Permethrin
The standard cream for scabies. It kills the mites overnight, but it only works if everyone in the household is treated on the same night, and the itching carries on for weeks after the mites are dead.
Key facts
Permethrin at a glance.
Used for
Scabies or head lice; products differ
Results
Itch may last 2–4 weeks
Treatment commitment
Diagnosis-specific application and repeats
Key precautions
Scabies contacts need coordinated treatment
What is it?
Top things to know about Permethrin
- It targets parasites. Permethrin disrupts nerve function in mites and lice.
- It does not treat itch directly. Itching can persist after the parasites are killed.
- Strengths differ by use. The 5% scabies cream differs from 1% lice products.
- Scabies usually needs two treatments. A repeat application is common because one may not clear all mites.
HOW IT WORKS
How Permethrin works
Diagram explanation and sources
Disrupts mite sodium channels: Interferes with electrical signals in mite nerves. Paralyzes and kills mites: Mites can no longer function normally. Treats the infestation: Skin recovers after the mites are eliminated.
Permethrin delays repolarization through effects on arthropod sodium channels. The shallow burrow is in the stratum corneum. Residual itch can persist after successful scabies treatment; this is not an application guide.
Brands
Brands of Permethrin
Brand names and available preparations vary by country. The examples below identify specific labeled products.
Elimite
Permethrin cream used for scabies. It is a different treatment product from lice preparations.
Nix
Permethrin lice-treatment products. Check the active ingredient because the brand also has other products.
Strengths
Permethrin strengths
Permethrin 1% head-lice lotion/rinse and 5% scabies cream treat different infestations. They are not lower and higher steps for the same diagnosis. Contact time, body coverage, age and repeat treatment must follow the correct product’s instructions.
1%
5%
A scalp/hair formulation approved from age 2 months; repeat-treatment directions differ from scabies treatment.
A skin formulation used for scabies, generally left on for 8–14 hours under the cited guidance. Do not substitute the lice rinse.
Strength sources
Forms
Permethrin forms
Cream
Richer and more moisturizing; often suits dry skin. The full formula still affects comfort.
Cream rinse
A slippery emulsion spread through hair and rinsed away. The base helps distribution; rinse-out directions belong to the specific product.
How to use it
Your treatment, step by step.
How to apply it
- 01
When to Apply
At bedtime, on cool dry skin. Adults and older children apply from the jaw line down and cover everything — between fingers and toes, under the nails, wrists, armpits, waistband, navel, groin, buttock crease, soles. In babies, young children and anyone with a weakened immune system, treat the scalp, face, ears and hairline too. Wash off after eight to fourteen hours, usually the next morning.
- 02
How to Start
Everyone in the household and every recent close contact is treated on the same night, itching or not. A person can carry mites for weeks before a rash appears, and one untreated contact reinfects the house. The same day, wash bedding, towels and clothes from the last three days on a hot wash and dry hot, or bag them for three days.
- 03
If It Irritates
Mild stinging, burning or a burst of extra itching in the first day or two is expected. A plain moisturizer after rinsing helps. Stop and ask if you get spreading redness, swelling or blistering — that points to allergy, not the usual sting.
- 04
If It’s Not Working
The second full application a week after the first is standard, not failure. Itching alone is not failure either. New burrows, new spots four weeks after treatment, or itching clearly getting worse rather than slowly better need another look.
Monitoring & follow-up
No blood tests or laboratory monitoring for ordinary use.
Monitoring is a look at the skin four weeks after the last application. The question is whether there are new burrows or new spots, not whether you still itch — persistent itching is expected.
Crusted scabies, sometimes called Norwegian scabies, is different — an enormous mite count, thick scale rather than scattered spots, mostly in people who are elderly, immunosuppressed or unable to feel the itch. It spreads easily and needs specialist care: repeated applications, usually an oral medicine, close follow-up.
What to expect
How things change over time.
Treating
Applied head to toe and left on overnight. Stinging or extra itching for a few hours is common. The mites die within hours, and you will not feel it happen.
Still itching
The rash and itch stay the same or get slightly worse — the immune reaction to dead mites, not live ones.
Second application
The repeat dose, about seven days after the first.
Settling
The itch fades gradually. Most are comfortable by four weeks, occasionally six.
Judge it here
No new burrows and no new spots four weeks after the last application is the sign it worked.
- Night 1
- Days 1 to 7
- Week 1
- Weeks 2 to 4
- After 4 weeks
When you stop
There is nothing to taper and no rebound. Permethrin is a short course that ends after the second application.
Itching afterwards is treated in its own right — a moisturizer, an antihistamine at night, or a mild steroid cream. That treats the immune reaction, not the mites. The itch commonly takes two to four weeks and sometimes up to six to settle.
The other reason it comes back is reinfestation — almost always someone in the household or close circle who was not treated.
What it Pairs with
Permethrin + your routine
| Product or situation | With Permethrin | What to know |
|---|---|---|
| Moisturizer | Can pair | A plain moisturizer after rinsing helps. |
| A hot bath or shower right before applying | Avoid | It opens the skin's blood vessels, increasing absorption and the sting. Cool dry skin is the right surface. |
| Washing your hands during the treatment | Avoid | If you wash them, put the cream back on. Hands are the most commonly missed and reinfested area. |
| Treating only the person who itches | Avoid | The most common reason scabies comes back. |
| Repeating it because you still itch | Avoid | Extra applications irritate the skin and cause a rash of their own, which gets mistaken for more scabies. |
| Strong steroid creams before diagnosis | Avoid | They calm the rash enough to hide the burrows, making scabies much harder to identify. |
| Fumigating the house or spraying furniture | Avoid | The mite does not survive long off a person. Washing bedding and recent clothing is enough. |
| If you are pregnant or breastfeeding | Use care | Permethrin is the usual choice in pregnancy, but ask the doctor managing your pregnancy before you apply it. |
| If you are treating a young baby | Use care | Not approved below two months old, and the areas treated in infants differ. This needs a doctor. |
| If you have eczema or broken skin | Use care | More is absorbed through skin that is not intact, and it stings sharply on raw skin. |
| If you have reacted to chrysanthemums | Use care | Ragweed or an insect repellent counts too. Permethrin allergy is uncommon but reported, so say so first. |
| If you have new spots or burrows | Use care | Four weeks after treatment, that is the finding that needs review, not the itch. |
| If the skin is thickly scaled and crusted | Use care | Rather than scattered and itchy. Crusted scabies carries a very high mite count, spreads easily and usually needs an oral medicine too. |
| If you take an immune-suppressing medicine | Use care | Infestations are heavier, harder to clear and need closer follow-up. |
Getting it and cost
Getting Permethrin.
Cost & access
Generic 5% permethrin cream is inexpensive, widely stocked, and on the World Health Organization list of essential medicines. Cost is rarely the barrier. The branded version costs more for nothing extra.
What affects the cost
Where cost adds up is treating the household. Four or five people on the same night means several tubes at once, and some plans cover only one tube per prescription. Tell the prescriber how many people are being treated so the quantity is written for the household rather than the patient.
Alternatives
Other options to consider.
Oral ivermectin
The usual alternative when a cream is impractical, such as in outbreaks, in crusted scabies, or for someone who cannot apply cream everywhere. Taken as two doses about a week apart. Avoided in pregnancy and in very small children.
Benzyl benzoate lotion
Long-standing evidence and very cheap, used widely outside the United States. It stings considerably more, which is the usual reason permethrin is chosen where both are available.
Sulfur ointment
The oldest option, with weaker formal evidence but a long safety record. It is greasy, smells strongly and needs three nights in a row. It is the fallback in very young infants and sometimes in pregnancy.
Crotamiton
Weaker evidence for killing the mites and lower cure rates. Its useful role is easing the itch rather than clearing the infestation.
Malathion lotion
Effective, and used mainly where permethrin resistance is a local concern. Flammable and strong-smelling.
Questions
Questions you might be asking.
Why do I still itch two weeks later?
The itch is an allergic reaction to mite proteins and droppings left in the skin, not to living mites. It takes two to four weeks, sometimes six, to settle. Not failure.
Does everyone in the house really need treating?
Yes. Someone can carry mites for four to six weeks before they itch, and an untreated contact reinfects everybody else.
Do I need a second application?
Yes, a full one about a week later. Permethrin kills mites reliably and eggs less reliably, so the repeat catches anything that hatched.
Do I have to treat my face and scalp?
Adults and older children treat from the jaw line down. Babies, young children and anyone with a weakened immune system have the scalp, face and ears treated too — mites are found there.
What do I do about bedding and clothes?
Wash anything used in the last three days hot and dry it hot, or seal it in a bag for three days. No need to spray furniture or fumigate.
Can I use it in pregnancy?
Permethrin is the usual choice when scabies has to be treated in pregnancy, but ask the doctor managing your pregnancy first.
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