How do I apply permethrin (permethrin) for a scabies infection?

How to Apply Permethrin 5% Cream for Scabies

Apply permethrin 5% cream to all areas of your body from the neck down to the soles of your feet, leave it on for 8-14 hours (overnight is ideal), then wash it off thoroughly with soap and water. 1, 2

Step-by-Step Application Instructions

Before Application

• Do NOT bathe or shower immediately before applying permethrin - this can increase absorption and potential side effects 1
• Ensure skin is completely dry before application 2
• Trim fingernails short to reduce injury from scratching 1

Application Technique

• Massage the cream thoroughly into the skin covering all areas from the neck down 2
• Include these often-missed areas: between fingers and toes, under fingernails and toenails, wrists, elbows, armpits, genitals, and buttocks 1
• Amount needed: Approximately 30 grams (one full tube) is sufficient for an average adult 2
• Apply to the entire body surface - do not skip any areas from neck down 1

Special Considerations for Head and Scalp

• Adults typically do NOT need scalp treatment, as scabies rarely infests the adult scalp 2
• However, treat the hairline, neck, temple, and forehead in infants, young children, and elderly patients 1, 2
• If you are elderly or have visible lesions on your head/scalp, consider applying permethrin to these areas as well 3

Timing

• Leave the cream on for 8-14 hours - applying before bedtime and washing off in the morning is most practical 1, 2
• Remove by thorough washing with soap and water (shower or bath) 2

After Treatment Expectations

Normal Post-Treatment Symptoms

• Itching may persist for up to 2 weeks after successful treatment - this is NOT a sign of treatment failure 1, 4
• This persistent itching is due to an allergic reaction to dead mites and does not require retreatment 1, 2

When Retreatment is Needed

• ONE application is generally curative 2
• Retreatment is only necessary if living mites are visible after 14 days 2
• If symptoms persist beyond 2 weeks with evidence of active infestation, a second application may be warranted 1

Environmental and Contact Management

Decontamination Requirements

• Machine wash and dry all bedding, clothing, and towels using the hot cycle on the same day as treatment 1, 4
• Alternatively, dry clean these items or seal them in plastic bags and remove from body contact for at least 72 hours 1, 4
• Fumigation of your home is NOT necessary 1

Treating Close Contacts

• All household members and sexual partners from the past month must be treated simultaneously, even if they have no symptoms 1, 4
• Failure to treat contacts is the most common reason for treatment failure and reinfection 5, 4

Common Pitfalls to Avoid

• Do not apply permethrin immediately after bathing - this increases systemic absorption and risk of side effects 1
• Do not apply inadequately - many treatment failures occur because patients don't cover all body surfaces thoroughly 5, 4
• Do not retreat immediately for persistent itching - wait at least 14 days to assess for living mites 2
• Do not fail to treat all close contacts at the same time - this leads to reinfection 5, 4

Safety Information

Who Can Use Permethrin

• Permethrin is safe for pregnant and breastfeeding women 1, 4
• Safe for infants and young children (treat their scalp as well) 1, 4, 2
• Permethrin has minimal toxicity and is safer than alternative treatments like lindane 1, 6

Expected Side Effects

• Mild, temporary burning or stinging sensation is common and not dangerous 6
• New or increased itching immediately after application may occur 6
• These effects are generally mild and resolve quickly 6