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Permethrin 5% Cream (Lyclear): How to Use It for Scabies - A UK Pharmacist's Guide
Permethrin cream, also known as Lyclear dermal cream, is a highly effective, first-line topical treatment used to treat scabies infestations.
It works by targeting and destroying the microscopic mites and their eggs directly at the source. Read on to discover how the cream is used, and what to expect during treatment.
What is permethrin cream, and what is it used for?
Permethrin belongs to a class of medications called pyrethroids, which work by disrupting the nervous system of insects and mites. In doing so, it paralyses and kills them, without harming the human host.
For this reason, it is clinically indicated for use in scabies - a highly contagious skin condition caused by the microscopic sarcoptes scabiei mite. These mites burrow into the skin to live and lay eggs.
Symptoms of scabies include intense itching, especially at night and raised spots. Some patients also find silvery-grey burrow lines. The rash usually spreads across the whole body except the head and neck and often attacks skin between fingers, wrists, under the arms and around the waist and groin.
Permethrin cannot just be applied to the spots. It must be applied to the entire body from the neck down, paying attention to the spaces between the fingers/toes, under the nails and the groin.
Can you buy permethrin (Lyclear) over the counter in the UK?
Yes, both permethrin and the branded Lyclear can be bought over-the-counter.
You do not need a prescription though as they are classed as pharmacy-only (P) medicines, you will need to answer a few questions to ensure the treatment is safe and suitable for you.
How do you apply permethrin 5% cream for scabies?
The most important factor to treatment success is applying the cream correctly. The cream needs to be applied once a week for 2 doses.
On a general note:
Rub it into cool, dry skin
Apply over your entire body from the neck down,
Leave it on for 8 to 12 hours (usually overnight)
Then wash it off completely.
The treatment must be repeated exactly 7 days later, to kill any newly hatched mites. Follow the below step by step guide for exact instructions:
Prepare the skin
The skin must be cool and dry. Do not apply immediately after a bath/shower as this causes excessive absorption. For effectiveness, the cream should stay on the skin surface where mites live.
Apply to the entire body
Rub the cream thoroughly to the whole body from the neck down. Make sure the cream gets into every skin fold, paying extra attention to:
The spaces between your fingers and toes
Under the nails
In armpits
Belly button
Genital areas
For babies, the elderly, or those with weakened immune systems, you must also apply the cream to the neck, face, scalp, and ears (avoiding the eyes and mouth).
The cream disappears once it has been rubbed in. There is no need to continue applying until you see the cream.
Allow the cream to dry
It takes a few minutes for the cream to dry, following which you can get dressed. Ensure to wear loose-fitting clothing as tight outfits may rub the cream away.
Wait for 12-hours
The cream should be left on for 8-12 hours (overnight).
If you wash your hands during this treatment window, it must be reapplied.
Wash off completely
After 12 hours, take a shower or bath to completely wash the cream off. Do not leave the cream on for longer periods as this may cause skin irritation.
How many times should you use permethrin?
Permethrin cream is used for a total of two times, applied 7 days apart.
The initial application will kill living mites but doesn’t always destroy unhatched eggs: which can lead to a reinfestation. The second dose catches the newly hatched mites before they reproduce.
Who needs to be treated?
Scabies is highly contagious. The mites can live on the skin for up to 6 weeks without a person showing symptoms. For this reason, everyone in the immediate household and close physical contacts must be treated at the same time.
If even one person does not treat, they can potentially pass on mites to someone else who has successfully been treated, leading to a reinfestation.
How long do you leave it on, and can you wear clothes / wash?
Permethrin cream needs to be left on for at least 8 hours (usually overnight), before being washed off.
If the cream is washed off, for example through handwashing, it must be reapplied.
You can dress after applying the cream, but only once it dries - this only takes a few minutes. It is recommended to wear loose-fitting clothing as tight clothing may rub off the cream.
How long does permethrin (Lyclear) take to work?
Permethrin works within 8 to 12 hours, i.e. the first application, to kill the living mites. However, symptoms will take 2 to 4 weeks to actually disappear. Understanding this timeline is important so that you don’t assume treatment hasn’t worked.
Timeframe | What is happening | What you feel |
|---|---|---|
8-12 hours | Mites living on the skin are killed. | Itching may get worse. As mites die, they release proteins which trigger symptoms. |
Any unhatched eggs that survived the first dose of treatment begin to emerge. | The itching remains intense. The mandatory second dose is applied to kill the new hatchlings. | |
All mites are dead. The body starts naturally shedding the skin to clear burrows. | Persistent itching. Your body is still reacting to dead mites and eggs left behind under the skin. | |
Weeks 3-4 | The skin entirely regenerates, pushing old burrow debris out. | Itching slowly fades away. |
What should you expect after treatment?
The most common symptom following two applications of treatment is persistent itching at night. This is also known as post-scabetic itch and is not a sign of ongoing infestation.
Permethrin kills living mites, but their bodies, eggs and waste remain in the outer layer of the skin. The immune system continues to react to this foreign material until the skin naturally sheds, ridding itself of the contaminants.
It can take up to 4 weeks for the itching to slowly subside, following treatment. This can be managed using emollients or antihistamines to help with sleep.
What are the side effects?
Permethrin cream is generally safe as it isn’t well absorbed. However, as it’s a strong chemical formulated to kill mites, it can cause skin irritation.
The most common side effects are:
Skin irritation and redness - temporary and fades after cream is washed off.
Paresthesia - temporary numbness or pins and needles on the skin.
Itching - expected as mites die, leaving behind proteins which the skin reacts to.
Dry or flaky skin - the cream can dry out the skin, mimicking mild eczema.
Rarely, the treatment may cause allergic reactions due to an allergy to chrysanthemums or benzyl alcohol. In the event of a severe allergic reaction, you should seek immediate medical attention.
Who should be careful?
Whilst the cream is licensed to be used for anyone over 2 months old, certain patient groups must take extra care:
Patients with skin conditions
Permethrin can irritate the skin. For those individuals with active eczema or psoriasis, applying permethrin can trigger a flare-up or intense burning.
A healthcare professional can advise appropriately. You may be advised to treat the underlying inflammation first, or to use an alternative scabies treatment.
Pregnant and breastfeeding mothers
The amount of permethrin absorbed systemically is very low. Furthermore, data from animal studies does not show any evidence of harm to the foetus. However, as animal studies do not always predict the human response, treatment must only be initiated in pregnancy if the benefit outweighs the risk.
Similarly for breastfeeding mothers, there is limited evidence to quantify how much permethrin is excreted in breast milk. However, patients may be advised to withhold treatment during nursing or discontinue nursing.
Infants under 2 years old
Children over 2 months but under 2 years can safely use permethrin but this must be initiated by a GP. This group of patients cannot be treated with over-the-counter permethrin.
As infants usually put their hands in their mouths, mittens are recommended to prevent accidental ingestion.
Infants under 2 months old should not use permethrin due to a lack of safety data.
Cat owners
Whilst safe for humans and dogs, permethrin is highly toxic to cats. Cats cannot break down the ingredients which can lead to significant health issues and even death.
Patients with cats are advised to keep pets completely away from infected individuals until the treatment has been completely washed off.
What if permethrin doesn't clear the scabies?
If permethrin hasn’t managed to clear the scabies infestation, there are alternative treatments available. Before considering these however, it’s important to establish if treatment has actually failed, or if you are experiencing normal side effects.
Post-scabies itch - the Primary Care Dermatology Society (PCDS) confirms itching can persist for up to 4 weeks after all mites are dead. This is not a sign the treatment has failed, unless new spots appear or you still experience persistent itching beyond 4 weeks.
True treatment failure is when:
New, visible burrow lines or fluid filled spots appear a week after your second dose, or
Intense itching has not improved at all after 4 weeks.
If permethrin fails, do not keep reapplying it as this will cause skin irritation. You should speak to your GP or dermatologist for oral anti-parasitic tablets or other specialist treatments.
Frequently Asked Questions
Everything you need to know
Can I watch TV or sleep after applying permethrin cream?+−
Yes, you can resume normal low-intensity activities. Once you massage the cream into your skin, it will disappear and dry within a few minutes. You should wear loose-fitting clothing rather than tight clothes which may rub the cream off.
Avoid activities where you are likely to sweat a lot as this may remove the cream off.
What happens if I accidentally wash my hands whilst I have applied the cream?+−
If you wash your hands, particularly with soap at any point whilst having the cream on, you must immediately re-apply the cream.
Hands are a hotspot for scabies mites, especially between the fingers. Leaving them unprotected for the remainder of the treatment length is a common cause of treatment failure.
Why does my skin itch more right after applying permethrin cream?+−
An increase in itching is very common and is a sign the treatment is working.
As the cream kills the mites, the dying parasites release proteins which the immune system reacts to, causing an itch. This is usually temporary.
Do I need to wash all my clothes and bedding at 60℃?+−
Yes, clothing, towels and bedding must be washed at a minimum of 60℃ - the high heat helps to kill any mites or eggs that have fallen onto fabrics.
Any items which cannot be washed at high temperatures must be sealed in a plastic bag for at least 3 days. The scabies mites cannot survive for longer than 3 days without human contact.
Can I use Lyclear cream if I am pregnant or breastfeeding?+−
You should consult your doctor before using Lyclear if pregnant/breastfeeding. Whilst it is unlikely to be absorbed, there is not enough data to justify using it unless the benefits outweigh potential risks.
How safe is the cream around household pets?+−
Permethrin cream is safe for humans and dogs but is highly toxic and fatal to cats. Cats do not have the ability to metabolise the cream's ingredients - extra care should be taken to ensure cats do not come into contact with the cream.
