When a rash or itching turns out to be scabies or a stubborn lice infestation, the first question is: "Which product will actually work without turning the skin into a battlefield?" The market is crowded with creams, lotions, and oral tablets, each promising a quick fix. This guide cuts through the hype by comparing Elimite a 5% permethrin cream approved for scabies and head lice against the most common alternatives. By the end you’ll know which option fits your budget, health profile, and urgency.
Elimite contains permethrin, a synthetic pyrethroid that attacks the nervous system of mites and lice. Within minutes it disrupts sodium channels, leading to paralysis and death of the parasite. The cream is applied once to the entire body, left for 8-14hours (usually overnight), then washed off. Clinical trials show a 95‑99% cure rate for scabies after a single application and a 92‑98% success rate for head lice after a single head‑to‑toe treatment.
Key attributes of Elimite:
Below are the most frequently prescribed or over‑the‑counter (OTC) rivals. Each entry includes a brief definition, core attributes, and typical use cases.
Benzyl benzoate an oil‑based lotion (25%‑25%) used for scabies and lice works by suffocating the parasites. It’s cheap but often causes burning and stinging, especially on sensitive skin.
Ivermectin an oral antiparasitic available in 3mg tablets disrupts nerve signaling in mites and lice. A single dose (200µg/kg) can clear scabies; for lice, a repeat dose after 7days is common.
Crotamiton a 10% cream (Eurax) that acts as a mild antipruritic and scabicide needs two applications 24hours apart, and relief of itching can be slower.
Sulfur ointment a 5%-10% mineral oil‑based preparation used for infants and pregnant women works by a keratolytic effect, requiring nightly application for 3‑5days.
Malathion a 0.5% lotion primarily marketed for head lice provides a rapid kill but can be neurotoxic if misused; it’s not recommended for scabies.
Lindane an organochlorine neurotoxin historically used for scabies and lice has been largely withdrawn in many countries due to severe neuro‑side effects.
| Product | Efficacy (Scabies) | Efficacy (Lice) | Typical Regimen | Side‑Effect Profile | Pregnancy Safety | Cost (US) |
|---|---|---|---|---|---|---|
| Elimite (permethrin 5%) | 95‑99% after 1application | 92‑98% after 1application | Apply full‑body, leave 8‑14h, wash | Mild itching, transient redness | Category B - safe when used correctly | $12‑$18 per tube |
| Benzyl benzoate (25%) | 80‑90% after 2applications | 70‑85% after 2applications | Apply, leave 24h, repeat 24h later | Burning, stinging, allergic dermatitis | Not recommended in pregnancy | $5‑$9 per bottle |
| Ivermectin (oral) | 90‑95% after single dose | 85‑90% after two doses (7d apart) | Single oral tablet 200µg/kg | Rare nausea, headache | Category C - avoid unless benefits outweigh risks | $20‑$30 per tablet |
| Crotamiton (10% cream) | 70‑80% after 2applications | 65‑75% after 2applications | Apply, leave 8h, repeat next day | Mild itching, occasional rash | Category B - considered safe | $8‑$12 per tube |
| Sulfur ointment (5%‑10%) | 60‑70% after nightly use 3‑5d | Not typically used for lice | Apply nightly, wash next morning | Strong odor, mild irritation | Category A - safest for pregnancy & infants | $4‑$7 per tube |
| Malathion (0.5% lotion) | Not indicated for scabies | 90‑95% after single application | Apply to dry hair, leave 10min, wash | Potential neurotoxicity, scalp irritation | Contraindicated in pregnancy | $10‑$15 per bottle |
| Lindane (1% cream) | 85‑90% (historical data) | 80‑85% (historical data) | Apply once, wash after 8h | Severe neurotoxicity, skin reactions | Category X - avoid | Discontinued in US, $30‑$40 where available |
Scabies in adults or older children: Elimite remains the gold standard because of its rapid kill rate and low irritation. If cost is a barrier, benzyl benzoate works, but expect a second application and more skin discomfort.
Infants under 2months: Permethrin isn’t licensed for that age group in many regions. Sulfur ointment is the safest, though you’ll need nightly applications for a few days.
Pregnant or breastfeeding mothers: Both permethrin (Category B) and sulfur (Category A) are considered safe, but many clinicians prefer sulfur to avoid any theoretical risk.
Severe, crusted (Norwegian) scabies: A single topical may not be enough. Combining oral ivermectin with a topical permethrin regimen yields the highest cure rates.
Head lice in school‑age children: Elimite and malathion give the fastest results. However, malathion requires precise timing and can smell strong. Permethrin is less irritating and is easier to apply at home.
Budget‑focused households: Benzyl benzoate or crotamiton are the cheapest OTC choices, but plan for two applications and watch for skin irritation.
Elimite is approved for children older than 2months. For newborns, doctors usually recommend sulfur ointment because it has a long safety record for that age group.
Most schools allow a child to return 24hours after the first treatment, provided the head has been washed and no live lice are seen. A second check‑up after 7days is advisable.
Ivermectin falls under Category C, meaning it should only be used if the potential benefit outweighs the risk. Most clinicians prefer topical permethrin or sulfur ointment for pregnant patients.
The oil‑based formulation can disrupt the skin’s natural barrier, leading to irritation. Applying a moisturizer after the required contact time can lessen the sting, but the sensation is still common.
In Australia, Elimite is available over the counter for both scabies and head lice, but pharmacists may ask about age and pregnancy status before handing it out.
Ira Andani Agustianingrum
Sounds like you’ve got a solid tool here, folks. If you’re juggling a tight budget, start with the cheaper benzyl benzoate or crotamiton and monitor for any irritation. Remember to treat every household member at the same time – scabies loves a good group hug.
James Higdon
It is ethically indefensible to ignore the established safety profiles when selecting a treatment for vulnerable populations.