Elimite (Permethrin 5% Cream): Uses, How to Apply, Side Effects, and FAQs

Night-time itch that keeps you awake, burrows on the wrists or waist, and a rash that won’t quit-scabies is maddening, and it spreads fast at home. The good news: used correctly, Elimite (permethrin 5% cream) usually clears it with two well-timed applications. The bad news: most treatment failures come from small mistakes-missed skin areas, not treating close contacts, or skipping the second dose. I’ll walk you through what it is, how to use it so it works first time, and how to tell if you actually need a second plan.

• TL;DR: Elimite is a permethrin 5% cream for scabies. Apply head-to-toe (jawline down; include face for babies/elderly if lesions there), leave on 8-12 hours, wash off, and repeat in 7 days.
• Treat everyone in the same household and close sexual contacts on the same night. Wash bedding/clothes at 50°C+ or bag 72 hours. Vacuum sofas/carpets.
• Itch can last 2-4 weeks after mites are dead (post-scabetic itch). New burrows or new lesions after 2 weeks suggest treatment failure or reinfestation.
• Common side effects: mild burning, stinging, redness. Safe in pregnancy and breastfeeding per CDC and NICE; minimal absorption.
• UK note: “Elimite” is a US brand name. In the UK, ask for permethrin 5% dermal cream (first-line on NHS). Malathion 0.5% is a second option if permethrin isn’t suitable.

What Elimite is for, when to use it, and who shouldn’t

Elimite is a brand of permethrin 5% dermal cream, a synthetic pyrethroid that paralyses and kills scabies mites and their eggs. It’s the first-line treatment for ordinary (classic) scabies in many guidelines, including the CDC and the UK’s NICE/BNF. When applied to the whole body correctly, cure rates are high-typically above 90%-especially when you repeat it in one week and treat all close contacts at the same time.

Use it if you’ve been diagnosed with scabies, or a clinician has advised presumptive treatment based on exposure and typical symptoms: intense itch (worse at night), thread-like “burrows,” and a rash on wrists, finger webs, elbows, waist, buttocks, nipples, penis, and ankles. In kids, palms, soles, and scalp/face can be involved. If you’re unsure, speak to your GP or pharmacist before treating.

Conditions it treats well:

• Ordinary scabies (most cases in households and dorms)
• Part of combination therapy for crusted scabies (Norwegian scabies), usually coordinated by a specialist service

What it’s not for:

• Head lice: that’s usually 1% permethrin (or newer lice treatments); the 5% scabies cream is not the standard lice option.
• Body lice, pubic lice, bed bug bites, ringworm, eczema flares-these need different approaches.

Who can use it:

• Adults and children from 2 months of age. Under 2 months, see a clinician-sulfur-based treatments are often used.
• Pregnant and breastfeeding people: widely considered safe (CDC, NICE CKS Scabies 2023; BNF). If applying to the breast, wash off before feeds and reapply after.
• Elderly, immunocompromised: safe, but include face/scalp if lesions are present, and seek clinician input early if thick, crusted plaques develop.

Allergy cautions:

• True permethrin allergy is rare. If you’ve had reactions to synthetic pyrethroids or excipients (e.g., formaldehyde releasers in some creams), discuss alternatives like malathion or sulfur with your clinician.

Household strategy matters as much as the cream. Scabies is an intimate-contact problem, not a hygiene problem. If you treat only yourself, mites often bounce right back from untreated partners, kids, or flatmates.

Effectiveness notes: A Cochrane review and multiple trials show permethrin 5% is at least as effective as two-dose ivermectin for ordinary scabies, and more effective than a single dose ivermectin. Cure rates drop if you miss areas, don’t repeat, or skip contact treatment.

How to apply Elimite step by step (and avoid the usual mistakes)

Getting this right is the whole game. Scabies lives where your application misses: between the fingers, under nails, around the waistline, groin, and on the soles. Here’s the routine I give friends and family, and yes-this is exactly how I’d do it at home in a Cambridge terrace when one kid brings mites back from school.

1. Pick the night. Everyone in the household and close sexual contacts treats on the same evening. Arrange childcare or help if you need an extra set of hands.
2. Trim nails short and remove rings/watches. Lightly cool shower if you’re hot and sweaty, then dry completely. Don’t apply to wet skin.
3. Apply from jawline down. Use enough cream to cover every bit of skin, not just the rash. Think: neck (if advised), shoulders, arms, hands, between fingers, under nails (use a soft brush or cotton bud), armpits, chest, belly, back, buttocks, genitals, thighs, legs, ankles, feet, between toes, and soles.
4. Include these easy-to-miss spots: around nails, inside belly button, under breasts, behind knees, along the sides of the fingers and heels, under rings/smartwatches, and in skin folds.
5. Babies/elderly/immunocompromised: If lesions are on the face or scalp, apply there too (avoid eyes, nostrils, and mouth). Dab a thin amount behind ears and along hairline if advised by your clinician.
6. Leave on for 8-12 hours. Sleep in it. If hands are washed or you use the loo, reapply to hands and genitals.
7. Morning rinse. Shower off and put on fresh clothes. Change bedding and towels. Wash worn clothes and bedding at 50°C+ or tumble dry hot. Items that can’t be washed: bag for 72 hours (mites off the body die in 2-3 days).
8. Repeat in 7 days. Same routine. This catches newly hatched mites.

Cleaning checklist (quick, not manic):

• Wash sheets, pillowcases, pajamas, underwear, and recent towels on hot cycle (50°C+).
• Bag non-washables 72 hours. Or tumble dry on hot if fabric allows.
• Vacuum mattresses, sofas, carpets. No need for sprays or “bombs.”

Pro tips:

• Quantity matters. Most adults need about a full 30 g tube per application. If you used a teaspoon for your whole body, you didn’t treat.
• Itch after treatment doesn’t mean failure. Post-scabetic itch can last 2-4 weeks. Use emollients, mild topical steroids on inflamed patches, and antihistamines at night if needed. Check with your GP for eczema-friendly options.
• Rash can look angrier for a few days. That can be a normal inflammatory response to dead mites (and to the cream itself).
• Work/school: in the UK, you can often return the day after the first overnight treatment (UKHSA guidance). Let the school or workplace know if requested.

Classic mistakes to avoid:

• Not treating partners or kids the same night.
• Missing the soles of the feet, finger webs, under nails, and genitals.
• Not reapplying on hands after washing during the 8-12 hour period.
• Skipping the second application at day 7.
• Using too little cream to cover the whole body.

Small-space scenario (how to pull it off in a flat): Do a family assembly line after dinner. Adults apply to kids, then themselves. Lay out old towels, wear an old T-shirt and shorts while the cream dries, and keep hand cream nearby to reapply to hands after bathroom breaks.

Safety, side effects, and what to do if it’s not working

Permethrin has been around for decades. It’s low-absorption when used on skin, which is why it’s a go-to in pregnancy and breastfeeding according to the CDC, BNF, and NICE. Still, you’ll want to know what’s normal and what’s not.

Common, usually mild:

• Itching, mild burning or stinging, redness, or tingling where you applied it.
• Dryness or a temporary eczema flare in people with sensitive skin. Emollients help once you’ve washed the cream off.

Less common, seek advice:

• Hives, swelling, or blistering beyond the usual rash-could be an allergic reaction or infection from scratching.
• Yellow crusts, spreading redness, fever-may be secondary bacterial infection. See your GP; you may need antibiotics.

Pregnancy and breastfeeding:

• Widely recommended as first-line. Systemic absorption is minimal. If using on the breast, wash off before feeds and reapply after.

Drug interactions: None meaningful on skin. Don’t layer with other topical insecticides. If you use strong keratolytics (like salicylic acid) for psoriasis or thick skin, ask your clinician-these can alter absorption.

Storage and practicals:

• Store at room temperature. Don’t freeze. Keep away from eyes and mucous membranes.
• Check expiry dates. Don’t “save a bit for later”-scabies needs a complete, coordinated hit.

Is it working? Use this quick decision guide:

• Days 0-7: Itch may feel the same or worse. That’s common. No new burrows is a good sign.
• Day 7: Do the second application even if you feel better.
• Days 14-21: If you still develop new burrows/lesions in new places, or new people in the house are getting symptoms after treating, consider reinfestation or resistance and speak to your GP.

When treatment fails or scabies is severe:

• Reinfestation is the top cause: someone close didn’t treat, or a flatmate treated late. Repeat coordinated treatment and environmental measures.
• Application error: under-dosing or missing areas. Re-treat with careful coverage.
• Crusted scabies: thick, warty, or scaly plaques with heavy mite loads. Needs urgent specialist care, infection control, repeated permethrin applications, and oral ivermectin in a set schedule.
• Persistent post-scabetic itch: can linger 2-8 weeks. Treat as eczema-emollients, short course of mild to moderate topical steroids, menthol creams, or sedating antihistamines at night. Your GP can tailor this.

Evidence and guidance you can trust:

• CDC “Scabies: Resources for Health Professionals,” last reviewed 2023: permethrin 5% as first-line; treat contacts; repeat in 7 days.
• NICE Clinical Knowledge Summary (Scabies), updated 2023: same core advice; safe in pregnancy/breastfeeding; keratolytics for crusted cases.
• BNF (2024 edition): permethrin 5% dermal cream first-line in the UK; malathion alternative; infants under 2 months need specialist advice.
• FDA label for permethrin 5%: application and safety profile.
• UKHSA guidance for schools/workplaces: return after first adequate treatment.

Mini‑FAQ

• Is Elimite available over the counter in the UK? Pharmacies can supply permethrin 5% dermal cream without a prescription after a short consultation. The brand name “Elimite” is US; in the UK you’ll usually see generic permethrin or brands like Lyclear Dermal Cream 5%.
• Do I put it on my face? For adults with ordinary scabies, usually jawline down. If you have lesions on the face or you’re treating infants/elderly, include the face/scalp carefully, avoiding eyes, nostrils, and mouth.
• How fast am I no longer contagious? After the first proper overnight application and rinse, you’re typically considered non-infectious for ordinary scabies. Still complete the second application at day 7.
• Can I use it if I have eczema? Yes, but it may sting on active eczema. Apply permethrin first as directed; after washing it off, use emollients and any prescribed steroid creams to calm the skin.
• What if I washed my hands during the 8-12 hours? Reapply to hands (and genitals after bathroom use). Missing these spots is a common reason for failure.
• Can pets give me scabies? Human scabies is human-specific. Pets can’t keep human scabies going. They can cause temporary itch from other mites, but it doesn’t persist.
• What about oral ivermectin? For ordinary scabies, permethrin is usually first-line. Oral ivermectin is used when topical treatment isn’t feasible, in outbreaks, or for crusted scabies-typically arranged by a clinician.

Next steps and troubleshooting

• If you forgot the day‑7 dose: Do it as soon as you remember, then count a fresh 7 days if your clinician advises a third application.
• If a housemate didn’t treat: Repeat coordinated treatment for the whole group. Scabies loves staggered efforts.
• If you have thick crusts or a weakened immune system: Call your GP or dermatology service promptly. You may need frequent applications, keratolytics, and oral ivermectin with infection control measures.
• If the itch is brutal after treatment: Cool compresses, oatmeal baths, emollients, and a short course of a mild to moderate topical steroid can help. Night-time antihistamines may improve sleep. Ask your GP for the best match for your skin.
• If you’re pregnant/breastfeeding and anxious about using it: Permethrin is the recommended first choice. A quick chat with your midwife, GP, or pharmacist can settle any concerns and confirm the plan.
• If you keep getting it back from a care home or dorm: Raise it with management or public health. Coordinated treatment across the setting (residents and staff) is key, sometimes with oral ivermectin.
• If you suspect it’s not scabies: See your GP or a dermatologist. Eczema, allergic dermatitis, folliculitis, bed bug bites, and other conditions can mimic scabies. A skin scraping or dermatoscopy can help confirm.

Bottom line: scabies yields to good process. Cover every inch, treat everyone together, repeat at day 7, and don’t panic if itch lingers. If new burrows appear two weeks after the second treatment-or if anyone in the house keeps erupting-loop in your GP for the next step. That’s how you close the door on mites and get your sleep back.