From the Guidelines
A valid prescription for permethrin for scabies is 5% permethrin cream applied to all areas of the body from the neck down and washed off after 8–14 hours. This treatment is recommended for all patients, including infants and young children, as stated in the 2015 sexually transmitted diseases treatment guidelines 1. The guidelines emphasize that infants and young children should be treated with permethrin, and it is the preferred treatment for pregnant or lactating women due to its safety profile 1.
When applying permethrin cream, it is essential to cover all areas of the body from the neck down, and for children and infants, the cream should also be applied to the scalp, hairline, neck, face, and ears, avoiding the eyes and mouth. The treatment should be repeated after 7-10 days to kill newly hatched mites. Each treatment typically requires 30-60 grams of cream (one to two 30g tubes) for an average adult.
Permethrin works by paralyzing and killing the scabies mites and their eggs, disrupting the mite's nervous system while having minimal absorption into the human bloodstream. Side effects are generally mild and may include temporary burning, stinging, or itching. Itching may persist for 2-4 weeks after successful treatment due to the body's allergic response to dead mites.
It is crucial to note that persons with HIV infection and others who are immunosuppressed are at increased risk for crusted scabies and should be managed in consultation with a specialist 1. However, for uncomplicated scabies, the same treatment regimens as those who are HIV negative can be used.
In terms of application, the skin should be clean and dry, and special attention should be paid to areas commonly affected by scabies, such as between fingers and toes, wrists, armpits, genitals, and under fingernails. By following this treatment regimen, patients can effectively manage scabies and reduce the risk of complications.
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. Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested in infants and geriatric patients. Usually 30 grams is sufficient for an average adult. The cream should be removed by washing (shower or bath) after 8 to 14 hours. Infants should be treated on the scalp, temple, and forehead. ONE APPLICATION IS GENERALLY CURATIVE.
A valid prescription for permethrin for scabies is:
- Permethrin Cream, 5%
- Applied from the head to the soles of the feet
- 30 grams is usually sufficient for an average adult
- Left on for 8 to 14 hours before washing off
- One application is generally curative 2
From the Research
Valid Prescription for Permethrin in Scabies
- A valid prescription for permethrin in scabies typically involves the use of 5% permethrin cream, applied from the neck down for adults, but may require scalp-to-toes application in certain cases, such as infants or patients with scalp involvement 3.
- The application of permethrin can be done in various regimens, including a single application, or multiple applications with a one-week interval 4, 5, 6.
- The treatment may need to be repeated 7-10 days later, and follow-up is typically recommended 2 months after the end of treatment 6.
- Permethrin is considered a first-line treatment for scabies, and can be used during pregnancy and lactation, as well as in children under 2 months old 7.
Efficacy of Permethrin in Scabies
- Permethrin has been shown to be highly effective in treating scabies, with cure rates ranging from 89.7% to 96.9% in various studies 4, 5, 6.
- The efficacy of permethrin can be influenced by the application regimen, with multiple applications showing higher cure rates than single applications 5, 6.
- Permethrin has been compared to oral ivermectin in several studies, and has been found to be equally effective, with some studies showing a faster onset of action for permethrin 4, 5, 7.