Understanding Pubic Lice (Pediculosis Pubis)

A Patient's Guide to Diagnosis, Treatment, and Prevention

Dermatology

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Last updated: Mar 24, 2025

What Are Pubic Lice?

Pubic lice (Pthirus pubis), commonly known as 'crabs,' are tiny parasitic insects that infest the pubic hair region. These parasites are typically 1-2mm in size and attach to coarse body hair, primarily in the genital area.

Common Symptoms

  • Intense itching in the pubic region
  • Visible gray-white eggs (nits) on hair shafts
  • Small blue spots on the skin
  • Visible brown or gray lice
  • Dark or rust-colored spots on underwear

Transmission

Pubic lice are primarily transmitted through:

  • Intimate sexual contact
  • Close physical contact
  • Sharing bedding or towels

Diagnosis

Diagnosis is typically made through:

  • Visual examination
  • Identification of lice or nits
  • Microscopic confirmation if needed

Treatment Options

Over-the-Counter Treatments

  • Permethrin 1% lotion
  • Pyrethrin-based products

Prescription Medications

  • Malathion 0.5% lotion
  • Ivermectin (oral medication)

Prevention Measures

  1. Avoid intimate contact with infected individuals
  2. Wash all bedding and clothing in hot water (at least 130°F)
  3. Dry items on high heat for at least 20 minutes
  4. Seal non-washable items in plastic bags for 2 weeks

When to Seek Medical Care

  • If over-the-counter treatments fail
  • If symptoms persist after treatment
  • If you develop skin infections
  • If you're pregnant or treating a child

Follow-up Care

  • Repeat treatment after 9-10 days if recommended
  • Check all close contacts
  • Return for evaluation if symptoms persist

Important Notes

  • Treatment failure is often due to improper application or reinfection
  • All sexual partners should be treated simultaneously
  • Regular check-ups are recommended until infestation is cleared

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