Guideline sources The following summarized guidelines for the management of pediculosis pubis are prepared by our editorial team based on guidelines from the International Union Against Sexually Transmitted Infections (IUSTI 2017). 1 Guidelines 1. Medical management First-line therapy: Use one of the following medications as first-line therapy: permethrin 1% cream applied to the affected areas and washed off after 10 min pyrethrins with piperonyl butoxide applied to the affected areas and washed off after 10 min. B Second-line therapy: Use one of the following medications as second-line therapy: phenothrin 0.2% lotion on dry hair, wash out after 2 hours B malathion 0.5% lotion on dry hair, wash out 12 hours B ivermectin PO 250 g/kg, repeat after 1 week. B Advise patients to avoid heat exposure (including electric hair dryer) as malathion products are potentially flammable. B Alternative treatment options: Consider the following medications as alternative treatment options: topical ivermectin benzyl benzoate 25% lotion. C https://web.pathway.md/diseases/recFxbmoiWkyQdVJ3 1/2 6/29/23, 10:57 PM Pediculosis pubis Pathway Management of pediculosis ciliaris: Consider the following medications in patients with pediculosis ciliaris: inert ophthalmic ointment with paraffin or yellow mercuric oxide applied as eye patch BID for 8-10 days ivermectin PO 200 g/kg as two doses 1 week apart permethrin 1% lotion applied to the eyelashes and washed off after 10 min. C Management of sexual partners: treat individuals who have been sexual partners of an infected patient within the past 3 months. B 2. Specific circumstances Pregnant patients: consider using permethrin in pregnant patients, given its evidence for safety in this population. C 3. Follow-up and surveillance Follow-up: arrange a follow-up visit 1 week after completion of treatment to verify its efficacy by searching for lice or nits. B References 1. C M Salavastru, O Chosidow, M Janier et al. European guideline for the management of pediculosis pubis. J Eur Acad Dermatol Venereol. 2017 Sep;31 9 1425 1428. Open 2. Karen Gunning, Bernadette Kiraly, Karly Pippitt. Pediculosis and Scabies: A Treatment Update. Am Fam Physician. 2019 May 15;99 10 635 642. Open https://web.pathway.md/diseases/recFxbmoiWkyQdVJ3 2/2