Dermatology
Scabies and lice treatments
Topical antiparasitics (insecticides) — Topical insecticides for scabies and head lice — permethrin is first-line for scabies, with oral ivermectin reserved for difficult or crusted cases.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
Quick answer
What is Scabies and lice treatments?
These are treatments for skin infestations: scabies, caused by a tiny burrowing mite, and head lice. Most are applied to the skin or scalp as creams, lotions or liquids.
- How it works: These medicines kill the mites or lice and, in scabies, their eggs by acting on the parasite's nervous system, paralysing and killing it.
- In practice: In practice, scabies is treated by applying permethrin to the whole body — not just the obvious rash — including often-missed areas such as under the nails, between the fingers and toes, and the genital area, then repeating after the recommended interval.
What it is
These are treatments for skin infestations: scabies, caused by a tiny burrowing mite, and head lice. Most are applied to the skin or scalp as creams, lotions or liquids. Permethrin cream is the usual first-line treatment for scabies, applied to the whole body and repeated after an interval, while head lice are treated with topical insecticides or physical methods. For difficult or crusted (severe) scabies, an oral medicine, ivermectin, may be used under medical guidance.
How it works
These medicines kill the mites or lice and, in scabies, their eggs by acting on the parasite's nervous system, paralysing and killing it. Because scabies mites spread easily through close skin contact, treatment of the affected person alone is not enough — close contacts are treated at the same time even if they have no symptoms yet. A second application after an interval helps catch mites that hatch from eggs the first treatment may have missed.
In practice
In practice, scabies is treated by applying permethrin to the whole body — not just the obvious rash — including often-missed areas such as under the nails, between the fingers and toes, and the genital area, then repeating after the recommended interval. All household members and recent close or sexual contacts are treated simultaneously, and bedding, towels and clothing are hot-washed or sealed away to break the cycle. A crucial counselling point is that the itch can persist for weeks after the mites are dead, driven by an allergic reaction rather than ongoing infestation, so persistent itching is not automatically treatment failure. Crusted scabies and outbreaks may need oral ivermectin and specialist input.
Examples
Practical use
How to take it & use it well
- Apply the cream over the whole body from the jaw and neck downwards, including between the fingers and toes, under the nails, the genitals, soles of the feet and skin folds, as missed areas let the mites survive.
- If you wash your hands during the treatment time, reapply the cream to them afterwards, and leave it on for the full period stated before washing off.
- A second application about a week later is usually advised to catch any mites that hatch after the first treatment.
- Treat all close contacts and household members at the same time, even if they have no itching yet, because the rash can take weeks to appear.
- On the day of treatment, hot-wash or seal away bedding, towels and recently worn clothing to remove mites.
- In babies, older people, and those with weakened immune systems, include the head and neck as well, as mites can affect these areas in these groups.
Common uses
- Scabies (permethrin first-line)
- Head lice
- Crusted (severe) scabies — often with oral ivermectin
- Treatment of close contacts to prevent re-infestation
Monitoring
- Resolution of the rash and burrows over the following weeks
- Whether contacts were treated and re-infestation avoided
- Review crusted or non-responding cases for specialist treatment
Weighing it up
Advantages & disadvantages
Advantages
- Applied correctly, the cream is very effective at clearing the mites that cause scabies.
- Treatment is straightforward and done at home, usually with one repeat application.
- It allows the whole household to be treated together to stop the infestation spreading.
- Most of the medicine acts on the skin with little absorbed into the body.
- It is suitable for a wide range of ages when used as directed.
Disadvantages
- The itch can carry on for several weeks after successful treatment, which people often mistake for failure.
- Missing areas such as under the nails or between the toes can leave mites behind and allow it to return.
- Applying it correctly over the whole body is fiddly and may need help.
- It can cause skin irritation or a temporary worsening of itch.
- It only works if all close contacts are treated at the same time, which can be hard to arrange.
Key safety principles
What to watch for
- Apply scabies treatment to the whole body, not just the visible rash, and treat close contacts at the same time.
- A repeat application after an interval is usually needed to clear newly hatched mites.
- Persistent itch after treatment is common and is not the same as treatment failure.
- Oral ivermectin for crusted or difficult scabies is used on specialist advice.
- Take care in young children, pregnancy and breastfeeding — check which product is suitable.
Key interactions
What to avoid or check alongside
- Re-treating repeatedly because the itch persists is unnecessary and can irritate the skin, since lingering itch is normal after cure.
- Other creams or moisturisers applied at the same time can dilute the treatment, so follow the timing instructions carefully.
- Failing to treat all contacts together allows the mites to pass back and forth and defeats the treatment.
- Washing hands without reapplying the cream leaves untreated areas where mites can survive.
Patient & carer advice
- Apply to clean, cool, dry skin over the whole body and leave on for the recommended time before washing off
- Treat everyone in the household and close contacts on the same day
- Wash bedding, towels and clothing at a hot temperature or seal them away for a few days
- Expect itching to continue for some weeks after successful treatment — it does not mean it has failed
Answers
Scabies and lice treatments: frequently asked questions
Why am I still itchy after scabies treatment?
Itching often continues for several weeks after the mites are killed because your skin is still reacting to them. This is normal and does not mean the treatment failed, so do not keep re-treating without advice.
Do I need to treat my family if they have no symptoms?
Yes, all close contacts and household members should be treated on the same day, even without symptoms. The rash can take weeks to appear, so untreated people can pass the mites back to you.
Where exactly do I put the cream?
Cover the whole body from the jaw down, including between fingers and toes, under the nails, the genitals and skin folds. In babies and older or immunosuppressed people, include the head and neck too.
Do I need to wash all my bedding and clothes?
Yes, hot-wash bedding, towels and recently worn clothing on the day of treatment, or seal items away for several days. This helps remove any mites and prevents reinfestation.
How many times do I apply the treatment?
A second application about a week after the first is usually recommended to catch mites that hatch later. Follow the specific instructions on your product or from your pharmacist.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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