Permethrin cream (permethrin cream 5% w/w*) is a generic medication used to treat scabies. It’s also available as the brand-name drugs Acticin and Elimite. Permethrin cream is only available with a prescription from a doctor or licensed healthcare professional.

* w/w refers to weight per weight.

Permethrin lotion (permethrin lotion 1%) is a generic medication that’s used to treat head lice. It’s available as the brand-name drug Nix. You can buy permethrin lotion over the counter (OTC) at most pharmacies or online.

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Scabies

Permethrin cream is approved by the Food and Drug Administration (FDA) to get rid of scabies in adults and children ages 2 months and older. Doctors usually prescribe it as a one-time treatment.

Scabies is a skin condition that’s caused by parasitic mites. You won’t be able to see these mites with the naked eye. These mites can burrow into your skin to lay eggs, causing an itchy skin rash. Symptoms of scabies may include:

a very itchy skin rash
itching that gets worse at night
a rash that looks like tiny bites or bumps under the skin
squiggly-looking lines on the skin

How do you use permethrin cream for scabies?

To use permethrin cream for scabies, you typically will apply the cream all over your body, from the neck down, one time.

You should thoroughly massage the cream into your skin from your head to the soles of your feet. Usually about 30 grams (g) of permethrin cream will be enough to cover the body. You usually will not need to apply permethrin above the neck since scabies don’t usually infest the scalp of adults. Although it is possible that scabies may infest the hairline, neck, temples, and forehead of infants and older adults (ages 65 years and older). In this case, permethrin may be applied to those areas as well.

After 8 to 14 hours, you can remove permethrin cream by washing it off in the shower or bath.

Most people only need to apply permethrin cream one time for scabies. It is common for people to experience worsening skin itching right after using permethrin cream, but if you still notice additional signs of scabies after 14 days, talk with your doctor. They may recommend that you use the cream for an additional time.

Head lice

Permethrin lotion is used to get rid of head lice in adults and children. It may need to be used more than one time.

Head lice are tiny, wingless bugs that can infest your hair and lay eggs on or near your scalp. Head lice infestations are especially common among preschool and elementary school children and their families.

Head lice don’t always cause symptoms, but may include:

an itchy scalp
a crawling sensation on the scalp
sores on the scalp due to scratching

You can treat head lice with both OTC and prescription medications. If an OTC product like permethrin lotion doesn’t work, you may want to get a prescription medication.

How do you use permethrin cream for head lice?

Permethrin lotion will kill head lice, but it doesn’t kill or remove nits. Nits are tiny, oval-shaped, greyish-white lice eggs. They stay attached to your hair with a waterproof glue-like substance that cannot be washed out or blown away. In addition to using permethrin cream to kill head lice, it is also important to remove all nits.

For using permethrin cream follow the three steps below to treat head lice:

Inspect all members of the household for lice and nits
Treat with permethrin lotion:
1. First, wash your hair with shampoo but without conditioner. Rinse with water
2. Starting at the back of your neck and behind your ears, completely saturate all of your hair and scalp with permethrin lotion
3. Leave permethrin lotion on your hair for about 10 minutes, then rinse with warm water
4. Dry your hair with a towel and comb out any tangles
Remove any remaining lice or nits:
- Permethrin lotion often comes with a comb made for removing nits
- Make sure the hair stays slightly damp while removing nits
- Starting at the top of the head, lift a 1 to 2 inch wide strand of hair and get the teeth of the comb as close to the scalp as possible. Comb away from the scalp to the end of the hair in a firm, even motion
- Wipe any nits from the comb as you go

If any live lice are seen seven days after using permethrin lotion, a second treatment with permethrin should be given.

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Summary

Permethrin comes as a cream and as a lotion. Permethrin cream is used to treat scabies, a skin condition accompanied by an itchy rash caused by tiny parasite mites. Permethrin lotion is used to treat head lice. Head lice are tiny, wingless bugs that can infest your hair and lay eggs on or near your scalp.

When using permethrin for scabies or head lice, you will usually only have to complete one round of treatment, although there are some cases where you may have to do a second round.