Benzyl benzoate (BB) is a topical medication used worldwide to treat infestations of the Sarcoptes scabiei mite, which causes scabies. This chemical compound functions as an acaricide, meaning it is specifically formulated to kill mites and their eggs. The medication achieves this by being absorbed into the mites, where it disrupts their nervous system, leading to their destruction. Successful treatment depends entirely on proper preparation and application, as insufficient coverage is the main reason for treatment failure. This guide provides detailed instructions to ensure the safe and effective use of this topical agent.
Preparing the Skin and Solution
Prior to beginning treatment, it is important to prepare both the skin and the benzyl benzoate solution correctly. Start by taking a warm bath or shower to cleanse the skin of any lotions, oils, or creams that might interfere with the medication’s absorption. Thoroughly dry the entire body with a clean towel afterward, as the skin must be completely dry and cool before application. Avoid applying the emulsion immediately after a hot bath, as this can increase irritation and the risk of systemic absorption.
Benzyl benzoate is frequently sold as a 25% concentration and often requires dilution, particularly for children, to minimize the risk of skin irritation. For older children, you should mix the 25% lotion with an equal quantity of water to achieve a 12.5% concentration. For infants, a greater dilution is necessary, typically mixing one part of the 25% lotion with three parts of water. Always shake the bottle well before diluting or applying to ensure the emulsion is properly mixed.
Step-by-Step Application Instructions
The application process requires meticulous attention to detail, as every part of the body below the neck must be covered. Begin by applying the diluted or undiluted emulsion over the entire body, starting from the neck and working downward to the soles of the feet. The lotion must be rubbed in well until it is absorbed into the skin, not just resting on the surface.
Pay special attention to areas where mites commonly hide, such as all skin folds, the armpits, the groin, the belly button, and the buttocks. It is also essential to ensure coverage between the fingers and toes. For the fingernails and toenails, a thin layer of the medication should be applied under the nail tips using a small brush after the nails have been trimmed.
The head and face are typically spared from treatment in adults. However, in cases of severe infestation, treatment failure, or for at-risk groups like the elderly and infants, it may be necessary to include the scalp, face, and outer ears. Always carefully avoid the eyes and mucous membranes. For infants, their hands should be covered with mittens immediately after application to prevent them from accidentally ingesting the medication or rubbing it into their eyes.
The treatment must remain on the skin for a full 24 hours. If hands are washed during this period, the medication must be immediately reapplied to the washed skin surface. After the 24-hour period, wash the body thoroughly with warm water and soap, and then dry with a clean towel. A second, identical application is usually required five to seven days later to kill any mites that hatched from eggs that survived the first treatment.
Managing Potential Side Effects
Some users may experience common, temporary side effects, primarily related to skin irritation. These reactions can include a burning sensation, mild redness, or a feeling of itchiness, which may be more pronounced immediately after application. These effects often diminish once the medication is washed off, but if the irritation is severe or persists, the product should be washed off immediately, and medical advice should be sought.
Avoid using benzyl benzoate on broken, inflamed, or secondarily infected skin, as this increases the risk of greater systemic absorption. The medication must be kept away from the eyes and other mucous membranes, such as the inside of the nose and mouth, because it is extremely irritating to these sensitive tissues. Should accidental contact occur, flush the affected area immediately and thoroughly with plenty of water. Though rare, systemic side effects like jerking movements or sudden loss of consciousness can occur with excessive absorption, and any such serious reaction requires immediate medical attention.
Cleaning the Environment and Follow-Up
Environmental decontamination is necessary to prevent re-infestation after topical treatment. All clothing, bedding, and towels used by the infested person within the 72 hours before treatment must be cleaned. These items should be laundered in hot water, with a temperature of at least 122°F (50°C), and then dried in a hot dryer. The high heat effectively kills any mites and their eggs that have fallen off the skin.
For items that cannot be washed, such as shoes, stuffed animals, or delicate clothing, eliminate mites by isolating the objects. Place these non-washable items in a sealed plastic bag for a minimum of 72 hours. This duration is sufficient for the mites to die naturally, as they cannot survive for long away from a human host.
It is highly recommended that all close physical contacts of the infested person be treated simultaneously, even if they show no symptoms, to break the cycle of transmission. Following successful treatment, a rash and itching can continue for up to four weeks as the body reacts to the dead mites remaining in the skin. If new burrows or rashes appear several weeks after the second treatment, this may indicate treatment failure and requires consultation with a healthcare professional.