Permethrin Indications
Permethrin is FDA-approved for the treatment of scabies (Sarcoptes scabiei infestation) at 5% concentration and is a recommended first-line treatment for pediculosis pubis (pubic lice) at 1% concentration. 1, 2
FDA-Approved Indication
- Permethrin 5% cream is indicated for the treatment of scabies (Sarcoptes scabiei infestation). 1
- The 5% formulation requires a prescription and is applied to the entire body from neck down (scalp included in infants and young children) for 8-14 hours before washing off. 2, 3
CDC-Recommended Uses (Guideline-Based)
Pediculosis Pubis (Pubic Lice)
- Permethrin 1% creme rinse is a recommended first-line treatment for pubic lice, applied to affected areas and washed off after 10 minutes. 2
- This formulation has less potential for toxicity compared to lindane and is preferred for pregnant and lactating women. 2
- Sex partners within the preceding month should be treated simultaneously. 2
Scabies Treatment
- Permethrin 5% cream is the CDC's recommended first-line treatment for scabies, applied to all body areas from the neck down and washed off after 8-14 hours. 2, 4
- For infants, young children, and elderly patients, application should include the scalp, hairline, neck, temple, and forehead. 3, 5
- The treatment is safe for pregnant and lactating women, as well as infants as young as 2 months of age. 2, 3, 6
Special Populations
Pregnancy and Lactation
- Permethrin is the preferred agent for both scabies and pediculosis pubis in pregnant and lactating women due to its superior safety profile. 2, 4
Pediatric Use
- Permethrin is considered safe in infants less than 2 months of age for scabies treatment. 6
- For head lice in children, 5% permethrin cream has been used off-label when standard 1% treatments fail, though it is not FDA-approved as a pediculicide at this concentration. 2
Important Clinical Considerations
Application Technique
- Proper application is critical for treatment success: apply to completely dry skin, massage thoroughly into all body areas including between fingers/toes, under nails, wrists, elbows, armpits, genitals, and buttocks. 3
- Rinse over a sink (not shower/bath) with warm (not hot) water to minimize systemic absorption. 2
Post-Treatment Expectations
- Pruritus may persist for up to 2 weeks after successful treatment and does not indicate treatment failure—this represents an allergic reaction to dead mites. 4, 3
- Retreatment is only necessary if living mites are visible after 14 days. 3
Environmental Management
- Decontaminate all bedding and clothing by machine washing/drying on hot cycle, dry cleaning, or removing from body contact for at least 72 hours. 2, 3
- All household members and sexual contacts from the past month must be treated simultaneously, even if asymptomatic. 3