Body lice are treated primarily through clothing and bedding decontamination, not medications applied to the skin. Unlike head lice, body lice live in the seams of clothing and only move onto the skin to feed. This means removing and laundering infested garments is the single most important step, and in many cases, it’s the only treatment needed.
Why Body Lice Are Different From Head Lice
Body lice don’t live on your body. They live and lay their eggs in the seams of clothing and bedding, particularly in areas near the armpits and groin where fabric sits close to skin. They crawl onto the body to feed, mostly at night, then retreat back into the fabric. This is why you’ll rarely spot a body louse on the skin itself. Diagnosis typically comes from finding eggs or crawling lice in the inner seams of clothing rather than on the body.
This biology is what makes treatment so different from head lice. Killing the lice means targeting the clothing, not just the person.
Recognizing the Symptoms
The hallmark symptom is intense itching that gets worse at night, when lice move from clothing to skin to feed. The itching concentrates on the torso, armpits, and groin. You may notice small red bumps or raised welts at bite sites.
People who’ve had a long-standing infestation can develop a condition sometimes called “vagabond skin,” where the skin becomes thickened and darkened from years of bites, scratching, and irritation. Excessive scratching also opens the door to secondary bacterial skin infections, which can become a more serious problem than the lice themselves.
Step One: Decontaminate All Clothing and Bedding
Wash every piece of clothing, bedding, and towel you’ve used in the last 48 hours in hot water, at least 140°F (60°C). Then run everything through a hot dryer cycle. The combination of hot water and sustained dryer heat kills both adult lice and their eggs.
For items you can’t wash, you have two options. You can tumble them in a hot dryer on high heat for at least 20 minutes, or you can seal them in a plastic bag for a minimum of 10 days. Body lice can’t survive without a blood meal for that long, so sealing items away starves them out. Dry cleaning also works for delicate fabrics.
Bathing thoroughly and putting on freshly laundered clothes is often enough to end a body lice infestation on its own. The lice have no permanent hold on your body, so once the infested clothing is gone, the lice go with it.
When Medication Is Needed
If you still have active lice on your skin after laundering, or if the infestation is heavy, topical or oral medications can help. The two main options are permethrin cream and oral ivermectin.
Permethrin 5% Cream
Permethrin is a topical insecticide applied to the entire body from the neck down, then washed off after 8 to 14 hours. A single application is generally effective. In some cases, a second application about a week later may be necessary to catch any lice that hatched after the first treatment. The CDC considers permethrin safe and effective as a first-line option.
Oral Ivermectin
Ivermectin is a pill taken with food (eating increases how well the body absorbs it). It works systemically, meaning it gets into your bloodstream and kills lice when they feed. The standard approach is two doses taken 14 days apart. That second dose matters because ivermectin has limited ability to kill eggs. Lice that hatch after the first dose need to be caught by the second.
Ivermectin has not been established as safe for pregnant women or for children weighing under about 33 pounds (15 kg).
Treating Skin Irritation and Secondary Infections
Once the lice are gone, the itching doesn’t always stop immediately. Your skin may remain irritated for days. Over-the-counter anti-itch creams or antihistamines can help manage this. If you notice areas that are swollen, warm, oozing, or increasingly painful, that suggests a bacterial infection from scratching. Infected skin may need antibiotic treatment.
Preventing Reinfestation
Body lice infestations are closely tied to hygiene access. They spread through prolonged contact with infested clothing or bedding and are most common among people experiencing homelessness or those without regular access to laundry facilities. The core prevention strategy is straightforward: regular bathing, changing into clean clothes at least once a week (more often when possible), and laundering clothing and bedding in hot water.
If you share living quarters or bedding with someone who has body lice, treat your clothing and bedding the same way, even if you don’t have symptoms yet. Body lice spread easily through shared fabric.
Diseases Body Lice Can Carry
Body lice are more than a nuisance. They’re one of the few types of lice that can transmit serious bacterial infections. The most notable is epidemic typhus, caused by the bacterium Rickettsia prowazekii. Symptoms include high fever, chills, severe headache, muscle aches, rash, and confusion. Epidemic typhus is uncommon today but still occurs in conditions of crowding and poor sanitation.
Body lice can also transmit trench fever and relapsing fever. These diseases are rare in most settings, but they’re a real risk for people with chronic infestations. Prompt treatment of body lice eliminates the transmission pathway for all of them.