First line
At first, treatment is usually with topical permethrin 1% cream, which can be bought over the counter without a prescription. It is applied to the areas affected by pubic lice and washed off after 10 minutes. Brands of permethrin include Lyclear, available in the UK as a creme rinse or dermal cream at 5% strengths. In the US, permethrin may be familiar as NIX, Actin and ElimiteAn alternative is the combination of pyrethrins and piperonyl butoxide, in a topical application, which include the brands Licide, and A-200, Pronto and RID shampoos. These medications are safe and effective when used exactly according to the instructions in the package or on the label. To kill newly hatched lice, both treatments can be repeated within the following seven to ten days.European guidelines state alternatives to permethrin as including either the application of 0.2% phenothrin (washed off after two hours), or 0.5% malathion lotions (washed off after 12 hours). The CDC states alternatives as topical 0.5% malathion or oral ivermectin. Other treatments
Lindane is still used in a shampoo form in some non-European countries. Its licence was withdrawn by the European Medicines Agency in 2008. It may be considered as a last resort in some people who show resistance to other treatments, but is not recommended to be used for a second round of treatment. Lindane is not recommended in pregnant and breastfeeding women, children under the age of two years, and people who have extensive dermatitis.
The FDA warns against use in people with a history of uncontrolled seizure disorders and cautious use in infants, children, the elderly, and individuals with other skin conditions (e.g., atopic dermatitis, psoriasis) and in those who weigh less than 110 lbs (50 kg). Carbaryl has been used since 1976 but found to have the potential to cause cancer in rodents and not to be as effective as previously thought. It is either not used at all or its use is restricted.Sexual partners should be evaluated and treated, and sexual contact should be avoided until all partners are better. Because of the strong association between the presence of pubic lice and sexually transmitted infections (STIs), affected people require investigation for other STIs. Eyes
Infestation of the eyes is treated differently than other parts of the body. Lice can be removed with forceps or by removing or trimming the lashes. Eyelashes may be treated with a gentle petroleum jelly for occlusion. Complications
Complications are usually as a result of persistent scratching and include thickening of the skin, darkened skin, and secondary bacterial infection including impetigo, conjunctivitis and blepharitis. Epidemiology
Infestation with pubic lice is found in all parts of the world, occurs in all ethnic groups and all levels of society.Current worldwide prevalence has been very approximately estimated at two percent of the human population. Accurate numbers are difficult to acquire, because pubic lice infestations are not considered a reportable condition by many governments.