are on eyelashes and/or eyebrows, it may be possible to remove them with a nit comb or fingernails. [14]\nFluorescein dye strips, which are used in the diagnosis of corneal abrasions, may be used in combination with white petrolatum. The strips are applied to the eyelashes for 3 nights.\nUse of a pediculicide is usually unnecessary with P humanus corporis infestation because the lice live on the clothing. Treatment of clothing and bed linens includes laundering in hot water, ironing with a hot iron, or drying in a hot dryer. Dry cleaning is also effective for killing lice and their nits on clothing.\nEducation about hygiene and accessibility to laundering facilities are important in preventing the spread of body lice and re-infestation. [55]\nTopical agents can be applied to clothing, especially the seams. Published data suggest that permethrin spray can help prevent body louse re-infestation.\nIn cases of heavy pediculosis, treatment of the body with a pediculicide shampoo or lotion may be beneficial, especially if the patient also has confirmed or suspected concomitant head or pubic louse infestation. Oral ivermectin 12 mg given as 3 doses 7 days apart has also been shown to be effective in a cohort of homeless men. [22] None of these agents is currently labeled or marketed for treatment of body lice in the United States. In some cultures, monkeys are used as patient nit pickers to groom the hair and to remove adult lice and nits.\nThe treatment of infested family members, friends, and/or other close contacts at the same time as the infested individual is important in helping to prevent further spread of head lice and in preventing re-infestation. In the case of pubic lice, all sexual partners from within the previous month should be treated. [14]\nPatient education regarding treatment of contacts is essential. Parents with children who are infested should be advised to treat all infested family members with a pediculicide and to provide environmental fomite control.\nTo prevent head lice re-infestation, all household members and contacts of a patient should be examined and treated at the same time if infested. Bedmates should also ideally be treated even if they do not show evidence of infestation. Washing combs, brushes, and other fomites may reduce re-infestation.\nChildren should be educated not to exchange or use another child's hat, comb, or brush. Some parents choose to extend this prohibition to use of \"common\" headwear such as is available in the dress-up area of various play spaces or public libraries.\nOnce an infestation has been identified and treated, ongoing vigilance with close, direct visualization of hair and scalp at periodic intervals is recommended.\nSexual partners within the previous month of individuals with pubic lice should be treated at the same time as the infested individual. Sexual contact should be avoided between sexual partner(s) until they have both been successfully treated. [14] Bed linens, towels, and underwear and clothing should be washed at the same time as treatment with medication.\nPrevention of re-infestation with body lice can be accomplished by ensuring that infested clothing, bedding, and towels were appropriately laundered with hot water (at least 130°F) and then dried in a dryer using a hot setting to destroy the lice, improving the individual’s hygiene, regularly laundering clothing, and changing to clean clothing at least weekly. [10]\nAraujo A, Ferreira LF, Guidon N, et al. Ten thousand years of head lice infection. Parasitol Today. 2000 Jul. 16(7):269. [Medline].\nWalsh J, Nicholson A. Head lice in children--a modern pandemic. Ir Med J. 2005 May. 98(5):156-7. [Medline].\nFalagas ME, Matthaiou DK, Rafailidis PI, Panos G, Pappas G. Worldwide prevalence of head lice. Emerg Infect Dis. 2008 Sep. 14(9):1493-4. [Medline].\nHead Lice. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/parasites/lice/head. 2013 Sep 24; Accessed: August 2, 2014.\nMumcuoglu KY, Gallili N, Reshef A, Brauner P, Grant H. Use of human lice in forensic entomology. J Med Entomol. 2004 Jul. 41(4):803-6. [Medline].\nKo CJ, Elston DM. Pediculosis. J Am Acad Dermatol. 2004 Jan. 50(1):1-12. [Medline].\nElston DM. Nit picking. J Am Acad Dermatol. 2005 Jul. 53(1):164-7. [Medline].\nElston DM. Drugs used in the treatment of pediculosis. J Drugs Dermatol. 2005 Mar-Apr. 4(2):207-11. [Medline].\nBurkhart CN, Burkhart CG. Fomite transmission in head lice. J Am Acad Dermatol. 2007 Jun. 56(6):1044-7. [Medline].\nBody Lice. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/parasites/lice/body. 2013 Sep 24; Accessed: October 31, 2014.\nSchmidt GD, Roberts LS. Foundations of Parasitology. 4th ed. St. Louis: Times Mirror/Mosby College Publishing; 1989.\nKoehler JE, Sanchez MA, Garrido CS, Whitfeld MJ, Chen FM, Berger TG, et al. Molecular epidemiology of bartonella infections in patients with bacillary angiomatosis-peliosis. N Engl J Med. 1997 Dec 25. 337(26):1876-83. [Medline].\nMimouni D, Ankol OE, Gdalevich M, Grotto I, Davidovitch N, Zangvil E. Seasonality trends of Pediculosis capitis and Phthirus pubis in a young adult population: follow-up of 20 years. J Eur Acad Dermatol Venereol. 2002 May. 16(3):257-9. [Medline].\nPubic \"Crab\" Lice. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/parasites/lice/pubic/index. 2013 Sep 24; Accessed: October 31, 2014.\nChosidow O. Scabies and pediculosis. Lancet. 2000 Mar 4. 355(9206):819-26. [Medline].\nMumcuoglu KY, Meinking TA, Burkhart CN, Burkhart CG. Head louse infestations: the \"no nit\" policy and its consequences. Int J Dermatol. 2006 Aug. 45(8):891-6. [Medline].\nWillems S, Lapeere H, Haedens N, Pasteels I, Naeyaert JM, De Maeseneer J. The importance of socio-economic status and individual characteristics on the prevalence of head lice in schoolchildren. Eur J Dermatol. 2005 Sep-Oct. 15(5):387-92. [Medline].\nAkisu C, Aksoy U, Delibas SB, Ozkoc S, Sahin S. The prevalence of head lice infestation in school children in Izmir, Turkey. Pediatr Dermatol. 2005 Jul-Aug. 22(4):372-3. [Medline].\nRupes V, Vlckova J, Mazanek L, Chmela J, Ledvinka J. [Pediatric head lice: taxonomy, incidence, resistance, delousing]. Epidemiol Mikrobiol Imunol. 2006 Aug. 55(3):112-9. [Medline].\nBahamdan K, Mahfouz AA, Tallab T, Badawi IA, al-Amari OM. Skin diseases among adolescent boys in Abha, Saudi Arabia. Int J Dermatol. 1996 Jun. 35(6):405-7. [Medline].\nLeung AK, Fong JH, Pinto-Rojas A. Pediculosis capitis. J Pediatr Health Care. 2005 Nov-Dec. 19(6):369-73. [Medline].\nFoucault C, Ranque S, Badiaga S, Rovery C, Raoult D, Brouqui P. Oral ivermectin in the treatment of body lice. J Infect Dis. 2006 Feb 1. 193(3):474-6. [Medline].\nElston DM. Treating pediculosis--those nit-picking details. Pediatr Dermatol. 2007 Jul-Aug. 24(4):415-6. [Medline].\nKlaus S, Shvil Y, Mumcuoglu KY. Generalized infestation of a 3 1/2-year-old girl with the pubic louse. Pediatr Dermatol. 1994 Mar. 11(1):26-8. [Medline].\nMumcuoglu KY, Miller J, Manor O, Ben-Yshai F, Klaus S. The prevalence of ectoparasites in Ethiopian immigrants. Isr J Med Sci. 1993 Jun-Jul. 29(6-7):371-3. [Medline].\nBrouqui P, Lascola B, Roux V, Raoult D. Chronic Bartonella quintana bacteremia in homeless patients. N Engl J Med. 1999 Jan 21. 340(3):184-9. [Medline].\nWilliams LK, Reichert A, MacKenzie WR, Hightower AW, Blake PA. Lice, nits, and school policy. Pediatrics. 2001 May. 107(5):1011-5. [Medline].\nLwegaba A. Shaving can be safer head lice treatment than insecticides. BMJ. 2005 Jun 25. 330(7506):1510. [Medline]. [Full Text].\nJahnke C, Bauer E, Hengge UR, Feldmeier H. Accuracy of diagnosis of pediculosis capitis: visual inspection vs wet combing. Arch Dermatol. 2009 Mar. 145(3):309-13. [Medline].\nDi Stefani A, Hofmann-Wellenhof R, Zalaudek I. Dermoscopy for diagnosis and treatment monitoring of pediculosis capitis. J Am Acad Dermatol. 2006 May. 54(5):909-11. [Medline].\nBritish Association for Sexual Health and HIV. United Kingdom national guideline on the management of phthirus pubis infestation. National Guideline Clearinghouse. Feb 2008.\nStough D, Shellabarger S, Quiring J, Gabrielsen AA Jr. Efficacy and safety of spinosad and permethrin creme rinses for pediculosis capitis (head lice). Pediatrics. 2009 Sep. 124(3):e389-95. [Medline].\nPearlman DL. A simple treatment for head lice: dry-on, suffocation-based pediculicide. Pediatrics. 2004 Sep. 114(3):e275-9. [Medline].\nPearlman DL. Nuvo lotion and the future of head-lice treatment. Pediatrics. 2005 May. 115(5):1452-3. [Medline].\nBenzyl alcohol lotion 5% [package insert]. Atlanta, GA: Sciele Pharma Inc; 2009.\nwww.getresultz.ca Accessed January 8, 2015.\nBurgess IF, Brown CM, Lee PN. Treatment of head louse infestation with 4% dimeticone lotion: randomised controlled equivalence trial. BMJ. 2005 Jun 18. 330(7505):1423. [Medline]. [Full Text].\nBurgess IF, Lee PN, Matlock G. Randomised, controlled, assessor blind trial comparing 4% dimeticone lotion with 0.5% malathion liquid for head louse infestation. PLoS One. 2007 Nov 7. 2(11):e1127. [Medline]. [Full Text].\nHeukelbach J, Pilger D, Oliveira FA, Khakban A, Ariza L, Feldmeier H. A highly efficacious pediculicide based on dimeticone: randomized observer blinded comparative trial. BMC Infect Dis. 2008. 8:115. [Medline].\nMumcuoglu KY, Magdassi S, Miller J, Ben-Ishai F, Zentner G, Helbin V, et al. Repellency of citronella for head lice: double-blind randomized trial of efficacy and safety. Isr Med Assoc J. 2004 Dec. 6(12):756-9. [Medline].\nBurgess IF. Current treatments for pediculosis capitis. Curr Opin Infect Dis. 2009 Apr. 22(2):131-6. [Medline].\nToloza AC, Vassena C, Picollo MI. Ovicidal and adulticidal effects of monoterpenoids against permethrin-resistant human head lice, Pediculus humanus capitis. Med Vet Entomol. 2008 Dec. 22(4):335-9. [Medline].\nBurgess IF. The mode of action of dimeticone 4% lotion against head lice, Pediculus capitis. BMC Pharmacol. 2009 Feb 20. 9:3. [Medline]. [Full Text].\nAkisu C, Delibas SB, Aksoy U. Albendazole: single or combination therapy with permethrin against pediculosis capitis. Pediatr Dermatol. 2006 Mar-Apr. 23(2):179-82. [Medline].\nChosidow O, Giraudeau B, Cottrell J, Izri A, Hofmann R, Mann SG, et al. Oral ivermectin versus malathion lotion for difficult-to-treat head lice. N Engl J Med. 2010 Mar 11. 362(10):896-905. [Medline].\nBailey AM, Prociv P. Persistent head lice following multiple treatments: evidence for insecticide resistance in Pediculus humanus capitis. Australas J Dermatol. 2000 Nov. 41(4):250-4. [Medline].\nDowns AM, Stafford KA, Harvey I, Coles GC. Evidence for double resistance to permethrin and malathion in head lice. Br J Dermatol. 1999 Sep. 141(3):508-11. [Medline].\nGonzalez Audino P, Barrios S, Vassena C, Mougabure Cueto G, Zerba E, Picollo MI. Increased monooxygenase activity associated with resistance to permethrin in Pediculus humanus capitis (Anoplura: Pediculidae) from Argentina. J Med Entomol. 2005 May. 42(3):342-5. [Medline].\nPicollo MI, Vassena CV, Mougabure Cueto GA, Vernetti M, Zerba EN. Resistance to insecticides and effect of synergists on permethrin toxicity in Pediculus capitis (Anoplura: Pediculidae) from Buenos Aires. J Med Entomol. 2000 Sep. 37(5):721-5. [Medline].\nKristensen M, Knorr M, Rasmussen AM, Jespersen JB. Survey of permethrin and malathion resistance in human head lice populations from Denmark. J Med Entomol. 2006 May. 43(3):533-8. [Medline].\nMeinking TL, Entzel P, Villar ME, Vicaria M, Lemard GA, Porcelain SL. Comparative efficacy of treatments for pediculosis capitis infestations: update 2000. Arch Dermatol. 2001 Mar. 137(3):287-92. [Medline].\nDrugs for head lice. Med Lett Drugs Ther. 1997 Jan 17. 39(992):6-7. [Medline].\nYoon KS, Gao JR, Lee SH, Clark JM, Brown L, Taplin D. Permethrin-resistant human head lice, Pediculus capitis, and their treatment. Arch Dermatol. 2003 Aug. 139(8):994-1000. [Medline].\nRoberts RJ, Casey D, Morgan DA, Petrovic M. Comparison of wet combing with malathion for treatment of head lice in the UK: a pragmatic randomised controlled trial. Lancet. 2000 Aug 12. 356(9229):540-4. [Medline].\nIzri A, Chosidow O. Efficacy of machine laundering to eradicate head lice: recommendations to decontaminate washable clothes, linens, and fomites. Clin Infect Dis. 2006 Jan 15. 42(2):e9-10. [Medline].\nNit on a hair. Note the thin, translucent cement surrounding the hair shaft. Photo courtesy of David Shum, MDWestern University, London Ontario.\nTwo empty nits from Pediculus humanus capitis. Note the open shells still attached to the hairs and the porous operculi through which the lice have hatched. Photo courtesy of David G. Schaus.\nThree specimens of Pediculus humanus capitis.\nPediculus humanus corporis.\nPhthirus pubis. Note the crab-like appearance.\nThe head louse, Pediculus humanus capitis, has an elongated body and narrow anterior mouthparts. Body lice look similar but lay their eggs (nits) on clothing fibers instead of hair fibers.\nThe pubic louse, Pthirus pubis, is identified by its wide crablike body.\nLyn C C Guenther, MD, FRCPC, FAAD Medical Director, The Guenther Dermatology Research Centre; President, Guenther Research, Inc; Professor of Dermatology, Department of Medicine, Western University of Health Sciences, Canada\nLyn C C Guenther, MD, FRCPC, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, Association of Professors of Dermatology, Canadian Dermatology Association, Canadian Dermatology Foundation, Canadian Medical Association, Canadian Society for Dermatologic Surgery, College of Physicians and Surgeons of Ontario, Drug Industry Association, European Academy of Dermatology and Venereology, International Hyperhidrosis Society, International League of Dermatological Societies, International Society for Dermatologic Surgery, London and District Academy of Medicine, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Society for Investigative Dermatology, Society for Pediatric Dermatology\nDisclosure: Received consulting fee and honorarium and performed clinical research for consulting for: Johnson & Johnson.\nSheilagh Maguiness, MD, FAAD, FRCPC Pediatric Dermatologist, Boston Children's Hospital\nSheilagh Maguiness, MD, FAAD, FRCPC is a member of the following medical societies: American Academy of Dermatology, Canadian Dermatology Association, Canadian Medical Association, Society for Pediatric Dermatology, Women's Dermatologic Society\nThomas W Austin, MD Professor Emeritus, Department of Medicine, Division of Infectious and Sexually Transmitted Diseases, University of Western Ontario, Canada\nThomas W Austin, MD is a member of the following medical societies: Canadian Infectious Disease Society, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada\nDavid F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic\nDavid F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa\nEdward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine\nEdward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology\nPamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center\nPamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine\nDirk M Elston, MD, Director, Ackerman Academy of Dermatopathology, New York\nDirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology\nJoseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center\nDaniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center\nDaniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association\nEdmond A Hooker II, MD, DrPH, FAAEM Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine\nEdmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association\nAbdul-Ghani Kibbi, MD Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon\nRick Kulkarni, MD\nRick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine\nDisclosure: WebMD Salary Employment\nDavid A Peak, MD Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary\nDavid A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society\nNelly Rubeiz, MD Consulting Staff, Department of Dermatology, American University of Beirut Medical Center; Associate Professor, Department of Dermatology, American University of Beirut, Lebanon\nNelly Rubeiz, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology\nRobert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School\nRobert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi\nRussell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine\nRussell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association\nJeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist\nJeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine\nMary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, Medscape\nWayne Wolfram, MD, MPH Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center\nWayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine\nNeil W Yoder, DO Staff Physician, Department of Emergency Medicine, St Vincent Mercy Medical Center\nNeil W Yoder, DO is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association\nJeffrey M Zaks, MD Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital\nJeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American College of Physician Executives, and American Medical Association\nencoded search term (Pediculosis and Pthiriasis (Lice Infestation)) and Pediculosis and Pthiriasis (Lice Infestation)\nFast Five Quiz: Test Yourself on Clinical Information About Insect Bites\nTrichomycosis Pubis\nCaterpillar Envenomation\nAccording to Internists\nVitamins and Supplements Are a Waste of Money\nHow to Be Elderly and Not Frail\nIs the Sunscreen Scare Legitimate?\nSupplements for Sex: What To Know\nThe Antibiotic You Should (Almost) Always Avoid\nDiseases & Conditions Pediculosis and Pthiriasis (Lice Infestation)\nDiseases & Conditions Trichomycosis Pubis\nDiseases & Conditions Piedra\nDiseases & Conditions Caterpillar Envenomation"