Body lice are similar to head lice, except they are slightly larger. They are primarily seen in the homeless and indigent populations, with transmission occurring with direct body contact or sharing of contaminated clothes or bedding.
The body louse, contrary to popular belief, does not live on the body. It lives in the seams of clothing, clinging to the fibers. It will feed, remaining on the clothes, and only in massive infestations are they typically seen moving about the body. The axillae, groin, and truncal areas are the most severely affected. Patients have severe itching and tend to excoriate these regions. In chronically infested patients a postinflammatory hyperpigmentation can be observed.
Treatment
Persons infested with body lice need to discard or launder their clothing using hot water, and then bathe themselves. In cases of massive infestation—such as this case, in which head lice were also found—a pediculicide should be applied to the hair and entire body from head to toe. This can then be washed off in the shower (level of evidence [LOE]=1a, from Cochrane Review). This same Cochrane systematic review of the treatment of head lice found no evidence that any one pediculicide has greater effect than another (LOE=1a).1
In this case, the patient did not want to get rid of her green pants because she was able to find the “bugs” easily in its seams, which she thought helped keep them under control. When we explained that the full treatment of this condition required her to be given new clothes, she finally accepted this course of action.
Arrangements were made for her to shower at the shelter and obtain new clothes, and she was given permethrin shampoo to apply over her entire body from head to toe. She was scheduled to follow up in 1 week but unfortunately never returned to the clinic.