Examples

How It Works

Prescription-strength permethrin 5% kills the scabies mite. The medicine will come with instructions, and your doctor will also give you a treatment schedule. The National Institutes of Health recommends the following use of 5% permethrin cream for scabies:

• Read the package directions carefully before using the medicine.
• Thoroughly wash and dry skin.
• Massage the cream into the skin from the head to the soles of the feet, paying special attention to creases in the skin, hands, feet, between fingers and toes, underarms, and groin. Scabies rarely infests the scalp of adults, although the hairline, neck, side of the head, and forehead may be infested in older people and in infants. Infants should be treated on the scalp, side of the head, and forehead.
• Leave the permethrin cream on the skin for 8 to 14 hours.
• Wash off by taking a shower or bath.
• Put on clean clothes.
• After treatment, itching may continue for up to 4 weeks.

National Institutes of Health information available online: www.nlm.nih.gov/medlineplus/druginfo/meds/a698037.html.

Why It Is Used

Permethrin cream (Elimite) is one of the first medicines doctors prescribe to cure a scabies infestation.¹ It is the treatment of choice for children and for women who are pregnant or breast-feeding. Permethrin 5% cream is considered safe for infants as young as 2 months old.²

Permethrin should be used with caution on people who are allergic to pyrethrin products or chrysanthemums.

How Well It Works

Research has shown permethrin to be more effective than lindane, without the risk of rare yet severe side effects.³ A single application of permethrin cream (Elimite) cures most scabies infestations. Itching usually decreases significantly within 24 hours, though some itching is common for up to several weeks after treatment.

People who have crusted (Norwegian) scabies (rare) may need to apply the medicine several times. It may be necessary to follow the initial permethrin treatment with other scabies medicines (such as ivermectin, lindane, or sulfur) to cure this form of scabies.

Side Effects

Permethrin is considered very safe. Possible side effects include:

• Temporary redness of the skin.
• Itching.
• Burning or stinging.

If these side effects persist, call your doctor.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Itching commonly continues for up to several weeks after treatment with a scabies medicine. This doesn't mean that the scabies mites are still alive. It means that the body is still reacting to the mites and their feces.

Unless your doctor recommends it, do not apply permethrin scabies medicine (Elimite) more than once. Overuse of scabies medicines can irritate the skin and may increase the risk of side effects.

Nonprescription permethrin 1% is used to treat lice but is not strong enough to cure scabies.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

1. Mathieu ME, Wilson BB (2005). Scabies. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practices of Infectious Diseases, 6th ed., chap. 292, pp. 3304–3307. Philadelphia: Elsevier Churchill Livingstone.
2. American Academy of Pediatrics (2006). Scabies. In LK Pickering, ed., Red Book: 2006 Report on the Committee of Infectious Diseases, 27th ed., pp. 584–587. Elk Grove Village, IL: American Academy of Pediatrics.
3. Chosidow O (2006). Scabies. New England Journal of Medicine, 354(16): 1718–1727.