Use Kwell, Nix or Rid shampoos, or similar products.  Adequate pre-cleaning followed by adequate medication contact time is the key.  The hair should be routinely shampooed clean and toweled dry (i.e. moist but not dripping wet) before the application of the pediculocide shampoo.

The pediculocide shampoo should be directly applied from the bottle onto the affected areas and worked into lather without the addition of water.  Kwell shampoo should have at least 4-5 minutes and other products about 10 minutes of contact time before rinsing off with water.  Retreat one week later.  Treatment failure is not due to resistant lice.  The pediculocides available today do not kill nits as well as they kill live lice.  Treatment failure is most frequently due to reinfestation or inadequate contact time.

If treating the scalp, be sure to treat behind the ears and the base of the neck.  It is very easy to inadequately treat patients with long hair.  Longer haired patients should use a plastic shower cap to insure coverage.  Avoid the eyes.

Nits can be removed with a nit comb or picked off with tweezers (see figure 8).  Rinsing the hair with a 2:1 dilution of table vinegar before combing will help loosen the nits.  Combs and brushes should be soaked in the pediculocide shampoo for about an hour or heated to about 65 degrees Celsius for 5-10 minutes.

The treatment of crab lice should not just involve the pubic hair.  It should also cover the hairy skin from the umbilicus down to mid thigh.  In particularly hairy individuals, check the axilla and chest for involvement.

Lice on the eyelashes can be treated by thickly applying Vaseline 2-3 times a day for a week.  This treatment smothers the lice.  Ammoniated Mercury ointment 0.1% applied to the lids is also quite effective. The nits can then be mechanically removed.