Side effects of permethrin

Contents

Permethrin topical

Generic Name: permethrin topical (per METH rin)
Brand Name: Acticin, Elimite, Lice Bedding Spray, Nix Lice Control, RID Home Lice Control Spray for Surfaces, …show all 16 brand namesNix Cream Rinse, Lyclear, Pyrifoam Lice Breaker, Orange Medic Plus Head Lice Treatment, Quellada Head Lice Treatment for Short Hair, Ravine Anti-Lice Medicated Treatment, Quellada Head Lice Treatment, Quellada Scabies Treatment, Orange Medic Head Lice Treatment, Nix Complete Lice Treatment System, Nix Complete Lice Treatment

Medically reviewed by Drugs.com on Mar 12, 2019 – Written by Cerner Multum

  • Overview
  • Side Effects
  • Dosage
  • Professional
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What is permethrin topical?

Permethrin is an anti-parasite medication.

Permethrin topical (for the skin) is used to treat head lice and scabies.

Permethrin topical may also be used for other purposes not listed in this medication guide.

Important Information

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use permethrin topical if you are allergic to permethrin or to chrysanthemums.

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have other medical conditions.

Permethrin topical is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant.

It is not known whether permethrin topical passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Permethrin topical should not be used on a child younger than 2 months old.

How should I use permethrin topical?

Use exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

You may have a temporary increase in itching, swelling, or redness of treated skin when you first start using permethrin topical.

Do not take by mouth. This medicine is for use only on the skin. Do not apply to open cuts or wounds. If the medicine gets in your eyes or mouth, rinse with water. Use the surface spray only on household surfaces and not on your skin.

You may need to shake the medicine before each use. Follow the directions on the medicine label.

To treat scabies:

  • Clean and dry the skin. Apply a thin layer of this medicine to all body parts from the neck down to the soles of the feet. Rub in completely. Leave the medicine on your skin for 8 to 14 hours, then wash it off completely.

  • When using permethrin topical on an infant, also apply the medicine to the scalp, temples, and forehead. Avoid applying near the eyes, nose, mouth, or genitals.

  • If your condition does not clear up within 14 days, apply permethrin topical again.

To treat head lice:

  • Wash your hair using shampoo only (no conditioner or 2-in-1 shampoo). Rinse thoroughly and towel dry the hair, leaving it damp.

  • Protect your eyes with a towel or washcloth. Apply the medicine to completely saturate all hair, and leave it in for 10 minutes. Then rinse with warm water.

  • You may also use a nit comb to remove lice eggs from the hair. Your hair should be slightly damp while using a nit comb. Work on only one section of hair at a time, combing through 1 to 2-inch strands from the scalp to the ends.

  • Rinse the nit comb often during use. Place removed nits into a sealed plastic bag and throw it into the trash.

  • Check the scalp again daily to make sure all nits have been removed.

  • If you still see lice 7 days after your first treatment, use a second application.

To treat pubic lice (crabs):

  • All sexual partners should be treated.

  • Wash and dry the treatment area. Apply permethrin topical to all pubic hair and any surrounding hairs on the thighs and around the anus (avoid areas inside the rectum or vagina).

  • Leave the medicine on for 10 minutes. Then work into a lather and rinse thoroughly with warm water.

  • You may also use a nit comb to remove lice eggs from pubic hair (hair should be slightly damp).

To prevent reinfection, wash all clothing, hats, bed clothes, bed linens, and towels in hot water and dry in high heat. Dry-clean any non-washable clothing. Soak all hair brushes, combs, and hair accessories in hot water for at least 10 minutes.

Use permethrin surface spray to disinfect non-washable items such as:

  • furniture;

  • mattresses and pillows;

  • stuffed toys;

  • hats, gloves, and scarves;

  • headphones or headbands;

  • the inside of a bike helmet; or

  • seats and carpets inside your car.

Stuffed toys or pillows that cannot be washed should be sealed in air-tight plastic bags for 4 weeks. After removing from the bag, vigorously shake the item outdoors.

Vacuum all rugs, carpets, and car seats. Then throw away the vacuum cleaner bag.

For the most complete treatment of lice or scabies, you must treat your environment (clothing, bedding, etc) at the same time you treat your hair and/or body.

Store permethrin topical at room temperature away from moisture and heat.

What happens if I miss a dose?

Since permethrin topical is usually needed only once, you are not likely to be on a dosing schedule. Wait at least 7 days before using a second application.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if you think you have used too much, or if anyone has accidentally swallowed the medication.

What should I avoid while using permethrin topical?

Rinse with water if permethrin topical gets in your eyes.

Lice and scabies infections are highly contagious. Avoid sexual or intimate contact with others until your lice or scabies infection has cleared up. Avoid sharing hair brushes, combs, hair accessories, hats, clothing, bed linens, and other articles of personal use.

Avoid using other medications on the areas you treat with permethrin topical, unless your doctor tells you to.

Permethrin topical side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have severe burning, stinging, redness, or swelling after applying permethrin topical.

Common side effects may include:

  • mild burning, stinging, itching or mild rash;

  • numbness or tingling where the medicine was applied;

  • headache, dizziness;

  • fever; or

  • stomach pain, nausea, vomiting, diarrhea.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Permethrin topical dosing information

Usual Adult Dose for Scabies:

Permethrin topical 5% cream:
Thoroughly massage into the skin from the neck to the soles of the feet. The cream should be removed by washing (shower or bath) after 8 to 14 hours.

Usual Adult Dose for Lice:

Permethrin topical 1% kit:
Apply lotion/creme rinse to shampooed and towel-dried hair until hair and scalp are saturated (especially behind the ears and on the nape of the neck). Leave on hair for 10 minutes and rinse with water. Use comb and/or gloves provided to remove remaining nits.
Permethrin topical 1% solution:
Apply to shampooed and towel-dried hair until hair and scalp are saturated (especially behind the ears and on the nape of the neck). Leave on hair for 10 minutes and rinse with water.

Usual Pediatric Dose for Scabies:

Permethrin topical 5% cream
Infants: Thoroughly massage along the hairline, neck, temple, and forehead. The cream should be removed by washing after 8 to 14 hours.

Usual Pediatric Dose for Lice:

Permethrin topical 1% kit:
2 months or older: Apply lotion/creme rinse to shampooed and towel-dried hair until hair and scalp are saturated (especially behind the ears and on the nape of the neck). Leave on hair for 10 minutes and rinse with water. Use comb and/or gloves provided to remove remaining nits.

What other drugs will affect permethrin topical?

It is not likely that other drugs you take orally or inject will have an effect on topically applied permethrin topical. But many drugs can interact with each other. Tell each of your health care providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 7.01.

Related questions

  • Can you use Nix Permethrin lice shampoo on your body as a lotion to kill Scabies?

Medical Disclaimer

More about permethrin topical

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  • Drug class: topical anti-infectives

Consumer resources

  • Permethrin Cream
  • Permethrin Cream Rinse and Lotion
  • Permethrin Topical (Advanced Reading)

Other brands: Elimite, Nix, Acticin, Lice Bedding Spray, … +3 more

Professional resources

  • Permethrin (AHFS Monograph)
  • … +2 more

Related treatment guides

  • Scabies
  • Head Lice
  • Lice

Curing my scabies (my story)

Curing my scabies

About 18 months ago I had a small patch of bumpy, itchy skin on my arm, so I went to a dermatologist and he said “Eczema” and told me to put skin lotion on it.

Well, the itch spread from one elbow to my other elbow, up and down my arms, down to my legs, etc.

I went to another dermatologist. He said “Eczema” and told me to put regular skin lotion on it. I now have a row of bottles of useless lotion.

After months of research, I finally figured out I might have scabies. I read 5% permethrin cream was the treatment.

I went to an inner city clinic and the doctor didn’t think I had scabies, but I said “Can it hurt anything for me to try the cream?” She gave in and I got a prescription for the 5% permethrin cream. Went to Wal-Mart and it was $80 for a 2 ounce tube! $80!!! I bought a tube and smeared it on, but 2 ounces wasn’t enough to really cover me all over.

So I learned how to make my own. I ordered 10% permethrin (with no petroleum distillates) from Amazon and bought skin lotion at Wal-Mart. I mixed up my own home-made 5% permethrin cream and spread it all over. It went on much smoother than the prescription cream. Mixing up enough permethrin and lotion to make 4 ounces cost $4 (that’s $2 a “tube”).

I even made video on how to make your own 5% permethrin cream and put it on YouTube and got lots of views and grateful comments (see “My DIY instructions and video story” at the bottom of this page for how that went.

I thought I was cured and getting better when — “wham!” — 5 weeks later the scabies came back with a vengeance. That really freaked me out. I had done everything according to the book and I still wasn’t cured. I wondered if maybe I didn’t have scabies…maybe it was “something else.” I itched so much I could only sleep a few hours at a time. I was going insane from sleep deprivation and despair.

I did more research. I read piles of studies and tests and what their results were. Finally I found the Center for Disease Control of Northern Australia had a program for treating the scabies epidemic among the aborigines. It combined almost everything I had read in many separate studies. It is called the “Healthy Skin Program.”

The key to this program was using both a topical (applied to your skin) AND an oral medication. I used my home-made 5% permethrin cream on my skin and I went and talked the clinic doctor into giving me a prescription for 2 doses of ivermectin pills. Went to good old Wal-Mart, the “Always low prices” place, and they charged $40 per dose of ivermectin!!!

The Healthy Skin Program involved 7 doses of ivermectin, and the good doctor wouldn’t prescribe any more…so I wound up using ivermectin “horse paste”. It is a paste they squirt into animals’ mouths to treat them for intestinal parasites. I used it to treat my scabies. Only $4 for 5 doses! It tasted a bit yucky, but I was in ivermectin heaven. I cannot recommend anyone else to do what I did…I’m just telling you my personal journey as it occurred.

Permethrin cream can irritate your skin, so you can only use it once a week. And after you apply it you feel better immediately, but then the itching can turn on even worse. Partly because all of a sudden you have dead scabies mites and eggs under your skin and your body doesn’t like that.

So in between the permethrin and ivermectin that I used each week for 4 weeks, I also applied home-made sulfur cream. It stopped the itch so I could sleep. I think I slept ten hours straight the first night I used the sulfur lotion. I was so elated! But the sulfur did dry my skin out so I ordered some Eurax lotion and tried that. Wonder of wonders, it stopped the itch so I could sleep AND it softened my skin. Eurax is the only skin product that didn’t make me suffer when I used it — and it kills scabies mites, too. From what I read Eurax isn’t as powerful as permethrin, but I figured if I used them both (not on the same day) I’d have a better chance at a cure.

The second week I took ivermectin 4 days in a row. I think I may taken 2 doses on one of those days. Bad idea. Late one night I suddenly realized I had developed tunnel vision. The edges of my field of vision darkened, kind of like when they show someone using a binoculars on TV…like I was looking down a tunnel. I had read about that so I wasn’t scared…in fact, by now I didn’t really care. I was so used to perpetual suffering it seemed almost normal. So I went to bed and my vision was fine in the morning. That’s one of the wonderful things about ivermectin. If you use it only once or twice a week there are no side effects. And if you do overdose, the side effects are temporary. I’m just telling you about my experience so you’ll be smarter than me!

I had been itching and scratching for over a year and so I had open sores all over. I noticed they seemed to be infected so I went back to the clinic. They were very interested in looking me over. The doctor even called in another doctor to have a look at me. I have learned it is never a good sign when a doctor is interested in me. It means something is seriously wrong. They took a sample of the infection and gave me a prescription for an antibiotic (cephalexin, a relative of penicillin) and, you guessed it, off I went to Wal-Mart to bleed money again. To my surprise cephalexin is on Wal-Mart’s “blessed” list and a 14 day supply was only $4! Oh happy day!

I took the antibiotic religiously while I continued the Healthy Skin Program. My infections cleared up and my blood pressure dropped 40 points. I hadn’t realized my swollen ankles were caused by a systemic bacterial infection (“systemic” means it is everywhere in the body).

Anyway, after 29 days I was at the end of the Healthy Skin Program. I still itched here and there now and then, but no where near like I used to. I was paranoid as hell, so when I felt even one little prick I applied the Eurax lotion. My skin has gotten better gradually. As I write this it has been 2 months since the end of the program. I am cured. I have no living scabies mites on me. The scar tissue from a year and a half’s scratching is healing gradually.

UPDATE: it is over a year now and the scar tissue has all been replaced by new, healthy skin. Also, the darker, pigmented patches of skin which I had faded gradually until my skin is all one tone again. It is amazing what a memory skin has for getting back to normal.

Just so you know, during this long program piles of laundry had to be done. All sheets, towels, pillows and clothes had to be run through the dryer on high heat for 30 minutes before being reused (it is essential for the laundry to be completely dry first, and then to run it through the dryer on high for 30 minutes — the dry heat kills the mites and their eggs). And I treated some furniture and my car seats with permethrin, too. All the details are on my other scabies pages.

But after all this, even after my scabies was cured, and after my bacterial infection was gone, I still didn’t feel “normal”. I didn’t have much energy. I did more research and wound up taking a supplement called NAC. After a few days taking that I felt normal again. .

And in the midst of all this suffering some videos and this web site have been born. Hopefully they will help other folks to cure their scabies. And not have to spend hundreds or thousands of dollars on medical bills. And not have to beg, and then get turned down, for enough medication to actually do the job. It’s a good feeling to finally be in control. Whew!

Disclaimer: I am not a doctor or any sort of medical professional. I cannot diagnose or prescribe anything for you. I can tell you what I did, but that was for me. I did my own research, came to my own conclusions and I take responsibility for all of that. The same is true for you. Do your own research, come to your own conclusions and take responsibility for that. I am not telling you what to do or not to do. I am not telling you anything is “safe” because it is always possible for you to be allergic or to not follow instructions or whatever. I often had to proceed even though I knew I didn’t have complete enough information to be sure what the results of my actions would be, but I knew I had to do something or I would suffer forever. Follow your own star, live your own life, and don’t follow anyone else blindly. Otherwise you are living their life and nobody will have lived your life. I hope that makes sense.

My DIY instructions and video story

As I said, I made video describing how I made my own 5% permethrin cream and put it up on YouTube. Not surprisingly, a lot of people watched it and made their own and treated themselves.

Well, then a guy who sells some home-made permethrin lotion and sells it on-line wrote telling me I was killing his business and had a whole sob story about his family. I checked and found someone was going around the web writing reviews of other scabies products criticizing them and talking up this guy’s stuff. I can’t say for sure, but it looked to me like this guy was writing bogus reviews criticizing other products and puffing up his own product. It sounded too suspicious to me so I couldn’t recommend his product. And I refused to take down my DIY permethrin cream video just so he could sell more of his home brew.

Well, magically the permethrin company calls me and threatens to sue me and have the EPA and FDA prosecute me. Gee, I wonder who called them? And because I don’t want the permethrin company to sue me, I can’t describe how I did it or recommend it or anything. Oh well. I made a page with directions for how to mix up permethrin lotion for treating scabies on any animals except cats. When wet, permethrin is toxic to cats and certain breeds of dogs, such as collies (all the info is on my treating animals with permethrin page). With animals scabies is called “mange”.

So on my page about how to treat animals is my recipe to make 5% permethrin lotion…the same concoction that I used on myself. Ain’t it a strange world?

Scabies

How is scabies treated?

Everyone living in your house and all sexual partners should be treated at the same time. After the first treatment, you will no longer be contagious. You may return to work or school.

Scabies infection is most often treated with a prescription cream or lotion that has 5% permethrin. This kills the mites. When using prescription lotion or cream:

  • Follow instructions from your healthcare provider and pharmacist. Ask about safety steps for using this medicine.
  • Use the cream or lotion on your body when your skin is cool and dry. Don’t use it after a hot shower or bath.
  • Apply the cream or lotion to your entire body from the chin down. This includes the neck, palms of your hands, soles of your feet, groin, and under your fingernails.
  • Don’t use more than prescribed.
  • Leave the cream or lotion on for the advised amount of time. This is usually 8 to 14 hours. Don’t leave it on your skin longer than directed.
  • Wear only clean clothes after the treatment.
  • Reapply the cream or lotion to your hands after you wash them.
  • If you are breastfeeding, wash off your nipples before feeding. Then reapply the cream or lotion after breastfeeding.
  • If advised, repeat the application of cream or lotion 1 week later.

Other treatments include:

  • Ivermectin. This is an oral medicine for severe cases. It may also be used if you can’t apply cream or lotion. This can be used before other treatments, but it usually costs more than skin cream medicines.
  • Antihistamine medicine. Itching may cause the most discomfort. If large areas of your skin are affected, over-the-counter antihistamines may be used to reduce itching. Or you may be given a prescription antihistamine.
  • Antibiotics. This medicine may be used to treat infected sores from scratching. It is important to finish taking all of the antibiotics even if the sores look better. This is to make sure the infection has fully gone away.
  • Medicines work quickly to kill the mites, but the itchy rash may last for several weeks after treatment. Marks on the skin from scabies usually go away in 1 to 2 weeks, but sometimes take a few months to go away.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all treatments.

Bookshelf

Acute and Subchronic Effects

Dermal Irritation Robinson (1989b) showed permethrin to be a moderate skin irritant on the intact and abraded skin of rabbits (Category III). In an acute dermal toxicity test in rats, Robinson (1989a) found an LD50 greater than 200 mg/kg but also observed desquamation, edema, thickening, scab, or skin eruptions in 9 of 10 rats. These skin changes persisted in a few animals up to 10 days (Category III). In the rabbit study, Robinson (1989b) evaluated the skin irritation responses to several concentrations of permethrin. The author observed erythema and edema at a concentration of approximately 80 mg/cm2. The California Environmental Protection Agency (CEPA, 1992) concluded that the NOEL would be approximately 8 mg/cm2 (using an uncertainty factor of 10). The subcommittee believes that the CEPA’s estimated NOEL of 8 mg/cm2 is appropriate.

When a permethrin formulation was applied to the clipped dorsal surface (0.13 mg/cm2) of six New Zealand White rabbits (three of each sex) once a day for 16 days, a slight erythema appeared, which correlated with increased cutaneous blood flow. No significant histopathological changes were detected (Flannigan et al., 1985).

Single applications of up to 0.5-mL a permethrin produced only mild, localized irritation (McCreesh, 1977). The treated area showed focal acanthosis and hyperkeratosis of the epidermis. Those pathological conditions are common skin reactions to nonspecific irritant chemicals.

When 0.5 mL of undiluted technical permethrin (91.3 % purity) was applied to the clipped dorsal surface of Japanese White rabbits, there was no irritation (Okuno et al., 1976a).

In occupational settings, dermal contact is one of the main routes of exposure to pesticides. To simulate human dermal contact, rabbits were clipped free of hair and dressed with cotton cloth impregnated with permethrin. After 21 days of exposure, the animals were necropsied. Tissues examined were skin, brain, eye, stomach, small intestine, large intestine, cecum, lung, heart, thyroid, liver, pancreas, adrenal gland, kidney, testes, urinary bladder, skeletal muscle, bone, bone marrow, and trachea. SGOT, SGPT, LDH, glucose, BUN, bilirubin, total protein, Na + , and K + were determined. No abnormalities in any of the values were observed (McCreesh, 1977).

Dermal Sensitization In a study by Parkinson et al. (1976), guinea pigs were dermally administered permethrin as a 10% solution in dimethylformamide for 3 consecutive days. This was followed 4 days later by challenge doses of 0.1%, 1%, and 10% solutions of permethrin in dimethylformamide. Only very slight erythema was observed. Permethrin was therefore considered to be either nonsensitizing or only mildly so.

In studies conducted by the U.S. Army Environmental Hygiene Agency (AEHA), guinea pigs (10 per group) were initially injected intradermally with 0.1-mL permethrin solution, and 14 days later were challenged with an intradermal injection (0.1 mL) of either a 0.1% solution of permethrin or dinitrochlorobenzene (DNCB). Five other animals per group received intradermally a challenge dose of 0.1% permethrin or DNCB without a prior sensitizing dose. The positive control substance (DNCB) elicited sensitization reactions in all guinea pigs when examined 24 and 48 hr after the challenge dose, whereas permethrin did not cause any sensitization reactions (Metker et al., 1977; Metker, 1978).

Permethrin (cis/trans ratio, 25:75) in corn oil (1% wt/vol) or Freund’s complete adjuvant (1% wt/vol) did not produce dermal irritation or sensitization in groups of 10 male guinea pigs when applied as a 25% dispersion in petrolatum. The positive control, DNCB (5% wt/vol), in petrolatum produced marked sensitization (Chesher and Malone, 1974b).

Employing the guinea pig maximization test, Leah (1989a) reported permethrin to be a moderate skin sensitizer. In this study, technical-grade permethrin was applied both intradermally (six 0.05-0.1 mL injections of 10% solution in corn oil with and without Freund’s complete adjuvant) on day 0 and topically (undiluted) on day 7 of the induction phase. The animals were challenged on day 21 with a 30% solution in corn oil and with the undiluted test material, which were applied topically. Slight to moderate erythema was observed in 6 of 20 animals. However, the subcommittee believes that in the absence of supporting data from studies conducted by using current knowledge, the results of Leah (1989a) might have yielded a false positive response.

Permethrin skin cream

What is this medicine?

PERMETHRIN (per METH rin) skin cream is used to treat scabies.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Acticin, Elimite

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • asthma

  • an unusual or allergic reaction to permethrin, veterinary or household insecticides, other medicines, chrysanthemums, foods, dyes, or preservatives

  • pregnant or trying to get pregnant

  • breast-feeding

How should I use this medicine?

This medicine is for external use only. Do not take by mouth. Follow the directions on the prescription label. A bath or shower is NOT recommended before applying this medicine. Thoroughly rub the cream into all skin surfaces, from your head to the soles of your feet. It is important to apply it everywhere on your body, not just where the rash is. Apply the cream between fingers and toe creases, in the folds of the wrist and waistline, in the cleft of the buttocks, on the genitals, and in the belly button. Use a toothpick to apply the cream beneath your fingernails and toenails. Nails should be cut short. If you have little or no hair, or you are applying the cream to an infant or young child, make sure you rub the cream into the neck, scalp, hairline, temples, and forehead. Leave it on for 8 to 14 hours, then remove it by bathing and shampooing. If you are applying this medicine to another person, wear plastic or disposable gloves to protect yourself from infestation. Do not get this medicine in your eyes. If you do, rinse out with plenty of cool tap water.

Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for children as young as 2 months of age for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply.

What may interact with this medicine?

Interactions are not expected. Do not use any other skin products on the affected area without telling your doctor or health care professional.

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

It is not unusual for itching and rash to continue for as long as 2 to 4 weeks after treatment. These symptoms may be a temporary reaction to the remains of the mites. This does not mean this cream did not work or that it needs to be reapplied. If you feel that the itching and rash is intense or if it continues beyond 4 weeks, talk to your doctor or health care professional right away.

Scabies is spread by direct skin contact with an infected person. Family members and sexual partners may require treatment with this medicine. You should discuss this with your doctor or health care professional.

Using a normal washing cycle, you should wash all clothing, towels and bed linen that has touched your skin. You do not need to rewash clean clothing that has not yet been worn. Coats, furniture, rugs, floors, and walls do not need to be cleaned in any special manner.

What side effects may I notice from receiving this medicine?

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • itching

  • numbness

  • rash

  • redness or mild swelling of the skin

  • stinging or burning

  • tingling sensation

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature away from heat and direct light. Do not refrigerate or freeze. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

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About permethrin cream

Type of medicine An insecticide
Used for Treatment of scabies in adults and children; treatment of crab lice in adults
Also called Lyclear® Dermal Cream
Available as Cream

Permethrin cream contains an insecticide. It kills insects (parasites) that live on humans, such as the scabies mite and crab (pubic) lice. Two applications of treatment with permethrin cream are needed, one week apart. Your whole body should be treated both times.

Scabies is an itchy skin disorder that leads to a rash. It is caused by an infestation with a parasite – the scabies mite. The mite lives on the skin and burrows into it. Scabies is contagious and spreads to others through close skin-to-skin contact. The hand is the most common site to be first affected, probably from prolonged hand-holding with an infected person. Close skin-to-skin contact when having sex is another common way of catching scabies.

Crab lice are tiny insects that live on humans, usually in the pubic hair. They are passed on through close body contact, such as when having sex. Infestation with pubic lice can cause itching but not everyone affected has symptoms. Crab lice are grey or brown in colour. They get their name because some of their legs have crab-like claws.

Permethrin cream is available on prescription, or you can buy it without a prescription at a pharmacy. It is easy to apply and normally works well if used properly.

Before using permethrin cream

To make sure this is the right treatment for you, before you start using permethrin cream it is important that your doctor or pharmacist knows:

  • If you are pregnant or breastfeeding. This is because, while you are expecting or feeding a baby, you should only use medicines on the recommendation of a doctor.
  • If it is for a child or a teenager under 18 years if age. Permethrin cream should only be used for scabies on the advice of a doctor in children under 2 years of age. It can be used for crab lice, only in adults.
  • If you have ever had an allergic reaction to a cream or ointment, or if you know you are allergic to chrysanthemums or flowering plants known as Compositae.

How to use permethrin cream

  • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about applying permethrin cream and will provide you with a full list of the side-effects which you could experience from using it.
  • Two applications of treatment are needed, one week apart. Apply a thin layer of the cream over your whole body including your face, neck, scalp and ears, but try to take care not to get any into your eyes. Remember to include awkward places such as your back, the soles of your feet, between your fingers and toes, under your fingernails, and your genitals. The cream should be applied when your skin is cool and dry, so if you have just had a bath or shower, wait for a little while to let your skin cool before you apply the cream.
  • If you have scabies, pay special attention to the areas where mite burrows can commonly occur – the front of your wrists and elbows, beneath your breasts, your armpits, and around the nipples in women.
  • Leave the cream on for 8-12 hours for scabies, or 12 hours (overnight) for crab lice. After this time, you should remove the treatment from your skin by having a bath or a shower. If you need to wash your hands during the treatment time, remember to re-apply some cream to your hands afterwards. You will need to use the cream a second time, seven days after the first treatment. Apply the cream in the same way as the first time. Using two treatments, a week apart like this, helps to ensure that all the mites/lice are killed.
  • For the two applications, an adult is likely to need 60 g of cream (two tubes – one tube for each application), older children will require 30 g cream in total (½ tube for each application) and younger children will require 15 g cream in total (¼ tube for each application).
  • Please note – if you are breastfeeding a child, you should wash off the cream from your nipples before you breastfeed, and then re-apply the cream afterwards.

Getting the most from your treatment

  • If you have scabies, all your household members, close contacts, and sleeping/sexual partners should also be treated – even if they have no symptoms. This is because it can take up to six weeks to develop symptoms after you become infected. Close family and partners may be infected but have no symptoms, and may pass on the mite. Everyone who is treated, should be treated on the same day.
  • If you have crab lice, your recent close contacts and sexual partners should also be treated if they are infected. It is important to remember that lice may be present even without other symptoms such as itching. If you have caught crab lice from a sexual partner, you should also be tested for other sexually transmitted infections.

If you have scabies, the following also applies:

  • If you are applying permethrin cream to an infant or young child, put mittens on your child to stop them licking the cream off their hands. Don’t apply the cream to areas around their mouth where it could be licked off.
  • Children should stay off school until the first application of treatment for scabies has been completed.
  • Clothes, towels and bed linen should be machine-washed at 50°C or above after the first application of treatment. This kills the scabies mites. Keep any items of clothing that cannot be washed, in plastic bags for at least 72 hours to contain the mites until they die. Alternative options to kill any mites on clothes and linen are ironing the item with a hot iron, dry cleaning or putting items in a dryer on the hot cycle for 10-30 minutes. It is not necessary to fumigate living areas or furniture or to treat pets.
  • You will still be itchy for a while after successful treatment. If the itching becomes troublesome to you, your doctor or pharmacist will be able to advise you regarding suitable products to ease this. Moisturising creams can provide temporary relief from itching.
  • It is normal for it to take up to 2-3 weeks (and sometimes up to six weeks) for the itch to go completely after scabies mites have been killed. You should, however, see a doctor if the itch persists longer than 2-3 weeks after treatment. This is because sometimes the first insecticide does not work and you may need to use a different one.
  • Some people may develop a secondary skin infection which may need antibiotic treatment. If you suspect this is the case for you, you should make an appointment to see your doctor.

Can permethrin cream cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with permethrin. You will find a full list in the manufacturer’s information leaflet supplied with the cream. The unwanted effects often improve as your body adjusts to the new medicine but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common permethrin cream side-effects (these affect less than 1 in 10 people) What can I do if I experience this?
Skin irritation, burning, stinging, redness, rash These are usually mild and soon pass. If any continues or becomes troublesome, speak with your doctor or pharmacist for advice

If you experience any other symptoms which you think may be due to the cream, please speak with your doctor or pharmacist for further advice.

How to store permethrin cream

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Make sure that the person supplying this medicine knows about any other medicines that you are taking or using. This includes any prescribed medicines, and any medicines you buy such as herbal and homeopathic medicines.

If you are having an operation or dental treatment, please tell the person carrying out the treatment which medicines you are taking or using.

This preparation is for use on the skin only. If someone swallows some of it by accident, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine, please ask your pharmacist.

Permethrin (for scabies)

Easy-to-read medicine information about permethrin – what it is, how to use permethrin safely and possible side effects. Permethrin is also known by the brands names A-Scabies and Lyderm.

Type of medicine Also called
  • Treatment for scabies
  • Permethrin 5%
  • A-Scabies®
  • Lyderm®

What is permethrin?

Permethrin is a treatment for scabies. Scabies is an intensely itchy skin rash, which is caused by an allergic reaction to a tiny insect (called a mite). Permethrin is an insecticide that kills the scabies mite preventing its spread. Read more about scabies.

In New Zealand, permethrin is available on prescription from your doctor or can be bought from your pharmacy without a prescription. It is available as:

  • A-Scabies (which is a lotion)
  • Lyderm (which is a cream).

Both the lotion and cream are effective in killing the scabies mite. The choice is personal preference.

How to apply permethrin?

  • Apply permethrin when your skin is cool and dry, so if you have just had a bath or shower, wait for a little while to let your skin cool before applying it.
  • Permethrin must stay on the body for at least 8 hours (up to 12 hours) to kill the mites. It is best applied just before going to bed to avoid it being washed off.
  • If a part of the body such as your hands are washed within 8 hours of applying permethrin, you will need to re-apply it immediately.

Permethrin must be applied to the whole body

Apply permethrin to every patch of skin over the whole body, from head to toe, including the scalp, face, neck, ears down to the soles of the feet.

  • Make sure you apply to the areas between the fingers and toes, wrists, armpits, belly button, genitals and buttocks.
  • Also, apply permethrin under the finger and toenails – use a nail brush if necessary.
  • Do not wash your hands after applying the treatment.
  • Women also need to apply permethrin under the breasts and around the nipples, as the scabies mite can burrow in these areas as well.
  • If it’s easier, you can ask someone else to apply the cream or lotion for you. This will make sure your whole body surface is covered with permethrin.
  • Leave the lotion or cream on overnight (8-12 hours) then wash off in the morning, and wear clean clothes.

Additional instructions

  • Avoid getting permethrin in your eyes: if it does get into your eye, rinse your eye with plenty of water immediately.
  • Avoid applying to broken skin, such as on cuts, grazes or sores, or to skin that has an infection.
  • Breastfeeding: if you are breastfeeding a child, wash off the permethrin from your nipples before you breastfeed, and then re-apply afterwards.
  • Itching may continue: permethrin kills the scabies mite preventing its spread but it does not relieve the itching. The itching is caused by an allergic reaction to the scabies mite and can continue for up to four weeks after treatment. Ask your doctor or pharmacist about medicines to relieve itching.
  • Everyone living in the same household must be treated: scabies is contagious and spreads to others through close contact. It’s important that everyone living in the same household with the infested person is treated at the same time, even if they are not itchy.
  • Children under two years old and pregnant women: may have a different treatment and so should see a doctor first for advice.
  • Repeat the treatment: another application of permethrin treatment is needed, one week to two weeks later. Don’t apply permethrin treatment more than twice without medical advice. Overuse can irritate the skin.
  • Ask your pharmacist how much to apply. As a guide:
    • most adults need one 30mL bottle of lotion
    • larger adults may need two bottles
    • children 5-12 years may only need half a bottle
    • younger children 2-5 years, a quarter of a bottle.
    • children under 2 years should see their doctor for advice.
  • Wash clothes and bedding the morning after everyone in your household has been treated. Wash all clothing, sheets, towels and pillowcases anyone has used in the past week in hot water (50°C for at least 10 minutes). If you have a tumble drier, dry all items on the hottest tumble dryer setting for 20 minutes. If clothes or linen cannot be washed either:
    • dry clean, or
    • seal in a plastic bag for 7 days at room temperature, or
    • seal in a plastic bag and freeze overnight.
    • If you don’t do these things, the mites will come back.
    • Note: the mite is not small enough to go through the weave of sheets, so under blankets and mattresses do not require laundering.

Possible side effects

Permethrin can cause skin irritation at the site of application, such as burning, stinging or tingling, numbness, redness and swelling. This should settle after a few hours. If it continues or becomes troublesome, tell your doctor or pharmacist.

See your doctor if:

  • there is still itch 6 weeks after finishing the treatment
  • you think the scratched areas have become infected.
  1. Permethrin New Zealand Formulary

Elimite

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 3/26/2019

Elimite (permethrin) 5% Cream topical (for the skin) is an anti-parasite medication used to treat head lice and scabies. Elimite Cream is available in generic form. Common side effects of Elimite Cream include:

  • skin irritation, including itching, swelling, and redness, with scabies and may temporarily worsen after treatment.

Other side effects of Elimite Cream include:

  • mild burning,
  • stinging,
  • redness,
  • itching,
  • skin rash,
  • numbness, or
  • tingling where the medicine was applied.

Thoroughly massage Elimite 5% Cream into the skin from the head to the soles of the feet. Usually a 30-gram dose is sufficient for an average adult. The cream should be removed by washing (shower or bath) after 8 to 14 hours. One application is generally curative. It is not likely that other drugs you take orally or inject will have an effect on topically applied Elimite. But many drugs can interact with each other. Tell your doctor all prescription and over-the-counter medications and supplements you use. Tell your doctor if you are pregnant before using Elimite. It is unknown if this drug passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breastfeeding.

Our Elimite (permethrin) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

TREATMENT

The treatment of scabies is as important as making a correct diagnosis. The mainstay of treatment is topical scabicidal agents. Certain principles have to be followed to treat patients successfully and are summarised in box 1.

Box 1: Principles of treatment of scabies

  • Establish your diagnosis.

  • Choose an appropriate medication.

  • Treat the whole body from neck to toes in adults and head and face in babies.

  • Treat all the contacts.

  • Give a detail verbal and written prescription.

  • Treat secondary infection if present.

  • Avoid over treatment.

  • Have a follow up at one and four weeks after treatment.

  • Launder clothing and bedding after completing treatment.

Patients should be properly instructed about the method of using the scabicide; this information can also be given as a pamphlet. A typical instruction sheet is shown in box 2, and it can be modified to suit the drug.

Box 2: Instructions to patients

Instructions for the treatment of scabies

Scabies is caused by itch mite and it can be easily cured if the following instructions are followed carefully:

  1. Start with a warm bath and dry thoroughly afterwards.

  2. The medication provided should be rubbed into the skin. All parts of the body from chin downwards, whether involved or uninvolved should be treated.

  3. Treatment is best done at night before going to bed.

  4. Avoid touching your mouth or eyes with your hands.

  5. Change your underclothing and sheets the next day and launder them.

  6. You may itch for few days but do not repeat the treatment.

  7. Everyone in the house should be treated at the same time.

  8. Report to your doctor after one week.

Modified from Alexander’s Arthropods and Skin2

Various treatment modalities have been used since time immemorial but the search for an ideal scabicide is ongoing. An ideal scabicide should be effective against adult and egg, easily applicable, non-sensitising, non-irritating, non-toxic, and economical2; it should also be applicable in all ages. As yet, no drug can be considered an ideal scabicide.

Drugs

Scabicidal drugs can be broadly divided into topical agents and oral agents. The various topical agents that are used in the treatment of scabies are summarised in box 3 (drugs that are not used now are not listed).

Box 3: Antiscabietic drugs

Topical agents

Oral drug

  • Ivermectin.

The topical and oral agents that are used in both in developed and developing countries are discussed below.

Topical agents

Sulphur

Sulphur is the oldest antiscabietic in use. Celsus used sulphur mixed with liquid pitch for management of scabies as early as 25 AD.1,9 Sulphur is used as an ointment (2%–10%) and usually 6% ointment is preferred. The technique is very simple: after a preliminary bath, the sulphur ointment is applied and thoroughly rubbed into the skin over the whole body for two or three consecutive nights.16 Patients should apply the ointment personally, as it ensures that their hands will be well impregnated. Ointments are more useful than any other preparation.2,17

Topical sulphur ointment is messy, malodourous, stains clothing, and in a hot and humid climate may lead to irritant dermatitis.9 It has the advantage of being cheap and may be the only choice in areas of the world where the need for mass therapy or economy dictates the choice of scabicide.7

Sulphur should be used only in situations where adults cannot tolerate lindane, permethrin, or ivermectin as it is inferior to all these agents.4 Sulphur is recommended as a safe alternative for the treatment of scabies in infants, children, and pregnant women.3

Benzyl benzoate

Benzyl benzoate, an ester of benzoic acid and benzyl alcohol is obtained from balsam of Peru and Tolu. Benzyl benzoate is neurotoxic to the mites. It is used as a 25% emulsion and the contact period is 24 hours. Benzyl benzoate should be applied below the neck three times within 24 hours without an intervening bath.4,9 In young adults or children, the dosage can be reduced to 12.5%. Benzyl benzoate is very effective when used correctly. If not properly applied, it may lead to treatment failure. Moreover, it can also cause irritant dermatitis on the face and scrotum. Repeated usage may lead to allergic dermatitis. It is forbidden in pregnant and lactating women, infants, and young children less than 2 years of age.4 Because of the side effects and the availability of less toxic agents, this scabicide had fallen into disrepute.4 However, recent studies have found it to be effective in the management of permethrin resistant crusted scabies18 and in combination with ivermectin in patients with relapses after a single treatment with ivermectin.19 In developing countries where the resources are limited, it is used in the management of scabies as a cheaper alternative.

Crotamiton

Crotamiton (crotonyl-N-ethyl-o-toluidine) is used as 10% cream or lotion. The success rate varies between 50% and 70%. The best results have been obtained when applied twice daily for five consecutive days after bathing and changing clothes.20,21 However, much stress has been put on its antipruritic properties but recent studies have not revealed any specific antipruritic effects.12 Some authors do not recommend crotamiton because of the lack of efficacy and toxicity data.5

Monosulfiram

The chemical name of monosulfiram is tetraethyl thiuram monosulphide. Percival first used it to treat human scabies in 1942.22 Monosulfiram emulsion is applied all over the body after a bath,9 and it should be rubbed in well once a day on two or three consecutive days. Monosulfiram is chemically related to antabuse and hence alcoholic beverages should be avoided during or soon after treatment.2 Soaps containing monosulfiram have been used in the past as a prophylactic measure in infected communities.9

Malathion

Malathion is an organophosphate insecticide that irreversibly blocks the enzyme acetylcholinesterase. Malathion is not recommended nowadays for treatment of human ectoparasitic infestations because of the potential for severe adverse affects.4

Lindane

Lindane, also known as gamma benzene hexachloride, is an insecticide. Wooldridge first used it to treat scabies in 1948.23 It acts on the central nervous system (CNS) of insects and leads to increased excitability, convulsions, and death. Lindane is absorbed through all portals of entry including the lung mucosa, intestinal mucosa, and other mucous membranes and it is distributed to all body compartments with the highest concentration in lipid-rich tissue and the skin. It is metabolised and excreted in urine and faeces.4

A single six hour application is effective in treatment of scabies. Some authors recommend a repeat application after one week.9,12 Lindane 1% cream or lotion has been found to be very effective in the treatment. It is non-irritating and ease of application has made it a popular treatment. Its disadvantage is that it can cause CNS toxicity and rare cases of CNS toxicity, convulsions, and death have been reported. However, all these reports are in children or infants with overexposure or an altered skin barrier (which increases lindane absorption).9 Accidental ingestion can lead to lindane poisoning. The clinical signs of CNS toxicity after lindane poisoning include headache, nausea, dizziness, vomiting, restlessness, tremors, disorientation, weakness, twitching of eyelids, convulsions, respiratory failure, coma, and death.24,25 There is some evidence that lindane may affect the course of haematological abnormalities such as aplastic anaemia, thrombocytopenia, and pancytopenia.26 To reduce the incidence of failure and toxicity, the “do’s and don’ts” relating to the use of lindane are described in table 1.

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Table 1

 “Do’s and don’ts” with the use of lindane in scabies

Despite the problems, the benefits outweigh the risk.9 It is a cheap and effective alternative to permethrin in many developing countries where scabies is widely prevalent. Rare reports of resistance to lindane exist.27

Permethrin

Permethrin is a synthetic pyrethoid and potent insecticide.4 Permethrin is very effective against mites with a low mammalian toxicity. Permethrin is absorbed cutaneously only in small amounts, rapidly metabolised by skin esterases, and excreted in urine. Permethrin 5% dermal creams are applied overnight once a week for two weeks to the entire body, including the head in infants. The contact period is about eight hours. It is the latest and most effective treatment for scabies.4,12 Permethrin can be safely used in young children. It has virtually no allergic side effects and cosmetically it is highly acceptable. Several studies have shown that permethrin has a higher clearance rate than lindane and crotamiton.28 The limiting factor in the use of permethrin is its cost as it is the most expensive of all the topical scabicides.4

The various topical antiscabietic agents and their side effects are summarised in table 2.

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Table 2

 Topical antiscabietics and their side effects

Oral antiscabietic agent

Ivermectin

Ivermectin, the 22, 23 dihydro derivative of avermectin B1 is similar to macrolides, but without any antimicrobial action. It acts via the suppression of conduction of nerve impulses in the nerve-muscle synapses of insects by stimulation of gamma amino butyric acid from presynaptic nerve endings and enhancement of binding to postsynaptic receptors. Scabies is treated with ivermectin 0.2 mg/kg in a single dose.29,30 The clinical efficacy is good with good clearing of skin lesions and a marked decrease in pruritus.31 It is rapidly absorbed and excreted through the faeces. The toxic effect of ivermectin after a single dose for scabies appears to be insignificant. It is relatively safe with side effects such as headache, pruritus, pains in the joints and muscles, fever, maculopapular rash, and lymphadenopathy, which were observed in patients with filariasis. Whether these symptoms are directly related to drug action or secondary to destruction of the filariae remains unclear.4 Ivermectin is contraindicated in patients with an allergy to ivermectin and CNS disorders. It is also not indicated during pregnancy, lactation, and in children less than 5 years of age. It is very effective, safe to use, cheap, and convenient. Ivermectin has been found to be useful in patients with a high mite burden such as crusted scabies in addition to keratolytics.29,30,32 Ivermectin promises to be the drug of the future. Ivermectin lotion has also been used to treat scabies.33

Other agents

Allethrin I, widely used as an insect repellent, was effective when used as a spray in scabies. It is neither irritant nor sensitiser. Thiabendazole 5% cream has been tried in treatment of resistant scabies.

Although many drugs are used for treating scabies, recommendations for the management of scabies from the Centers for Disease Control in Atlanta include only lindane, permethrin, and ivermectin (see table 3).34

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Table 3

 Centers for Disease Control recommendations for treatment of scabies

Among the various array of drugs available, the most suitable for the individual patient can be decided based on the factors2 shown in box 4.

Box 4: Factors deciding suitability of patient for various drugs

  • Age of the patient.

  • Pregnancy and lactation status if women.

  • Efficacy of the drug.

  • Extent of eczematisation.

  • Potential toxicity of the agent.

  • Cost effectiveness.

In general, the drug of choice for scabies is permethrin followed by lindane and benzyl benzoate. In most patients, permethrin 5% cream can be used safely except in pregnant and lactating women where it should not be used. Ivermectin is now emerging as an effective oral drug and can be used safely in adults. It is the agent of choice in Norwegian scabies and scabies epidemics in institutions.3 Lindane and benzyl benzoate still hold the sway in developing world where permethrin is beyond the reach of the poorest of the poor.

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