Skip to main content

Health condition

Body lice, a clothing-borne infestation with global infection risk.

Body lice live in clothing seams, not on the skin. Hygiene and laundering are the primary cure, but the itch is the smaller part of the story: body lice are a vector for typhus, trench fever and louse-borne relapsing fever.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against UKHSA, NICE CKS and peer-reviewed infectious diseases sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on hygiene-first management, pediculicides and louse-borne infection surveillance.

Key facts

Body lice at a glance.

The essentials in plain English: what body lice are, how they differ from head and pubic lice, and why laundering matters more than any cream.

  • What it is

    Infestation with Pediculus humanus corporis, a louse that lives and lays eggs in the seams of clothing and bedding.

  • Not head lice

    Same species as head lice but a distinct subspecies. Pubic lice (Pthirus pubis) are a separate species entirely.

  • Where lice live

    On clothing and bedding, not on the body. They visit the skin only to feed, four or five times a day.

  • Who gets it

    Rare in the UK general community. More common in homelessness, prisons, refugee camps and settings where washing and changing clothes is not possible.

  • Why it matters

    Body lice are a vector for epidemic typhus, trench fever and louse-borne relapsing fever, all of which remain a global concern.

  • First-line care

    Hygiene and laundering. Wash clothing and bedding at 60 degrees Celsius or higher, or seal items for two weeks to starve the lice.

Why this guide matters

A parasite that lives in clothes, not on people.

Three ideas shape everything that follows. Get these three right and the rest of the plan almost writes itself.

  • The clothing is the problem

    Body lice live and breed in clothing and bedding seams, not on the body. If the clothing is not treated, the infestation returns.

  • The social context is the cause

    It flourishes where washing and changing clothes is impossible: homelessness, prisons, refugee camps, disaster settings.

  • The infections are the danger

    Typhus, trench fever and louse-borne relapsing fever are still with us. Fever in an infested person is never just the itch.

How the diagnosis is made

From itch to a clear plan.

The steps a UK clinician will follow, in order. Inspecting clothing seams is the single most important one.

  1. 01

    Assessing

    Inspect the clothing seams

    The key step. Nits, adult lice and dark faecal spots along the seams of shirts, waistbands and underwear are diagnostic.

  2. 02

    Assessing

    Examine the skin and hair

    Pruritic red macules and papules on the trunk, shoulders, waistband, back, axillae and groin, where clothing sits against skin.

  3. 03

    Assessing

    Look for secondary changes

    Excoriation, impetigo, lichenification and hyperpigmentation. Chronic disease can produce the pattern known as vagabond skin.

  4. 04

    Confirming

    Exclude other pruritic causes

    Scabies, eczema, insect bites and delusional parasitosis all mimic body lice. The clothing seam finding is what settles it.

  5. 05

    Confirming

    Screen for louse-borne infection

    If febrile, unwell or from a high-risk setting, take blood cultures and send serology or PCR for Bartonella, Rickettsia and Borrelia. Consider malaria and typhoid.

  6. 06

    Coordinating

    Safeguarding assessment

    Body lice often flags homelessness, neglect or domestic abuse. A social and safeguarding review sits alongside the clinical one.

  7. 07

    Coordinating

    Notify and coordinate

    Institutional or outbreak cases warrant UKHSA and local authority public health involvement early.

Typical timeline: clinical diagnosis and first laundering plan in a single visit.

Symptoms

What body lice actually looks like.

Itchy papules where clothes touch skin, secondary excoriation and impetigo, and the giveaway sign: nits and lice in the seams.

  • Pruritic red macules and papules

    Small, itchy inflammatory lesions on the trunk, shoulders, back, waistband, axillae and groin, following the line of clothing contact.

  • Excoriation and scratch marks

    Persistent itching leads to linear excoriations, often more visible than the primary lesions themselves.

  • Secondary impetigo

    Broken skin becomes colonised with staphylococci or streptococci. Golden crusts, pustules and sometimes cellulitis follow.

  • Lichenification

    Long-standing scratching thickens the skin and deepens skin markings, particularly around the waist and shoulders.

  • Hyperpigmentation (vagabond skin)

    Chronic untreated infestation produces a dusky, thickened, pigmented appearance on the trunk, known historically as vagabond disease.

  • Nits and lice on clothing seams

    Grey-white eggs cemented to seams, live adult lice up to three millimetres and dark faecal spots. The single most useful sign.

  • Occasional lice in body hair

    Adult lice may be seen crawling in axillary or body hair when infestation is heavy, though they do not settle there.

  • Red flag - fever or systemic illness

    Fever, headache, myalgia or rash in a person with body lice suggests trench fever, typhus or louse-borne relapsing fever. Urgent review.

Treatment

How body lice is treated in the UK.

Laundering first, pediculicides where the skin is heavily colonised, oral ivermectin for refractory or outbreak cases, and empirical antibiotics if the person is unwell.

  • Hygiene and laundering

    The primary treatment. Wash clothes and bedding at 60 degrees Celsius or higher, tumble dry on high for 30 minutes, iron seams, dry-clean or seal in plastic bags for two weeks.

  • Permethrin 5 percent cream

    A topical pediculicide applied from neck to feet, left for 12 to 24 hours and rinsed off. Useful when the body is heavily colonised.

  • Malathion 0.5 percent lotion

    An alternative topical pediculicide, applied to the whole body surface. Often not needed if laundering is thorough.

  • Benzyl benzoate

    A traditional topical option in some settings, applied to skin and left on for the recommended contact time.

  • Oral ivermectin

    A single 200 microgram per kilogram dose, sometimes repeated, useful in refractory disease, close contacts and institutional outbreaks.

  • Treat secondary infection

    Antibiotics for impetigo, short-course topical steroid and emollient for eczematised skin, and antipruritics to break the itch-scratch cycle.

  • Treat contacts and settings

    Household members, hostel dormitories and institutional groups need coordinated laundering and, sometimes, pediculicide to prevent re-infestation.

  • Empirical antibiotics if unwell

    Doxycycline empirically covers Bartonella, Borrelia and Rickettsia while confirmatory tests are pending. Escalate to infectious diseases early.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and international infectious diseases standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, dermatologist or infectious diseases team knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Head lice and other louse infestations - management.

  • UK Health Security Agency (UKHSA). Guidance on louse-borne infections and outbreak management.

  • BMJ Best Practice. Pediculosis corporis (body lice).

  • World Health Organization. Louse-borne relapsing fever, epidemic typhus and trench fever surveillance.

Red flags

When body lice needs urgent attention.

Most infestations are cleared with laundering. These are the situations where something more serious is in play.

  • Fever with body lice

    Fever, headache, myalgia or rash in an infested patient may signal trench fever, epidemic typhus or louse-borne relapsing fever. Urgent bloods and infectious diseases input.

  • Refugee or displaced background

    Recent time in refugee camps, prisons, warzones or long transit is a strong risk factor for louse-borne infection. Take a careful travel history.

  • Homelessness and rough sleeping

    Body lice is often the presenting problem that reveals unmet housing, hygiene and safeguarding need. Coordinate with hostels and outreach.

  • Suspected domestic abuse or neglect

    Persistent infestation in a person unable to wash or change clothes freely may indicate coercive control. Follow local safeguarding pathways.

  • Institutional or outbreak setting

    Cases in shelters, hostels, prisons or hospital wards require UKHSA and local authority public health engagement to prevent onward spread.

  • Severe secondary infection

    Widespread impetigo, cellulitis or systemic sepsis needs same-day antibiotics and, at times, admission.

  • Rash of louse-borne disease

    A petechial or maculopapular rash spreading centrally, especially with fever, warrants urgent hospital assessment for typhus.

  • Not responding to hygiene measures

    Persistent live lice despite thorough laundering points to environmental reservoirs, contacts or the need for oral ivermectin.

  • Suspected notifiable infection

    Louse-borne relapsing fever and typhus are notifiable in the UK. Report to UKHSA without waiting for confirmation.

Living with it

A treatable infestation, with a clear ladder.

Four things that make the biggest difference: hot washing, clean changes of clothes, help with the underlying situation, and knowing when to come back.

A quiet reminder

The cure is often the situation, not the cream.

Housing, hygiene and safe accommodation clear body lice more reliably than any single medicine.

  1. 01 Wash

    Sixty degrees or bag it up

    Wash clothing and bedding at 60 degrees Celsius or higher, or seal items in plastic bags for two weeks to starve the lice.

  2. 02 Change

    A clean set every day

    Where possible, change clothes daily and rotate through freshly laundered sets. Lice need clothing to survive between feeds.

  3. 03 Support

    Ask about housing help

    Local authorities, Shelter, Crisis, the Salvation Army and homeless health teams can help with access to laundry, showers and safe accommodation.

  4. 04 Return

    Come back if it returns

    Re-infestation is common when circumstances have not changed. Repeat treatment and social support work together, not apart.

Frequently asked

Everything we get asked about body lice.

Quick answers on laundering, pediculicides, ivermectin and louse-borne infection.

  • What are body lice?

    Body lice are small parasitic insects (Pediculus humanus corporis) that live and lay their eggs in the seams of clothing and bedding. They crawl onto the skin only to feed, four or five times a day, and cause an intensely itchy rash on the trunk and other areas where clothing sits against the skin.

  • How are body lice different from head lice and pubic lice?

    Body lice are the same species as head lice but a distinct subspecies, and they behave very differently, living on clothing rather than on the scalp. Pubic lice (Pthirus pubis) are a separate species that live in coarse body hair. All three are treated in different ways.

  • Who gets body lice in the UK?

    Body lice are rare in the UK general population but more common in homelessness, hostels, prisons, refugee camps and any setting where washing and changing clothes regularly is not possible. It is closely linked to poverty, overcrowding and displacement.

  • Are body lice dangerous?

    The itch and secondary skin infection are the everyday problem, but body lice are also a vector for three serious infections: epidemic typhus (Rickettsia prowazekii), trench fever (Bartonella quintana) and louse-borne relapsing fever (Borrelia recurrentis). Fever in someone with body lice always warrants medical review.

  • What is the main treatment?

    Hygiene and laundering. Washing clothing and bedding at 60 degrees Celsius or higher, tumble drying on high heat, ironing seams or sealing items in plastic bags for two weeks will clear the infestation. A pediculicide such as permethrin or malathion may be added if the skin is heavily colonised, and oral ivermectin is useful in refractory or outbreak cases.

  • What should I do if I keep getting body lice?

    Repeated infestation almost always points to an environmental or social problem that has not been resolved: shared bedding, limited access to laundry, contacts who have not been treated, or unstable housing. Alongside repeat treatment, ask for a social and safeguarding review and connect with local homelessness, refugee or public health services.

Related content

Keep reading.