The standard scabies treatment. Most failures come from how it was applied, not from the cream itself.
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Permethrin is an insecticide applied to the skin. It paralyses and kills the scabies mite and its eggs by acting on the mite's nerve cells.
It is first-line treatment for scabies in the UK, as a 5% cream applied over the whole body.
Very little passes through the skin, which is why it is considered safe in children over 2 months and, on specialist advice, in pregnancy.
Most treatment failures are application failures. The cream has to reach every part of the skin surface, and the places people miss are the places the mites live.
A second full application one week later is standard, to catch mites hatched from eggs that survived.
All household members and any sexual contacts from the previous two months must be treated on the same day, symptoms or not. Scabies is passed on well before it itches.
The itching that continues for two to four weeks after successful treatment is not a side effect and not failure. It is an allergic reaction to dead mites and their debris in the skin, and it settles on its own. This causes an enormous amount of unnecessary re-treatment.
No significant drug interactions — almost nothing is absorbed.
No monitoring bloods are required.
What does need review is whether it worked, and that judgement is made at four to six weeks, not at one week — because the itch outlasts the mite by a considerable margin.
Yes, and scabies is a condition where a video consultation works reasonably well — the burrows, the distribution and the history are usually recognisable, particularly with good photographs of the finger webs and wrists.
Permethrin 5% cream is also available from pharmacies without a prescription, so for a confident diagnosis that is often the quicker route, and we will say so.
What a consultation genuinely adds:
Where we will send you elsewhere: crusted scabies, extensive secondary infection, or an outbreak in a care home, which is a public health matter.
A prescription is never guaranteed. This page is information, not an offer to supply.
Permethrin 5% cream is inexpensive and available over the counter. One 30g tube treats one average adult once — so a household of four needing two applications each needs considerably more than people expect, and running out mid-application is a common cause of failure.
Buy enough for everyone, for both applications, before you start.
NHS prescriptions are free in Wales.
It is two applications a week apart, then you stop.
Itching commonly continues for two to four weeks after successful treatment, because your immune system is still reacting to dead mite material. Treat it with emollients, an antihistamine at night, and mild topical steroid if needed — not with more permethrin.
Suspect failure only if there are new burrows or new spots appearing more than two weeks after the second application. Before switching, check:
Because your immune system is still reacting to dead mites, not because the treatment failed. The itch commonly lasts two to four weeks. Re-treating at this point is the commonest mistake, and it just irritates the skin further.
Yes — jawline to soles, including between the toes and under the nails. The mites concentrate in finger webs, wrists and genitals, and a missed area is a reservoir that reinfects everything else.
Yes, on the same day, including anyone without symptoms — scabies is passed on for weeks before it itches. Sexual contacts from the last two months too.
No. The mite dies within two to three days away from skin. Hot-wash bedding, towels and clothing used in the last three days; bag anything unwashable for 72 hours. Professional cleaning is a waste of money.
Permethrin is generally the preferred treatment where scabies needs treating in pregnancy, but take advice first rather than starting on your own.
No — that is old advice and it is wrong. Hot skin increases absorption into the bloodstream and reduces how much stays in the skin where the mites are. Apply to cool, dry skin.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
September 8, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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