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What Are the Treatments?

There has been some controversy about the dangerous side effects of some pediculicides, which kill mites and lice. Several alternatives exist, including herbal remedies for those who want a more benign (though also potentially less effective) solution.

Gamma benzene hexachloride (also known as lindane) was at one time the most commonly prescribed pediculicide. If used improperly, it can attack and permanently damage the central nervous system. Multiple applications, especially in young children, have led to brain damage, paralysis and seizures. In 1990, the FDA approved the use of permethrin, a cream that works well against scabies without the potent side effects. Permethrin has quickly become the treatment of choice of most dermatologists, especially for children.

What Is the Treatment for Lice?

The goal of treatment is to remove all lice and nits. This usually requires repeated efforts, because a few adults may escape by hiding in clothing or bedding and eggs are difficult to kill.

To get rid of head lice, the most common treatment is to kill the adults with an insecticidal shampoo and to clear out the nits with a special fine-toothed comb. The safest and most effective preparation is permethrin cream rinse, available over the counter. For best results, follow the directions exactly. Other family members should be treated. About 60% of infected children have relatives who carry lice.

To avoid spreading the lice, infected children should be kept home from school until they are treated. Wash all clothing, towels and bed linens in hot, soapy water and dry in a hot dryer. Dry clean clothing that is not washable. You can also sterilize bedding or other items by placing them in a plastic bag for 14 days. The nits will hatch in about a week and die of starvation. Combs, brushes and barrettes can be disinfected by soaking in hot, soapy water for 10 minutes.

For those who prefer to avoid the use of insecticides, try a "combing only" technique. Wash the hair with ordinary shampoo and conditioner, and leave wet. With a fine-toothed comb, stroke slowly outward from the roots through one lock of hair at a time. Lice will land on the back of the comb, get caught between the teeth, or fall off. Space at least 30 strokes over the head. Repeat every three days. Because newborn lice do not lay eggs for the first week, all the lice should disappear after about two weeks of combing.

Pubic lice can be treated with over-the-counter medications containing pyrethrins (natural insecticides). Your sexual partners will also have to be treated. Crabs are sometimes found on eyelashes or eyebrows. To remove them, use an ophthalmic ointment such as physostigmine or coat the lashes with petroleum jelly. Both of these methods should be supervised by your doctor.

To treat body lice, wash the entire body with soap and water. If this is not effective, you may have to use an insecticidal preparation — either over-the-counter or prescription. Just as with head lice infestation, wash all clothing and bedding in hot water and dry in a hot dryer. Store clothes for two weeks in plastic bags or place them in dry heat of 140° F for three to five days.

What Is the Treatment for Scabies?

To get rid of scabies, those people who are infected and everyone they came in contact with must be treated at the same time. Since the mites can survive for two or three days on almost any surface, including tables and countertops, toys and linens, all areas must be thoroughly vacuumed and washed. Items that may be difficult to clean, such as stuffed animals, should be bagged and stored for a week.

A bath with soap and hot water will wash away some of the mites and their debris, but this step alone will not get rid of all the parasites. Most doctors prescribe a pediculicide, which you apply to your skin from the neck down. You may need some assistance with this treatment since you must be certain to cover all areas. Leave the lotion on the skin for 8 to 12 hours and then wash it off. Do not reapply the lotion without your physician's approval.

After you rid your skin of mites, you can take an antihistamine for the itch (which can still rage for days after treatment because of feces left in the burrows) and apply corticosteroid creams to reduce inflammation.