Pubic lice, commonly called crabs, are treatable with over-the-counter medicated lotions that kill the lice on contact. Most people can clear an infestation at home within one to two weeks using products available at any pharmacy, without needing a prescription. The key is following the treatment steps carefully and cleaning your environment at the same time.
Over-the-Counter Treatments
Two types of lice-killing products work against crabs and are sold without a prescription. The first is a lotion containing 1% permethrin. The second is a mousse containing pyrethrins combined with piperonyl butoxide. Both are available at drugstores and pharmacies, typically in the same aisle as head lice treatments.
To use either product, wash the infested area first and towel dry. Then apply the medication thoroughly to all affected hair, not just the pubic area. Crabs can spread to any coarse body hair, including the thighs, lower abdomen, chest, armpits, and beard. Leave the product on for the full time listed on the package, then rinse or remove it according to the label directions. Put on clean underwear and clothing afterward.
A single treatment usually kills live lice, but it may not destroy all the eggs (called nits) glued to hair shafts. That’s why a second treatment 9 to 10 days later is recommended if you still see live lice. This timing catches any newly hatched lice before they can lay eggs of their own.
What to Do if Treatment Doesn’t Work
If you’ve completed two rounds of over-the-counter treatment and still have live lice, resistance to the active ingredient may be the problem. In these cases, a doctor can prescribe stronger options. Malathion 0.5% lotion is applied to the affected areas and washed off after 8 to 12 hours. It’s specifically recommended when resistance to standard treatments is suspected. An oral medication, ivermectin, is another alternative that works systemically, meaning it kills lice through your bloodstream when they feed. It’s typically taken as a single dose and repeated 7 to 14 days later.
Does Shaving Work?
Shaving or trimming the affected hair is sometimes suggested as a way to remove crabs. In theory, removing the hair eliminates the surface lice cling to and the shafts where nits are attached. However, the CDC does not list shaving as a recommended treatment. Lice can survive on very short stubble or migrate to other body hair you haven’t removed. If you choose to shave, it’s best to use it alongside a medicated treatment rather than as a substitute.
Cleaning Your Home and Belongings
Treating your body alone isn’t enough. Crabs can survive off a human host for one to two days, so anything that touched your skin in the days before treatment could harbor live lice. Machine wash all clothing, towels, and bedding you used in the two days before treatment. Use the hottest water setting your fabrics can handle and dry on high heat. Items that can’t be washed, like pillows or stuffed items, can be sealed in a plastic bag for two weeks. Without a blood meal, any lice or nits inside will die.
You don’t need to fumigate your home or use insecticidal sprays on furniture. Pubic lice aren’t like bed bugs. They need human blood to survive and don’t infest mattresses or carpets in any lasting way. Vacuuming upholstered furniture and floors is a reasonable precaution but not strictly necessary.
Treating Lice on Eyelashes or Eyebrows
Crabs occasionally show up on eyelashes or eyebrows, and this requires a completely different approach. Never apply permethrin, pyrethrins, or any insecticidal product near your eyes. Instead, the treatment involves applying a thick layer of petroleum jelly (Vaseline) to the eyelashes and eyelid margins two to three times daily for 7 to 10 days. The jelly suffocates the lice and prevents them from gripping the lashes. Nits and visible lice can be picked off carefully with fine-tipped tweezers. If scratching has caused irritation or a secondary infection around the eyes, a doctor may prescribe a topical antibiotic ointment to help it heal.
Preventing Reinfestation
Crabs spread primarily through skin-to-skin contact during sex. They can also spread, less commonly, through shared bedding, towels, or clothing. To avoid getting them again, any sexual partners you’ve had in the past month should be treated at the same time you are, even if they don’t have symptoms yet. Lice can take several weeks to cause noticeable itching, so a partner may be carrying them without realizing it.
Condoms do not prevent the spread of pubic lice, since the lice live in hair rather than on genital skin. The only reliable prevention is avoiding close physical contact with someone who has an active infestation. If you’ve been treated successfully and your partner hasn’t, you can easily pick them up again the next time you’re together.
Pubic lice are also worth mentioning to a healthcare provider because they’re sexually transmitted. Having crabs increases the chance that other sexually transmitted infections were passed at the same time, so screening for those is a reasonable step.