From the Guidelines
Permethrin 5% cream, such as Elimite, should be applied to all areas of the body from the neck down and left on for 8-14 hours before being washed off, with the application repeated in 7 days if necessary, as supported by the most recent guidelines 1. The application frequency of permethrin (Elimite) ointment is typically a single application, but may be repeated in 7 days for a complete treatment course of scabies.
- The cream should be applied to the entire body from the neck down to the soles of the feet, paying special attention to skin folds, between fingers and toes, under nails, and the genital area.
- For children, also apply to the scalp, temples, and forehead.
- The cream should be left on for 8-14 hours (usually overnight) before washing it off.
- Permethrin works by disrupting the nervous system of the parasites, leading to their paralysis and death.
- It's essential to also wash all bedding, clothing, and towels used in the 3 days before treatment in hot water and dry on high heat to prevent reinfestation.
- Side effects are generally mild and may include temporary itching, burning, or stinging, as noted in studies on permethrin use 1. The most recent and highest quality study, from 2015, provides the best guidance on the application frequency of permethrin (Elimite) ointment, and should be prioritized in clinical decision-making 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults and children Thoroughly massage Permethrin Cream, 5% into the skin from the head to the soles of the feet. ... ONE APPLICATION IS GENERALLY CURATIVE. The application frequency of permethrin (Elimite) cream is one application, which is generally curative.
- The cream should be removed by washing after 8 to 14 hours.
- Retreatment may be necessary if demonstrable living mites are present after 14 days 2
From the Research
Application Frequency of Permethrin (Elimite) Ointment
The application frequency of permethrin (Elimite) ointment can be determined based on the following evidence:
- Permethrin 5% cream is typically applied to the body and repeated in four days 3
- For the treatment of scabies, two applications of permethrin with a one week interval is often recommended 4, 5
- A single "head to toe" application of permethrin is ideal for eradication programmes, but may not be sufficient for scabies treatment 6
Treatment Regimens
Some studies suggest the following treatment regimens:
- Permethrin 5% cream applied twice with a one week interval 4, 5
- Permethrin 5% cream applied to the body and repeated in four days 3
- Oral ivermectin as an alternative treatment option, with a single dose or two doses at a 2-week interval 4, 5
Efficacy of Permethrin
The efficacy of permethrin 5% cream has been compared to oral ivermectin in several studies: