Treatment Options for Itching Mites on the Face
Permethrin 5% cream is the first-line treatment for facial mite infestations, applied to all affected areas and washed off after 8-14 hours. 1
First-Line Treatment Options
Permethrin 5% Cream
- Apply thoroughly to all affected areas of the face
- Leave on for 8-14 hours before washing off
- Generally curative with a single application 2
- Safe and effective for most patients, including children and pregnant women 1
- May cause temporary exacerbation of pruritus, edema, and erythema 2
Oral Ivermectin
- Effective alternative at 200 μg/kg, particularly for widespread or severe infestations 1
- Should be taken with food to increase bioavailability
- Requires a repeat dose after 2 weeks due to limited ovicidal activity 1
- Provides cure rates of 61.9% after single dose, increasing to 78.5% after repeat treatment 3
Second-Line Treatment Options
Topical Ivermectin 1% Cream
- Once-daily application
- Particularly effective for Demodex-associated facial mite infestations 4
- Reduces mite density while improving inflammatory markers 4
- May be more suitable for facial application than some other treatments
Metronidazole
- Topical metronidazole 0.75% or 1% gel applied twice daily 5, 6
- Oral metronidazole in short courses has shown efficacy in reducing Demodex density 5
- Particularly useful for facial seborrheic dermatitis associated with mites 6
Crotamiton 10%
- Apply to affected areas nightly for 2 consecutive nights
- Wash off 24 hours after the second application 1
- Effective against various mite species including Demodex 5
Sulfur Preparations
- Sulfur 6-10% ointment applied nightly for 3 nights 1, 3
- Less effective than ivermectin (59.5% vs 78.5% cure rate at 4 weeks) 3
- May be useful for patients who cannot tolerate other treatments
Special Considerations
For Severe or Crusted Infestations
- Consider combination therapy with oral ivermectin and permethrin 5% cream 1
- May require longer treatment duration and multiple applications
For Secondary Bacterial Infections
- Combination treatment with antibiotics may be necessary for impetiginized lesions 1
- Staphylococcus aureus is the most frequently detected infectious agent in secondary infections 4
Environmental Management
- Wash bedding and clothing in hot water and dry on hot cycle 1
- Items that cannot be washed should be removed from body contact for at least 72 hours 1
- All household members and close contacts should be treated simultaneously to prevent reinfestation 1
Treatment Pitfalls to Avoid
- Inadequate application coverage - ensure complete coverage of all affected areas 1
- Mistaking persistent pruritus for treatment failure - itching may continue for up to 2 weeks after successful treatment 1, 2
- Failure to treat all close contacts simultaneously 1
- Inadequate environmental decontamination 1
- Overuse of lindane due to potential toxicity 1