Pubic lice can be treated at home with insecticide cream, lotion or shampoo. It will usually need to be applied once and repeated after three to seven days.
Most treatments need to be applied to the affected area and the whole body, apart from your scalp, face, eyebrows and eyelashes (but including your beard or moustache if you have one). Your doctor, nurse or pharmacist can give you more advice about this.
Everyone you have had close bodily contact with should also be treated at the same time. This includes any sexual partners you have had in the past three months and all members of your household.
Sometimes, pubic lice can be difficult to get rid of because they can develop resistance to insecticide treatments. If this is the case, you may need to try more than one type of treatment. Your doctor or pharmacist can advise you on suitable alternatives.
Treating yourself
You can treat yourself at home with an insecticide cream, lotion or shampoo. They are available on prescription from your doctor or you can buy them over the counter from your pharmacy.
Before using the treatment, speak to your doctor or pharmacist about the correct way to use it. Follow their instructions, even if they are different to those on the packaging.
Always ask for advice if the treatment is for:
- a child under 18 years of age
- someone who is pregnant or breastfeeding
These people may require a specific type of treatment.
Lotions and cream
The two most commonly used insecticides are:
- malathion 0.5% aqueous lotion
- permethrin 5% dermal cream
In most cases, the instructions for using malathion lotion or permethrin cream will be as follows:
- Apply the lotion to your whole body, particularly any hairy areas, when you are clean, dry and cool. Do not apply the lotion to your face, the hair on your head, your eyebrows or eyelashes.
- Apply the lotion to your beard and moustache, if you have one.
- Apply the lotion to your pubic area, including any pubic hair, hair between your legs and hair around your anus.
- Be careful not to get the lotion in your eyes. If you do, rinse your eyes thoroughly with water.
- As an approximate guide, an adult will need around 100ml of lotion or 30–60g of cream for one application.
- Leave malathion lotion on for 12 hours or overnight. Leave permethrin cream on for 24 hours.
- Reapply the treatment if you wash any part of your body during the treatment time.
- After the correct treatment time has passed, wash the lotion or cream off.
- Repeat the treatment after three to seven days as instructed.
Do not use medication more than twice.
Treating an eyelash infestation
If your eyelashes are infested, seek specialist advice and help from your doctor.
You cannot use the same insecticide lotion or cream as you use on your body because it will irritate your eyes. Your doctor will be able to recommend an alternative treatment for you.
Eye ointment
An eye ointment with a white or yellow soft paraffin base may be recommended. This works by coating the lice in the greasy ointment and suffocating them. You should:
- Apply the ointment to your eyelashes twice a day, ensuring that all your eyelashes are well covered.
- Each time you reapply the ointment, first gently wipe your eyelashes and eyelids clean with a tissue. Throw the tissue away afterwards.
- Continue the treatment for at least eight days.
- If you can still see lice or unhatched eggs (not empty eggshells, which are called nits), continue the treatment for 10 days because the eggs can take this long to hatch.
Side effects
Insecticides that are used to treat pubic lice may cause skin or eye irritation, such as itchiness, redness, stinging or burning.
If you have these side effects, wash the insecticide off the irritated area. If the insecticide gets into your eyes, rinse them thoroughly using plenty of water.
Some aqueous and alcoholic-based medications may discolour permed, coloured or bleached hair. Check the patient information leaflet for more details.
Follow-up treatment
The first treatment application will probably kill the lice, but the eggs may not have been destroyed. This means that more lice could hatch and the cycle will start again. Reapplying the treatment after seven days ensures that any lice are killed before they are old enough to lay more eggs.
Check for lice a week after your second treatment, or return to your doctor, sexual health clinic, or genitourinary medicine (GUM) clinic so that they can check for you.
If you find empty eggshells (nits), it does not necessarily mean that you are still infested. They can remain stuck to the hairs even after treatment. However, if you find lice or eggs that could still hatch, your treatment has not been successful and you should speak to your doctor.
The lice may be resistant to the treatment you have used and your doctor may recommend a different treatment.
Treating other people
To prevent re-infestation, anyone that you are in close contact with should also be treated at the same time as you. This includes your sexual partners and all members of your household, even if they do not have symptoms.
Infestations from sexual contact
If your pubic lice were caught through sexual contact, your GP may refer you to a GUM clinic so that you can be screened for other sexually transmitted infections (STIs), such as chlamydia.
Staff at the clinic will recommend that you inform any sexual partners you have had in the past three months so that they can also be examined for pubic lice and treated if necessary.
Some people feel angry, upset or embarrassed about talking to their current or former sexual partners about pubic lice. Do not be afraid to discuss your concerns with clinic staff. They can help you decide the best way to make contact. They can also contact a partner without releasing your details, if you prefer.
