Sometimes topical treatments are not effective or are too difficult to apply. In that case, oral ivermectin tablets can be used. Ivermectin is not FDA-approved for scabies but is used off-label in certain circumstances.

Typically, ivermectin is given as a single weight-based dose once and then repeated 7 days later. For crusted scabies, ivermectin is given as a three-, five-, or seven-dose treatment in combination with topical treatment.

Sometimes, scratching from the intense itching caused by scabies can lead to broken skin and bacterial skin infections. These infections need to be treated with antibiotics. Notify your provider if you develop redness, swelling, warmth, pain, pus, or other signs of a skin infection.

There are not currently any over-the-counter medications to treat scabies. Medication to treat scabies is available by prescription only.

Looking for a prescription? Schedule a same-day appointment with a Sesame provider. If your prescription is approved, it can be sent to a local pharmacy for same-day pickup.

Permethrin is available over the counter as a 1% lotion to treat head lice, but it will not work against scabies.

Permethrin is a topical treatment used to treat certain parasitic infections. It treats head lice, pubic lice, and scabies.

Scabies is a skin condition caused by the Sarcoptes scabiei mite. These mites burrow into the upper layer of skin and lay eggs. This causes a pimple-like rash and intense itching that gets worse at night. Symptoms commonly occur in skin folds, such as armpits, elbows, knees, genital areas, and between the fingers.

It is spread by prolonged skin-to-skin contact with someone infected. It may also be spread by sharing clothing, towels, or bedding.

Over-the-counter permethrin treats head lice in adults and children 2 months of age and older.

Head lice are parasitic insects that infest the human scalp and feed on blood by biting the scalp. They are a common problem, especially among school-aged children. They are usually transmitted through close head-to-head contact or sharing personal items like combs, brushes, hats, or headphones.

Head lice are tiny, wingless insects with a brownish-gray color and are about the size of a sesame seed. When they bite the scalp to feed, they inject saliva that can cause itching, which is often the primary symptom of a head lice infestation. Redness or small red bumps on the scalp and neck are frequently present, along with itching, which can be quite intense. In some cases, individuals with head lice may also develop sores from excessive scratching. Detection of head lice typically involves finding live lice or their eggs (nits) attached to the hair shafts, usually near the scalp.

While leaving permethrin on longer than recommended isn't likely to cause toxicity, it can increase the risk of bothersome side effects. You may be more likely to experience redness, itching, burning, and skin irritation.

It is best to rinse the permethrin cream off in the shower or bath after 8–14 hours. If you are using permethrin lotion for head lice, it should be rinsed off after 10 minutes.

When starting a new medication, it is important to tell your provider about all medications you take, including prescription and over-the-counter medications, vitamins, minerals, supplements, and herbal medications.

Also, tell your provider about any allergies, skin conditions, or whether you are pregnant or breastfeeding.

Permethrin is a synthetic chemical modeled after compounds found in chrysanthemum flowers. Chrysanthemum is similar to ragweed. People with a ragweed allergy may have a reaction to permethrin. This can result in wheezing, trouble breathing, or an exacerbation of asthma. Seek immediate help if you have trouble breathing, wheezing, or signs of an allergic reaction.

Permethrin is also highly toxic to cats. Avoid contact with your cat until the cream has dried. Also, prevent the cat from coming in contact with any contaminated clothing, bedding, or towels. Seek veterinary care if your cat experiences tremors, seizures, or drooling.

When 1% permethrin is used to treat head lice, it is about 97% effective after one treatment. Over-the-counter permethrin kills live lice but does not kill the unhatched eggs. Retreatment may be necessary if live lice are seen after 7 days.

For people with scabies, one treatment is generally enough. If live mites are seen after 7–14 days, retreatment may be necessary. It is normal to still have itching after treatment, and it does not mean that you still have active mites. The dead mites and their waste cause your immune system to react, causing itching.

Topical permethrin is supplied as a 1% lotion for head lice or 5% cream for scabies. The form of permethrin you should use will vary depending on the parasitic infection you are treating.

For head lice, apply topical permethrin to washed hair. Leave the solution on for 10 minutes, rinse, and then comb out nits and eggs. You may need to do this again after 7–10 days.

For scabies, apply the solution from the neck down. Leave it on overnight and rinse it off in the morning. Another application may be needed after 7–10 days, but one is usually enough.

Follow your doctor’s orders regarding the application of this drug. Thoroughly wash the affected area and let the skin dry before applying topical permethrin.

Permethrin is intended for topical use only. Do not ingest permethrin or apply it under the skin.

Do not discontinue or increase your topical permethrin dosage without consulting your doctor first. Take the medication exactly as prescribed, and inform your doctor if you begin to experience any side effects while taking the drug.