Scabies & Lice Treatment Recommendation Quiz
Elimite is a 5% permethrin cream licensed for treating scabies and pediculosis (head lice). It works by disrupting the nerve cells of the mite or louse, leading to rapid death. In the first 100words you’ll find a snapshot of how it measures up against the most common rivals.
Quick Takeaways
- Elimite offers >95% cure rates for scabies with a single 8‑hour application.
- Ivermectin (oral) is useful for resistant cases and for whole‑family treatment.
- Benzyl benzoate is cheap but can cause severe skin irritation.
- Malathion works well on resistant lice but has a strong odor.
- Lindane is largely phased out due to neurotoxicity concerns.
Why Compare Treatments?
When you or a family member faces an infestation, the choice isn’t just about price. You need to weigh efficacy, safety in pregnancy, speed of action, and the likelihood of resistance. The right answer often depends on age, skin condition, and past treatment history. Below we break down the top six options, linking each back to the core condition they target.
Core Conditions
Scabies is a contagious skin infestation caused by the mite Sarcoptes scabiei. The mite burrows into the upper skin layer, causing intense itching that worsens at night. Diagnosis typically relies on clinical signs and, occasionally, a skin scrape.
Pediculosis (head lice) involves the ectoparasite Pediculus humanus capitis attaching to hair shafts and feeding on blood. While not a health hazard, the social stigma and itching can be distressing.
Key Players in the Comparison
Beyond Elimite, the market features several alternatives, each with a distinct mechanism:
- Ivermectin is an oral antiparasitic that binds to glutamate‑gated chloride channels, paralyzing mites and lice.
- Benzyl benzoate is a topical oil‑based solution that works as a neurotoxin for mites.
- Malathion is a phosphorothioate insecticide applied as a lotion; it blocks acetylcholinesterase.
- Crotamiton is a dual‑action cream that both soothes itching and kills mites.
- Lindane is an organochlorine that interferes with nerve impulse transmission, now restricted in many countries.
Side‑by‑Side Comparison Table
| Product | Formulation | Typical Dose / Regimen | Efficacy (clinical studies) | Pregnancy Safety | Cost (UK average) |
|---|---|---|---|---|---|
| Elimite | Cream 5% (topical) | Apply thinly, leave 8h, repeat once if needed | 95‑98% cure (scabies), 99% lice eradication | Category B - generally safe, avoid in first trimester | £12‑£16 per tube |
| Ivermectin | Oral tablets 200µg/kg | Single dose, repeat after 7days for scabies; 2‑dose for lice | 88‑92% scabies cure, 85‑90% lice cure | Category C - limited data, avoid in first trimester | £7‑£10 per tablet |
| Benzyl benzoate | Oil solution 10‑25% | Apply nightly for 3days (scabies), 2‑3applications for lice | ≈80% scabies cure, 70‑75% lice cure | Not recommended in pregnancy | £4‑£6 per bottle |
| Malathion | Lotion 0.5% (topical) | Apply to dry hair, leave 8‑12h, repeat in 7days | ≈92% lice cure, not used for scabies | Contra‑indicated in pregnancy | £5‑£8 per 60ml |
| Crotamiton | Cream 10% (topical) | Apply nightly for 5days (scabies); no lice indication | ≈70% scabies cure, strong antipruritic effect | Category C - limited data, caution advised | £9‑£12 per tube |
| Lindane | Cream 1% (topical) | Apply 24h, repeat after 7days | ≈85% scabies cure (historical), neurotoxic risk | Contra‑indicated in pregnancy and children <12y | £8‑£10 per tube (where still available) |
How to Choose the Right Treatment
Think of the decision like a checklist. Tick the boxes that apply to your situation:
- Age & skin sensitivity: Babies under 2months tolerate permethrin poorly; ivermectin is off‑label.
- Pregnancy status: Elimite is the safest topical; oral ivermectin should be avoided early.
- Previous failures: If a single permethrin course didn’t work, consider adding a second agent or switching to oral ivermectin.
- Cost & accessibility: Over‑the‑counter benzyl benzoate is cheap but may need multiple applications.
- Resistance patterns: In regions with high permethrin resistance (e.g., parts of Australia), ivermectin or malathion often succeed.
By matching each criterion to the table above, you can pinpoint the most appropriate option without trial‑and‑error.
Safety Tips & Common Pitfalls
Even the most effective drug can backfire if used incorrectly.
- Application time: Elimite must stay on the skin for the full 8hours. Rushing the wash‑off step drops cure rates by up to 15%.
- Environmental decontamination: Wash bedding and clothing at 60°C after treatment; otherwise re‑infestation is common.
- Pregnancy caution: While Elimite is Category B, always discuss with a GP before starting any scabicide.
- Resistance awareness: Repeated use of the same topical (e.g., benzyl benzoate) can select for resistant mites.
- Allergic reactions: Benzyl benzoate and lindane cause severe dermatitis in 5‑10% of users; patch‑test if unsure.
Related Concepts and Next Steps
Understanding the broader ecosystem helps reinforce treatment success.
- WHO Guidelines: The World Health Organization recommends a single dose of 5% permethrin for uncomplicated scabies and repeated dosing for crusted forms.
- Resistance Monitoring: National health agencies publish annual reports on permethrin resistance rates; keep an eye on them if you treat large groups.
- Adjunctive Care: Antihistamines or topical steroids can control itching while the scabicide works.
- Follow‑up: Re‑examine the patient 2weeks after treatment; persistent burrows may indicate treatment failure.
After reading this, the logical next topics are “How to Perform a Scabies Skin Scrape” and “Managing Crusted Scabies in Immunocompromised Patients.”
Key Takeaway
The Elimite permethrin comparison shows that while Elimite remains the gold standard for most cases, alternatives like ivermectin, benzyl benzoate, malathion, crotamiton and lindane each fill specific niches-whether that’s pregnancy safety, resistance, or cost constraints.
Frequently Asked Questions
Can I use Elimite on children under 2 months?
No. The UK Medicines and Healthcare products Regulatory Agency advises against permethrin creams for infants younger than 2months because their skin barrier is still developing. For that age group, a pediatric‑approved benzyl benzoate schedule is preferred.
Is oral ivermectin safe during pregnancy?
Evidence is limited. Most guidelines place ivermectin in Category C, meaning it should be avoided in the first trimester and used only if the benefits outweigh risks later in pregnancy. Always consult your obstetrician before starting.
Why did my scabies persist after one application of Elimite?
Persistence can stem from incomplete coverage, insufficient contact time, or a resistant mite strain. Re‑apply after 7days, ensure the whole body (including scalp in infants) is treated, and wash all linens at high temperature.
How does malathion compare to permethrin for head lice?
Malathion works well on permethrin‑resistant lice, achieving around 92% cure rates. Its downside is a strong, lingering smell and contraindication in pregnancy. Permethrin remains first‑line for most cases because it’s faster acting and less odorous.
Is lindane still available in the UK?
Lindane has been withdrawn from routine use in the UK due to neurotoxicity risks. It may still be sourced for rare, severe cases under specialist supervision, but most clinicians now avoid it altogether.
Jauregui Goudy September 26, 2025
I used Elimite on my kid last winter when the whole daycare went nuts with scabies-worked like a charm. No fuss, no smell, just slap it on, wait eight hours, and boom-itching gone by morning. I swear by it now. Even my sister, who’s super paranoid about chemicals, let me talk her into trying it after I showed her the pregnancy safety data. She’s now the one pushing it to her mom’s group on Facebook.
Don’t get me wrong, Ivermectin’s great for big families or resistant cases, but if you’re just dealing with one person? Elimite’s the MVP. Cheap, effective, and way less drama than benzyl benzoate-which, btw, feels like someone poured hot vinegar on your skin. No thanks.
Malathion? Smells like a chemistry lab exploded. I’d rather deal with lice than that odor. And lindane? Please. We’re not living in the 90s. If your doctor still prescribes that, run.
Bottom line: Start with Elimite. Save the nuclear options for when it fails. And if you’re pregnant? Talk to your doc, but don’t panic-Category B means it’s not the enemy.
Tom Shepherd September 26, 2025
i used ivermectin after permethrin failed and it worked but my stomach was weird for 2 days. also the pill is tiny and i kept forgetting to take it. why dont they make it a cream too? like why does it have to be oral? i just want to rub something on and be done.
Rhiana Grob September 27, 2025
Thank you for this incredibly clear and well-structured comparison. As a nurse working in pediatrics, I see scabies and lice outbreaks regularly, and the confusion families face is real. Many assume ‘natural remedies’ like tea tree oil or mayonnaise are safe alternatives, but they’re not backed by evidence-and can delay proper treatment.
Elimite remains the gold standard for good reason: predictable efficacy, minimal systemic absorption, and a long safety record. I always recommend it first for children and pregnant patients, unless there’s known resistance. Ivermectin is a valuable second-line tool, especially in institutional outbreaks. But benzyl benzoate? I only suggest it if cost is an absolute barrier-and even then, I give detailed instructions on dilution and patch testing.
Let’s not forget: treatment success isn’t just about the drug. It’s about proper application, laundering bedding, and treating all close contacts simultaneously. A great medication won’t work if the whole household doesn’t follow through.
Frances Melendez September 27, 2025
People still use permethrin? Wow. You’re literally poisoning your skin with neurotoxins and calling it ‘safe.’
Have you even heard of neem oil? Or sulfur ointments? Traditional remedies that have been used for centuries without turning your nervous system into a glitchy smartphone?
And don’t get me started on Ivermectin-why are you letting Big Pharma convince you to swallow pills like some lab rat? The real solution is hygiene, not chemicals. Wash your sheets daily. Sleep alone. Stop touching your face. Simple. Clean. Natural.
And malathion? That’s just chemical warfare on your scalp. What kind of person chooses that over a fine-tooth comb and some patience? You’re not treating lice-you’re surrendering to modern medicine’s obsession with quick fixes.
Jonah Thunderbolt September 28, 2025
Okay, but let’s be real-Elimite is basically the Ferrari of scabies treatments. 🚗💨 95%+ efficacy? Category B safety? No chemical stench? No wonder it’s the #1 prescribed option.
Meanwhile, benzyl benzoate? That’s the 2003 Nokia 3310 of topical antiparasitics-functional, sure, but it gives you a chemical burn and looks like it was manufactured in a garage in 1997. 🤢
Malathion? Smells like a toxic swamp that got into a fight with a chemistry textbook. 🤮
And lindane? Bro. It’s not a treatment-it’s a cautionary tale wrapped in a cream. The FDA didn’t phase it out because they hate fun-they did it because they care about your brain.
Bottom line: If you’re not starting with Elimite, you’re not treating-you’re just… experimenting. And I’m not here for your ‘natural’ experiments. I want results. Not a Reddit post titled ‘I Tried Coconut Oil and Now My Child Has a Rash.’
Rebecca Price September 30, 2025
Thank you for highlighting the importance of context in treatment choice. Too often, people treat this like a one-size-fits-all problem.
For example: A pregnant woman with a mild case? Elimite is ideal. A teenager with resistant lice after three rounds of OTC shampoos? Malathion or Ivermectin. A low-income family with multiple kids? Benzyl benzoate might be the only affordable option-if used correctly.
What’s missing from most discussions is the emotional toll. Scabies isn’t just itchy-it’s isolating. Lice isn’t just annoying-it’s humiliating. The right treatment isn’t just the most effective one-it’s the one the person feels they can actually use without shame or fear.
So yes, data matters. But so does dignity. And compassion. And making sure people don’t feel like they’re failing because they can’t afford the ‘premium’ option.
Also-please, for the love of all that’s holy-stop using lindane. We’re better than this.
shawn monroe October 1, 2025
Let’s cut through the noise: permethrin is a pyrethroid, which targets voltage-gated sodium channels in arthropod nervous systems-highly selective for invertebrates, low mammalian toxicity. That’s why it’s Category B. Benzyl benzoate? It’s a solvent-based neurotoxin with no selectivity-hence the burning, the irritation, the erythema. Malathion? A cholinesterase inhibitor. That’s the same class as nerve agents-just less concentrated. And yes, it’s still used because it works on resistant strains.
But here’s the kicker: resistance to permethrin is rising. We’re seeing >20% failure rates in some regions. That’s why Ivermectin is becoming first-line in outbreaks-oral bioavailability, systemic distribution, kills mites in cryptic sites. No one talks about this because pharma doesn’t profit from off-label use.
Crotamiton? Antipruritic, yes. But efficacy? Barely above placebo in RCTs. Lindane? Still banned in 30+ countries for good reason-neurotoxicity in infants, seizures, even death. Don’t be that person who Googles ‘lindane alternative’ and finds a forum post from 2007.
Bottom line: Elimite is still the baseline. But if you’re in a high-risk group, or it’s failed before? Push for Ivermectin. Don’t settle for ‘good enough.’
Also: wash your bedding at 60°C. And don’t use fabric softener. It reduces efficacy. 🧴🔥