Pubic lice
Treatment of pubic lice
Malathion
Malathion 0.5% aqueous liquid
Apply once weekly for 2 doses, apply preparation over whole body, allow to dry naturally, wash off after 12 hours or overnight. See product information for treatment of crab (pubic) lice in adults.
Permethrin
Permethrin 5% cream
See product information for treatment of crab (pubic) lice in adults.
Prescribing Notes:
- A second treatment is needed after 7 days to kill lice emerging from surviving eggs.
- Alcoholic lotions are not recommended due to irritation of excoriated skin and genitalia.
- If treatment is not effective, a different insecticide should be used for the second course.
- Depending on the clinical situation treat pubic lice infestation of the eye lashes with either inert occlusive ophthalmic ointment or permethrin 1% lotion:
- Inert occlusive ophthalmic ointments should be used for people under the age of 18 years, and for those who are pregnant or breastfeeding.
- Occlusive ophthalmic ointment should be applied to the eyelid margins twice a day for 10 days.
- If permethrin 1% lotion is appropriate the person should be advised to apply the product to the eyelashes keeping the eyes closed during application and wash off after 10 minutes.
History Notes
15/12/2021
East Region Formulary content agreed.
Treatment of pubic lice
Malathion
Malathion 0.5% aqueous liquid
For dose, refer to BNF for Children.
Permethrin
Permethrin 5% cream
As per specialist.
Prescribing Notes:
- Permethrin and malathion are used to eliminate crab lice (Pthirus pubis); permethrin is not licensed for treatment of crab lice in children under 18 years. An aqueous preparation should be applied, allowed to dry naturally and washed off after 12 hours; a second treatment is needed after 7 days to kill lice emerging from surviving eggs. All surfaces of the body should be treated, including the scalp, neck, and face (paying particular attention to the eyebrows and other facial hair). A different insecticide should be used if a course of treatment fails.
- Alcoholic lotions are not recommended due to irritation of excoriated skin and genitalia.
- The recommended treatment of pubic lice infestation of the eye lashes in individuals under 18 years of age is with inert occlusive ophthalmic ointment. Occlusive ophthalmic ointment should be applied to the eyelid margins twice a day for 10 days.
- Seek advice of children’s service or sexual health team where there are safeguarding concerns. Document decision to seek or not seek advice.
History Notes
31/05/2024
East Region Formulary content agreed.
Pharmacy First - Pubic (crab) lice
Permethrin
Permethrin 5% cream
Dose according to age and product licence.
Malathion
Malathion 0.5% aqueous liquid
Dose according to age and product licence.
Prescribing Notes:
- Aqueous preparations are preferable to alcoholic lotions.
- All members of the household and close contacts should be treated.
- Apply to cool dry skin (i.e. not after a hot bath).
- Consider sedating antihistamine for night time if itch interferes with sleep.
- Crotamiton (Eurax) cream or liquid may help soothe itch which may last for 2-3 weeks after treatment.
History Notes
27/10/2020
Content migrated from ‘East Region Formulary: Pharmacy First - supporting minor ailments’ document.