Key points
- Use lice-killing lotion containing 1% permethrin or a mousse containing pyrethrins and piperonyl butoxide to treat pubic ("crab") lice.
- Both over-the-counter and prescription treatments are available.
- Infested people should notify sex partners.
Treatment options
You can treat pubic lice with a lice-killing lotion containing 1% permethrin or a mousse containing pyrethrins and piperonyl butoxide. These are available over-the-counter or via prescription.
Both topical and oral ivermectin can successfully treat lice. The FDA has approved topical ivermectin lotion for treatment of pubic lice; use of oral ivermectin in this case is off-label (I.e., not FDA-approved for treating lice).
Malathion lotion 0.5% (Ovide) is a prescription medication that can kill lice and some lice eggs but it's use is off label to treat pubic ("crab") lice.
Lindane shampoo is a prescription medication that can kill lice and lice eggs but is no longer available in the United States due to a risky side effect profile (toxic to the brain and other parts of the nervous system). Do not use lindane as the first treatment. Use it only for patients who have failed treatment with or cannot tolerate other medications that pose less risk.
Do not use lindane to treat:
- Premature infants,
- Children,
- Elderly people,
- People who weigh less than 110 pounds,
- People who are pregnant or breast-feeding, or
- People with irritated skin or sores in the infested area.
Lindane is effective at treating lice but is no longer available in the United States or Canada due to its risk for severe side effects.