Permethrin

STRENGTH IS PART OF THE DOSE: the UK SPC used here is Permethrin 5% w/w Cream (the scabies/crab lice strength). The openFDA record in the same bundle is a 1% permethrin creme rinse for head lice ('good sense lice killing creme rinse', L. Perrigo) — a different strength, product and indication; its instructions are NOT reproduced here and must not be applied to this entry. APPLICATION FOR SCABIES: carefully apply a thin layer of cream; adults, adolescents and children over 2 years should apply uniformly to the WHOLE BODY including the neck, palms of the hands and soles of the feet; the head and face can be spared unless scabies efflorescences are present there; treat the areas between fingers and toes (including under finger- and toe-nails), wrists, elbows, armpits, external genitalia and buttocks especially carefully. Apply to clean, dry, cool skin — if a warm bath has been taken, allow the skin to cool first. It is a vanishing cream: rubbed gently into the skin it disappears, so there is no need to keep applying until it remains visible. Wash the whole body thoroughly 8 to 12 hours after treatment. Approximately 90% of individuals are cured with a single application; if necessary a second application may be given not less than 7 days after the initial application, if there are no signs of the original lesions healing or if new lesions are present. ELDERLY (over 65 years): use the cream in the same way as adults, BUT the face, ears and scalp should also be treated, taking care to avoid applying cream to skin around the eyes. CRAB LICE — adults over 18 years: apply up to 30 g of the 5% cream to cover the pubic region, peri-anal area, inner thighs down to the knees and any hair growing up from the pubic area to the chest/stomach; leave on the skin for 24 hours, then wash the treated areas thoroughly. Check any facial hair (beards, moustaches) and eyelashes for live lice and eggs; cream may be applied to facial hair carefully avoiding the eyes, but must NOT be applied to the eyelashes (it can cause moderate eye irritation) — remove lice or eggs from eyelashes carefully with tweezers. PAEDIATRIC (numbers deliberately withheld here): the SPC gives reduced cream quantities by age band for children aged 6 to 12 years and 2 months to 5 years, repeated 7 to 14 days after the first treatment; safety and efficacy in children under 2 months have not been established (no data), and only limited experience is available in children aged 2 to 23 months, in whom treatment must be given only under close medical supervision. Children under 2 years should have the cream applied to the whole body including palms, soles, neck, face, ears and scalp, sparing skin around the mouth (the cream could be licked off) and the eyes; children should be kept from licking cream off their hands and may need gloves. Verify all paediatric dosing against a children's formulary. SAFETY: avoid contact with the eyes, mucous membranes and open wounds; nursing staff who routinely apply the cream may wish to wear gloves. The cream's paraffin excipients can reduce the reliability of latex products (condoms, diaphragms) and make fabric that has been in contact with the product burn more easily — instruct patients not to smoke or go near naked flames.