Lice and Scabies

Typical scabies rash
Typical scabies rash

Lice (Head, Body, and Genital)

  • Dx – must see the lice. Seeing nits alone does NOT diagnose, and is not an excuse for the kid to be out of school.
  • Rx – Permethrin 1% Shampoo. Leave on 10 min, then rinse. Repeat in 1 week to kill off any hatched eggs. Wash all clothes, bedsheets, towels with hot water.
  • If resistant, try malathion.


  • Dx – burrows, scales, papules. @ groin, wrists, hands, armpits, abdomen, to name a few places.
  • Takes about 15-20 min of close contact to transfer the mite to someone else. Does not jump or fly.
  • Rx – Permethrin 5% Cream. Apply neck down. Leave on for 8-14 hrs, then wash off. Repeat in 2 weeks if needed.
  • If resistant, Rx oral ivermectin x1.
  • If crusted scabies (bad), Rx permethrin 5% cream daily x 7 days + ivermectin on days 1, 2, 8, 9, 15.
  • Warn patients that skin will continue to itch even after treatment, due to dead scabies remaining in skin. Rx PRN itching with benadryl or hydroxyzine.