For Pediculosis Pubis (Crabs), what is the first line treatment?

The first line treatment for Pediculosis Pubis, commonly known as crabs, is indeed Permethrin 1% cream or Malathion 0.5% lotion. These are topical insecticides specifically designed to eliminate pubic lice through direct application. Permethrin disrupts the nervous system of the lice, leading to their death, while Malathion also works by acting as a neurotoxin, but it does so via a different mechanism.

Topical treatments like these are generally preferred because they directly target the lice and have a favorable safety profile when used as directed. It's important to apply these treatments not only to the affected areas but also to surrounding areas, and to wash clothing and linens to prevent reinfestation.

Other treatment options are less effective or inappropriate. Antihistamines may relieve itching but do not treat the lice themselves. Oral medications can be effective for other types of infestations but are not first line for pubic lice specifically. Surgical removal is unnecessary and not a viable option for treating this condition. Thus, the effectiveness and targeted action of Permethrin and Malathion make them the primary treatment choice for Pediculosis Pubis.