Permethrin Treatment for Scabies and Lice

Application Instructions

The American Academy of Pediatrics recommends applying 1% permethrin cream rinse to damp, towel-dried hair after shampooing with a non-conditioning shampoo, leaving on for 10 minutes, then rinsing thoroughly with warm water over a sink 1, 2
The American Academy of Family Physicians suggests washing hair with a non-conditioning shampoo and towel drying until damp before applying 1% permethrin cream rinse 1, 3
The American Academy of Pediatrics advises leaving the 1% permethrin cream rinse on for exactly 10 minutes, not longer or shorter, to ensure effective treatment 1, 3, 2
The American Academy of Pediatrics recommends rinsing the 1% permethrin cream rinse over a sink with warm water, not hot water, to minimize absorption 4, 2
The American Academy of Family Physicians recommends repeating the application in 7-10 days to kill newly hatched nymphs, as permethrin has only 70-80% ovicidal activity 1, 3, 2

The American Academy of Pediatrics suggests applying 1% permethrin cream rinse to the scalp, hairline, neck, temple, and forehead in infants and elderly patients, as these areas are more commonly infested in these age groups 4
The American Academy of Pediatrics notes that post-treatment itching is normal and not a sign of treatment failure, and can persist for many days after lice are killed due to inflammatory response 4, 2
The American Academy of Family Physicians recommends retreating only if live lice are seen 7-10 days after treatment, and not based on itching alone 1, 2

The American Academy of Pediatrics recommends washing all clothing, bedding, and linens in hot water and drying on hot cycle on the same day as treatment 2, 5
The American Academy of Pediatrics suggests removing items that cannot be washed from body contact for at least 72 hours, as lice and mites cannot survive off the human body for more than 2-3 days 5
The American Academy of Pediatrics advises washing hair care items, such as combs and brushes, in hot water 2
The American Academy of Pediatrics notes that fumigation of living areas is not necessary 5

The American Academy of Family Physicians warns against using conditioning shampoo before applying permethrin for lice, as it prevents proper adherence 1, 3
The American Academy of Pediatrics advises against rinsing with hot water, as warm water minimizes absorption 4, 2
The American Academy of Pediatrics recommends not retreating based on itching alone, as post-treatment pruritus is an inflammatory response, not treatment failure 4, 2
The American Academy of Pediatrics suggests considering improper application before assuming treatment failure, as most "resistance" is actually due to incorrect use 2
The American Academy of Family Physicians recommends not skipping the second application for head lice, as it is mandatory due to incomplete egg kill 1, 2