Permethrin 5% Cream Application Guidelines for Scabies Treatment

Application Instructions

The Centers for Disease Control and Prevention recommends applying permethrin 5% cream to all areas of the body from the neck down to the soles of the feet, leaving it on for 8-14 hours, then washing it off thoroughly with soap and water 1, 2
The American Academy of Pediatrics and other guidelines suggest trimming fingernails short to reduce injury from scratching, and ensuring skin is completely dry before application, although specific guidance on skin dryness comes from 1, 2
Massage the cream thoroughly into the skin, covering all areas from the neck down, including often-missed areas such as between fingers and toes, under fingernails and toenails, wrists, elbows, armpits, genitals, and buttocks 3, 1
Apply to the entire body surface, do not skip any areas from neck down 1, 2

Infants, young children, and elderly patients should have their hairline, neck, temple, and forehead treated 3, 4
Itching may persist for up to 2 weeks after successful treatment, which is not a sign of treatment failure, but rather an allergic reaction to dead mites 1, 2, 5

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

Machine wash and dry all bedding, clothing, and towels using the hot cycle on the same day as treatment, or dry clean these items, or seal them in plastic bags and remove from body contact for at least 72 hours 1, 2, 5
Fumigation of the home is not necessary 1, 4, 2
All household members and sexual partners from the past month must be treated simultaneously, even if they have no symptoms 1, 4, 2, 5

Permethrin is safe for pregnant and breastfeeding women, as well as infants and young children, including treatment of their scalp 1, 2, 5
Permethrin has minimal toxicity and is safer than alternative treatments like lindane 1, 2