Permethrin for scabies

Permethrin is a treatment for scabies. Find out how to apply it safely and possible side effects. Permethrin is also called A-Scabies lotion and Lyderm cream.

On this page, you can find the following information:

Key points

  • Permethrin is the treatment of choice in New Zealand for scabies because it is very effective in killing the scabies mite. Scabies won’t go away without treatment.
  • Scabies is highly contagious so everyone in the house must be treated at the same time, even if they are not itchy.
  • It is important to apply permethrin properly all over the body and not just to the itchy areas. See below: How do I apply permethrin?
  • Repeat this treatment after 7 days because the eggs will not be killed and will hatch after the first treatment.
  • Don’t apply permethrin more than twice without medical advice. Overuse can irritate the skin.

What is permethrin?

Permethrin is a treatment for scabies. Scabies is a very itchy skin rash mostly in the webs of your fingers and toes. The skin rash is caused by an allergic reaction to a tiny insect (called a mite) which burrows under your skin. Permethrin kills the scabies mite and prevents it spreading. Read more about scabies.

Do I need a prescription for permethrin?

In New Zealand, permethrin is available on prescription from your doctor or can be bought from your pharmacy without a prescription. It is available as A-Scabies lotion and Lyderm cream. Both the lotion and cream are effective.  

Although permethrin can be bought from a pharmacy without a prescription, it's important to talk to your healthcare provider if your child is younger than 2 years old.

Also see your doctor for advice before treatment if you:

  • have open wounds or skin infections
  • have crusted scabies (severe infestation)
  • are bed-bound.

How do I apply permethrin?

Apply permethrin when your skin is cool and dry, so if you have just had a bath or shower, wait for a little while to let your skin cool before applying it.

Permethrin must be applied to the whole body

Apply permethrin to every patch of skin over the whole body, from head to toe, including the scalp, face, neck, ears down to the soles of the feet. 

  • Apply to the areas between the fingers and toes, wrists, armpits, belly button, genitals and buttocks.
  • Apply under the finger and toenails – use a nail brush if necessary.
  • Women also need to apply permethrin under the breasts and around the nipples, as the scabies mite can burrow into these areas as well.
  • If it's easier, you can ask someone else to apply the cream or lotion for you to make sure your whole body is covered.
Note:
  • Avoid any broken skin, eg, cuts, grazes or sores, or skin that has an infection.
  • Be careful not to get it in your eyes. If it does get into your eyes, quickly rinse it out with plenty of water.

Leave permethrin on the body for 8 to 12 hours

  • To kill the scabies mite, it is important that the permethrin lotion or cream is left on the body for 8 to 12 hours and not washed off. It's best to apply it just before going to bed and leave it on overnight. Wash it off in the morning and wear clean clothes. 
  • Don't wash your hands after applying the treatment. If you wash part of your body (eg, your hands) within 8 hours of applying permethrin, you will need to re-apply it immediately.

To stop scabies from spreading

To kill the scabies mite and stop it from spreading, wash all clothing, sheets, towels, pillowcases and stuffed toys anyone has used in the past week in hot water. Read more about how scabies is treated. 

How much permethrin do I apply?

For each application, 1 bottle or tube (30 grams) of permethrin is usually enough for an average adult. Larger adults may need 2 bottles/tubes.

Children/tamariki aged 5–12 years may only need half a bottle and younger children 2–5 years, a quarter of a bottle. Ask your doctor about children under 2 years old.

Note: A second application is needed 7 days after. See below: second treatment.

What else do I need to know about permethrin?

  • Second treatment: A second application of permethrin treatment is needed 7 days later because permethrin is not effective against eggs. Applying it for a second time will treat any newly hatched larvae. Don’t apply more than twice without medical advice. Overuse can irritate the skin.
  • Treat everyone: Everyone in the same household/whare must be treated as scabies is contagious and spreads to others through close contact. It's important that everyone is treated at the same time as the infested person – even if they are not itchy. This is because they may be carrying the scabies mite.
  • Itching: Permethrin kills the scabies mite preventing its spread but it doesn't relieve the itching. The itching is caused by an allergic reaction to the scabies mite and can continue for up to 4 weeks after treatment. Ask your doctor or pharmacist about medicines to relieve itching. Read more about the scabies itching. 

Can I use permethrin if I am pregnant or breastfeeding? 

If you are pregnant, talk to your lead maternity carer or doctor for advice. If you are breastfeeding, wash the permethrin from your nipples before you breastfeed, and then re-apply afterwards.

How long do I need to be off school or work?

You or your child can go back to work or school 24 hours after the first treatment with permethrin.

What are the side effects of permethrin? 

Permethrin can cause skin irritation such as burning, stinging or tingling, numbness, redness and swelling. This should settle after a few hours. If it continues to bother you, tell your doctor or pharmacist.

See your doctor if:

  • you are still feeling itchy 6 weeks after finishing the treatment
  • you think the scratched areas have become infected.

Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product.

References

  1. Permethrin New Zealand Formulary
Credits: Sandra Ponen, pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 11 Sep 2022