Permethrin Use on the Face
Permethrin 5% cream should NOT be routinely applied to the face in adults, as standard application is from the neck down, but facial application IS indicated for infants, young children, and elderly/geriatric patients who require treatment of the hairline, neck, temple, forehead, and scalp. 1, 2
Standard Application Guidelines
- For adults with scabies: Apply permethrin 5% cream to all areas of the body from the neck down to the soles of the feet, leaving on for 8-14 hours before washing off 3, 1, 2
- The scalp rarely becomes infested in adults, making facial application unnecessary in this population 2
- The cream should be massaged thoroughly into skin, including often-missed areas like between fingers/toes, under nails, wrists, elbows, armpits, and genitals 1
Special Populations Requiring Facial Application
Infants and young children:
- Must have permethrin applied to the scalp, temple, forehead, hairline, and neck 1, 2
- This population is at higher risk for facial/scalp infestation compared to adults 2
- Permethrin is safe for infants as young as 2 months of age 2
Geriatric patients:
- Should receive treatment to the hairline, neck, temple, and forehead due to increased risk of infestation in these areas 1, 2
Eye Precautions
- Permethrin should NOT be applied to the eyes 4
- The medication may be mildly irritating to eyes 2
- If permethrin gets in the eyes, flush immediately with water 2
- For pediculosis (lice) of the eyelashes specifically, use occlusive ophthalmic ointment or petroleum jelly to eyelid margins twice daily for 10 days instead of permethrin 3, 4
Safety Profile for Facial Use
- Permethrin has minimal systemic absorption (only 0.35-0.52% urinary recovery of metabolites) and is rapidly metabolized in the skin 5
- It is safe for pregnant women, breastfeeding mothers, and young children when used as directed 3, 1, 2
- Mild burning, stinging, or temporary exacerbation of pruritus may occur but does not indicate treatment failure 2