Editing Scabies (section)

=== Permethrin ===
[[Permethrin]], a [[pyrethroid]] insecticide, is the most effective treatment for scabies,<ref name=Cochrane07>{{cite journal | vauthors = Strong M, Johnstone P | title = Interventions for treating scabies | journal = The Cochrane Database of Systematic Reviews | volume = 2007 | issue = 3 | pages = CD000320 | date = July 2007 | pmid = 17636630 | pmc = 6532717 | doi = 10.1002/14651858.CD000320.pub2 | veditors = Strong M }}</ref> and remains the treatment of choice.<ref name="Clinic2009" /><ref name=IDPH/> It is applied from the neck down, usually before sleep, and left on for about 8 to 14 hours, then washed off in the morning.<ref name=Clinic2009 /> Care should be taken to coat the entire skin surface, not just symptomatic areas; any patch of skin left untreated can provide a "safe haven" for one or more mites to survive. One application is normally sufficient, as permethrin kills eggs, hatchlings, and adult mites, though many physicians recommend a second application three to seven days later as a precaution.  Crusted scabies may require multiple applications or supplemental treatment with oral ivermectin (below).<ref name=Clinic2009 /><ref name=IDPH>{{cite web |url=http://www.idph.state.il.us/public/hb/hbscab.htm |title=Scabies |access-date=2010-10-07 |publisher=Illinois Department of Public Health |date=January 2008 |url-status=live |archive-url=https://web.archive.org/web/20101205092146/http://www.idph.state.il.us/public/hb/hbscab.htm |archive-date=2010-12-05 }}</ref><ref name=Pillbook>{{cite book |title=The Pill Book |pages=[https://archive.org/details/pillbook14thedit00haro/page/867 867–69] |isbn=978-0-553-59340-2 |year=2010 |publisher=Bantam Books |url-access=registration |url=https://archive.org/details/pillbook14thedit00haro/page/867 }}</ref> Permethrin may cause slight irritation of the skin that is usually tolerable.<ref name=Ray2009 /> In recent years, concern is growing about permethrin-resistant scabies,<ref>{{cite journal | vauthors = Mounsey KE, Pasay CJ, Arlian LG, Morgan MS, Holt DC, Currie BJ, Walton SF, McCarthy JS | title = Increased transcription of Glutathione S-transferases in acaricide exposed scabies mites | journal = Parasites & Vectors | volume = 3 | pages = 43 | date = May 2010 | pmid = 20482766 | pmc = 2890653 | doi = 10.1186/1756-3305-3-43 | doi-access = free }}</ref><ref>{{cite web | url=https://academic.oup.com/bjd/article/190/4/486/7478651 | doi=10.1093/bjd/ljad501 | title=Comparison of topical permethrin 5% vs. Benzyl benzoate 25% treatment in scabies: A double-blinded randomized controlled trial | date=2024 | journal=British Journal of Dermatology | volume=190 | issue=4 | pages=486–491 | vauthors = Meyersburg D, Hoellwerth M, Brandlmaier M, Handisurya A, Kaiser A, Prodinger C, Bauer JW }}</ref> although some researchers refer to this as pseudo-resistance.<ref>{{cite journal | vauthors = Yürekli A | title = Is there a really resistance to scabies treatment with permethrin? In vitro killing activity of permethrin on Sarcoptes scabiei from patients with resistant scabies | journal = Dermatologic Therapy | volume = 35 | issue = 3 | pages = e15260 | date = March 2022 | pmid = 34897912 | doi = 10.1111/dth.15260 | doi-access = free }}</ref>