Elimite

Elimite (permethrin) is commonly used for the following conditions caused by tiny insects: Head lice, Scabies (pestilent scabies mite). Permethrin kills tiny insects, such as head lice and mites, by disrupting their nerves and muscles. Similarly to all naturally occurring pyrethrins, Elimite permeates the nervous system of parasites leading to the disruption of sodium cation inflow throughout cell membrane ion channels. Subsequently, the insect dies.

Product dosage: 30 gm
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Elimite (permethrin) 5% cream is a topical prescription medication specifically formulated for the treatment of scabies infestations. As a synthetic pyrethroid, it represents a first-line therapeutic option, offering potent scabicidal and ovicidal activity against Sarcoptes scabiei var. hominis. Its mechanism of action involves disrupting the sodium channel current in the parasite’s nerve cells, leading to paralysis and death. This guide provides a comprehensive, evidence-based overview for healthcare professionals and informed patients, detailing its appropriate use, pharmacological profile, and essential safety information to ensure optimal therapeutic outcomes.

Features

• Active Ingredient: Permethrin 5% w/w.
• Formulation: Topical cream in a white, petrolatum base.
• Pharmacological Class: Synthetic pyrethroid scabicide.
• Mechanism of Action: Acts on nerve cell membranes to disrupt sodium channel kinetics, delaying polarization and causing paralysis of parasites.
• Spectrum of Activity: Effective against the scabies mite (Sarcoptes scabiei) and its eggs (ovicidal).
• Presentation: Typically supplied in 60-gram tubes, sufficient for a single adult application.

Benefits

• Provides high cure rates, often exceeding 95% with correct application, effectively breaking the transmission cycle of scabies.
• Offers ovicidal activity, eliminating both live mites and their eggs, which is critical for preventing recurrence.
• Generally well-tolerated with a favorable safety profile compared to older scabicides like lindane.
• Requires only a single application in most cases, though a second application may be recommended after one week.
• Is not systemically absorbed in significant amounts, minimizing risk of systemic adverse effects.
• Recommended as a first-line treatment by major dermatology and public health guidelines globally.

Common use

Elimite is indicated for the single-application treatment of scabies infestation. Scabies is a contagious skin condition characterized by intense pruritus (especially nocturnal), papules, and burrows, commonly found in the interdigital webs, wrists, axillae, genital area, and waistline. It is spread through prolonged skin-to-skin contact. Diagnosis is typically clinical, often confirmed by microscopic identification of mites, eggs, or fecal pellets from skin scrapings. Treatment of all close contacts simultaneously is crucial to prevent reinfestation, even if they are asymptomatic.

Dosage and direction

For topical use only. Not for oral, ophthalmic, or intravaginal use.

1. Preparation: The patient should shower or bathe and dry thoroughly before application.
2. Application: Apply a thin layer of cream to the entire body from the chin down, paying particular attention to all skin folds, creases, the interdigital webs, umbilicus, and under the fingernails and toenails (after trimming). In infants, young children, and the elderly, application should also include the scalp, temple, forehead, neck, and ears.
3. Duration: Leave the cream on for 8 to 14 hours (typically overnight).
4. Removal: After the recommended time, thoroughly wash off the cream by showering or bathing.
5. Re-treatment: A second application one week after the initial dose is sometimes recommended by physicians, particularly in cases of crusted (Norwegian) scabies or if new burrows or rashes appear.

Precautions

• For external use only. If contact with eyes occurs, rinse immediately with copious amounts of water.
• May cause transient burning, stinging, or tingling upon application.
• Pruritus, erythema, and edema may persist for several weeks after successful eradication of mites due to an ongoing allergic response to remaining mite parts; this does not indicate treatment failure.
• Launder all clothing, bedding, and towels used by the patient in the 48 hours prior to treatment in hot water and dry in a hot dryer, or seal in a plastic bag for at least 72 hours to kill any mites.
• Inform your physician if you are pregnant, planning to become pregnant, or are breastfeeding.

Contraindications

Elimite is contraindicated in patients with a known history of hypersensitivity to permethrin, any other synthetic pyrethroid or pyrethrin, or to any component of the formulation (e.g., petroleum base).

Possible side effect

Most adverse reactions are localised and mild to moderate in severity. The most common side effects include:

• Pruritus (itching)
• Mild burning or stinging sensation
• Erythema (redness)
• Rash
• Numbness or tingling
• Mild edema (swelling)

These effects are typically transient. Severe reactions, such as contact dermatitis or widespread allergic rash, are rare. If a severe skin reaction or signs of a systemic allergic reaction (e.g., wheezing, difficulty breathing, swelling of the lips/tongue/throat) occur, discontinue use immediately and seek emergency medical attention.

Drug interaction

Formal drug interaction studies have not been conducted with topical permethrin. Due to negligible systemic absorption (less than 2% of the applied dose), the potential for pharmacokinetic interactions with systemically administered drugs is considered very low. However, concomitant use with other topical medications, especially those that may increase skin permeability (e.g., topical corticosteroids, abrasives), could theoretically increase absorption and should be discussed with a physician.

Missed dose

As Elimite is typically administered as a single dose, the concept of a “missed dose” does not directly apply. If the application is washed off prematurely (e.g., before 8 hours), consult a physician. They may advise reapplication, but this should not be done without professional guidance due to the risk of increased irritation.

Overdose

Overdose from topical application is unlikely due to minimal systemic absorption. However, excessive application could lead to intensified local skin reactions, including severe erythema, burning, or rash. Accidental ingestion is a medical emergency and may produce neurological symptoms such as headache, dizziness, nausea, vomiting, and in severe cases, seizures or paresthesia. If ingested, seek immediate medical attention and contact a poison control center.

Storage

• Store at controlled room temperature, between 20°C to 25°C (68°F to 77°F).
• Keep the tube tightly closed.
• Keep out of reach of children and pets.
• Do not freeze.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

• “As a dermatologist, permethrin 5% cream remains my gold standard for first-line scabies treatment. Its efficacy and safety profile are well-established in countless clinical trials and decades of use. Patient education on proper application is key to success.” – Dr. A. Reynolds, MD, Dermatology
• “After my child contracted scabies from school, the pediatrician prescribed Elimite. The itching was intense for a few days after treatment, which we were warned about. One application was all it took. We followed the cleaning instructions meticulously and had no recurrence.” – Sarah T.
• “I’ve used this for patients in a long-term care facility outbreak. When applied correctly by staff to all residents and contacts, it is incredibly effective at halting transmission. It’s far safer than the older alternatives we used to use.” – Jane P., RN
• “The cream is quite thick and can feel greasy, but it’s a small price to pay for relief. The peace of mind knowing it kills the eggs was the main selling point for me. Just be prepared for the post-scabies itch to linger.” – Mark D.