How Many Times Can You Use Permethrin Cream For Scabies?
Permethrin cream for scabies is typically used one or two times to effectively eliminate the infestation, with a week or two between applications, depending on the severity of the infestation and doctor’s instructions. This article explains the correct application, potential need for repeat treatments, and crucial follow-up care.
Understanding Scabies and Permethrin
Scabies is a skin infestation caused by tiny mites called Sarcoptes scabiei. These mites burrow into the upper layer of the skin, where they live and lay eggs. This causes intense itching, especially at night, and a pimple-like skin rash.
Permethrin cream is a topical medication that kills scabies mites and their eggs. It’s a first-line treatment for scabies due to its effectiveness and relatively low risk of side effects when used correctly. It works by disrupting the nerve cell membranes of the mites, paralyzing and killing them.
The Standard Permethrin Treatment Protocol
The usual protocol for using permethrin cream involves:
- First Application: A single application of the cream applied to the entire body from the neck down to the toes.
- Application Time: Leaving the cream on for 8-14 hours (typically overnight).
- Washing Off: Thoroughly washing off the cream in the morning.
- Second Application (If Necessary): A second application a week or two later if symptoms persist or the infestation appears unresolved.
The reason for the potential second application is to kill any mites that may have hatched from eggs that were not killed by the initial treatment. Permethrin is most effective against adult mites, not the eggs themselves.
When is a Second Application Necessary?
Determining whether you need a second application of permethrin cream is crucial for successful treatment. Several factors influence this decision:
- Persistent Symptoms: If itching and rash continue unabated after the first week, a second application is generally recommended. Do not assume treatment failure based on residual itching alone, as this can occur even after the mites are dead.
- New Burrows: The appearance of new burrows or lesions suggests that live mites are still present.
- Doctor’s Recommendation: Always follow your doctor’s advice regarding the need for a second treatment. They can assess your condition and determine the best course of action.
Potential Reasons for Treatment Failure
Even with proper application, permethrin treatment can occasionally fail. This can be due to:
- Resistance: In some rare cases, scabies mites may develop resistance to permethrin.
- Re-infestation: Exposure to infected individuals or contaminated environments after treatment can lead to re-infestation.
- Incomplete Application: Failure to apply the cream to all affected areas, including skin folds, genitals, and under fingernails.
- Incorrect Application Time: Not leaving the cream on for the prescribed duration.
Addressing Persistent Itching After Treatment
It’s important to understand that itching can persist for several weeks even after the mites are dead. This is due to an allergic reaction to the dead mites and their waste products. Strategies for managing post-scabies itching include:
- Antihistamines: Oral antihistamines can help relieve itching.
- Topical Corticosteroids: Low-potency topical corticosteroids can reduce inflammation and itching.
- Emollients: Moisturizing creams can help soothe and hydrate irritated skin.
- Avoiding Irritants: Avoid harsh soaps, detergents, and hot water, which can exacerbate itching.
Preventative Measures
Preventing the spread of scabies is essential to control outbreaks. Important preventative measures include:
- Treating Close Contacts: Treat all household members and close contacts simultaneously, even if they don’t have symptoms.
- Washing Bedding and Clothing: Wash all bedding, clothing, and towels used in the 3 days before treatment in hot water and dry them on high heat. Items that cannot be washed can be dry-cleaned or sealed in a plastic bag for at least 72 hours.
- Avoiding Sharing: Avoid sharing clothing, bedding, and towels with others.
- Thorough Cleaning: Clean and vacuum the home to remove any shed mites.
How Many Times Can You Use Permethrin Cream For Scabies? Table Summary
| Factor | Description |
|---|---|
| Standard Treatment | One application of permethrin cream, followed by a potential second application 1-2 weeks later. |
| Second Application | Necessary if symptoms persist or new burrows appear after the initial treatment. |
| Treatment Failure | Resistance, re-infestation, incomplete application, or incorrect application time can cause treatment failure. |
| Post-Treatment Itching | Itching can persist for several weeks after successful treatment due to an allergic reaction. |
| Preventative Measures | Treat close contacts, wash bedding and clothing, and avoid sharing to prevent re-infestation. |
Frequently Asked Questions (FAQs)
What happens if I only use permethrin cream once and it doesn’t work?
If a single application of permethrin cream fails to eradicate the scabies infestation, it’s likely that some mites or eggs survived. As mentioned, the second application is to kill any mites that hatched after the initial treatment. Contact your doctor to discuss whether a second application is needed or if alternative treatments should be considered.
Can I use permethrin cream more than two times?
Using permethrin cream more than two times without medical supervision is generally not recommended. Overuse can lead to skin irritation and potentially contribute to the development of permethrin resistance in mites. Always consult your doctor if two treatments fail to resolve the scabies infestation.
How long does it take for permethrin cream to start working?
Permethrin cream starts working almost immediately by paralyzing the scabies mites. However, it may take several days to a week to notice a significant reduction in itching and rash. Remember that residual itching can persist even after the mites are dead.
What are the side effects of permethrin cream?
Common side effects of permethrin cream include mild burning, stinging, itching, or redness at the application site. These side effects are usually temporary and resolve on their own. In rare cases, more serious side effects, such as allergic reactions, can occur.
Should I see a doctor if permethrin cream doesn’t work?
Yes, it is important to see a doctor if permethrin cream doesn’t work after two applications. Your doctor can rule out other skin conditions, assess for permethrin resistance, and recommend alternative treatments, such as oral ivermectin or topical crotamiton.
Can I buy permethrin cream over the counter?
Permethrin cream is typically available by prescription in most countries, including the United States. This is because scabies is a contagious condition that requires proper diagnosis and treatment to prevent its spread.
How do I know if I’m still contagious after using permethrin cream?
You are considered no longer contagious after completing the recommended treatment course with permethrin cream. This typically involves one or two applications, as directed by your doctor. However, it’s still essential to follow preventative measures, such as washing bedding and clothing, to prevent re-infestation.
Is it possible to get scabies again after being treated?
Yes, it is possible to get scabies again after being treated, especially if you come into contact with someone who has scabies or live in an environment where scabies is prevalent. Practicing good hygiene and avoiding close contact with infected individuals can help prevent re-infestation.
Does permethrin cream kill scabies eggs?
Permethrin is more effective against adult mites than scabies eggs. This is why a second application is often recommended to kill any mites that hatch from eggs after the initial treatment.
What should I do if my baby has scabies?
If your baby has scabies, it is crucial to consult a pediatrician immediately. Infants and young children require special treatment considerations, and permethrin cream may not be suitable for all infants. Your doctor can recommend the safest and most effective treatment option for your baby.
Can I use permethrin cream if I’m pregnant or breastfeeding?
If you are pregnant or breastfeeding, it’s important to discuss the risks and benefits of using permethrin cream with your doctor. While permethrin is generally considered safe during pregnancy and breastfeeding, your doctor can provide personalized guidance based on your individual circumstances.
How long should I wait before showering after applying permethrin cream?
You should wait at least 8-14 hours before showering or washing off the permethrin cream. This allows the medication sufficient time to penetrate the skin and kill the scabies mites and eggs.