From the Guidelines
To use permethrin 5% cream, apply a thin layer to clean, dry skin from neck to toes, including between fingers and toes, and leave on for 8-14 hours, typically overnight, before washing off thoroughly with soap and water, as recommended by the 2015 guidelines 1. When using permethrin 5% cream, it is essential to follow the application instructions carefully to ensure effective treatment. Key points to consider:
- Treat the entire body except head and face
- Pay special attention to skin folds and creases
- Wash hands after application, unless treating hands
- Change into clean clothes after washing off
- Wash all recently used bedding and clothing Permethrin 5% works by paralyzing and killing scabies mites and their eggs, and the treatment is generally effective and well-tolerated, but may cause temporary itching or burning sensations, as noted in the guidelines 1. It is also important to note that permethrin 5% cream is recommended for infants and young children, and should be applied from the neck down and washed off after 8-14 hours, as stated in the 2015 guidelines 1. Consult a healthcare provider for use in children under 2 months, pregnant women, or if symptoms persist after treatment, as these cases may require special consideration and alternative treatment options, as suggested by the guidelines 1.
From the FDA Drug Label
Thoroughly massage Permethrin Cream, 5% into the skin from the head to the soles of the feet. The cream should be removed by washing (shower or bath) after 8 to 14 hours. The application instructions for permethrin (topical ectoparasiticide) 5% are to:
- Thoroughly massage the cream into the skin from the head to the soles of the feet
- Leave the cream on for 8 to 14 hours
- Remove the cream by washing with shower or bath 2
From the Research
Application Instructions for Permethrin (Topical Ectoparasiticide) 5%
- The application instructions for permethrin 5% cream vary depending on the condition being treated and the patient population 3, 4, 5, 6.
- For scabies, permethrin 5% cream is typically applied from the neck down, but some studies suggest that a scalp-to-toes application may be more effective in certain cases, such as in infants or patients with scalp involvement 4.
- The cream should be applied to all external surfaces of the body, including the scalp and head, and left on for 24 hours before being washed off 5.
- In some cases, a single application may be sufficient, but repeated applications 7-10 days later may be necessary to ensure complete eradication of the infestation 3, 5.
- Permethrin 5% cream can be used in combination with other treatments, such as fusidic acid 2% cream, to treat impetiginized scabies 7.
- It is recommended to store the cream in the refrigerator and apply it cold to the skin, and to avoid using other topical or systemic drugs except for a cleanser with chlorhexidine 5.
- Patients should be counseled on the proper use of permethrin 5% cream and the importance of completing the full treatment course to ensure effective treatment of scabies and pediculosis 6.
Special Considerations
- In adults, permethrin 5% cream is typically applied from the neck down, but in infants and young children, a scalp-to-toes application may be necessary 4.
- Patients with scabies crustosa, pregnant women, and nursing mothers may require special consideration when using permethrin 5% cream 3.
- Permethrin 5% cream should be used with caution in patients with a history of seizures or neurological complications 3.
Treatment Regimens
- A single application of permethrin 5% cream may be sufficient for some patients, but repeated applications 7-10 days later may be necessary to ensure complete eradication of the infestation 3, 5.
- A treatment regimen of permethrin 5% cream applied once daily for two consecutive days has been shown to be effective in adult immunocompetent patients with scabies 5.