Permethrin is available over the counter in the United States, but only at the 1% concentration used for head lice. The stronger 5% cream used for scabies requires a prescription. Permethrin also comes as an OTC spray for treating clothing and gear against ticks and mosquitoes. So the answer depends on what you need it for.
What’s Available Without a Prescription
Permethrin 1% lotion or cream rinse is sold over the counter at most pharmacies and big-box stores. It’s marketed under the brand name Nix and as generic store-brand versions. This concentration is FDA-approved for treating head lice in adults and children two months of age and older. You can pick it up in the hair care or lice treatment aisle without seeing a doctor first.
Permethrin sprays designed for clothing, shoes, and outdoor gear are also sold over the counter. These products, available at sporting goods stores and online, are meant to repel ticks and mosquitoes. They’re applied to fabric, not directly to skin. The EPA has reviewed these products and found that permethrin-treated clothing poses no significant short- or long-term hazard to the people wearing it, partly because permethrin absorbs very poorly through skin.
What Requires a Prescription
Permethrin 5% cream, the standard treatment for scabies, is prescription-only. The CDC is clear on this point: no over-the-counter products are approved to treat human scabies in the U.S. You’ll need a doctor or other provider to write a prescription for the 5% strength.
Without insurance, 5% permethrin cream can be expensive at retail, sometimes close to $100 for a single 60-gram tube. Discount programs and coupons can bring the price down significantly, often to the $15 to $30 range. Generic versions work identically to the brand-name product (Elimite) and cost less.
How to Use OTC Permethrin for Lice
The 1% cream rinse goes on after shampooing. You apply it to damp, towel-dried hair, work it through to the scalp, and leave it on for 10 minutes before rinsing. The American Academy of Pediatrics recommends rinsing over a sink rather than in the shower or bath, since this limits how much skin the product touches. Use warm water instead of hot, which can increase absorption.
Permethrin kills live lice on contact but does not kill unhatched eggs. It does continue killing newly hatched lice for several days after treatment, which is a useful residual effect. Still, a second treatment on day nine is often necessary to catch any lice that hatched after the first application, before they’re old enough to lay new eggs themselves. If you skip the second treatment, you may end up back where you started.
Using Permethrin Spray on Clothing
OTC permethrin sprays are designed to be applied to clothing, tents, backpacks, and other gear before spending time outdoors. The protection only covers the skin underneath the treated fabric, so you’ll still need a separate skin-applied repellent (like DEET or picaridin) on exposed areas like hands, neck, and face. Permethrin should not be sprayed on underwear, and it should never be applied directly to skin as a repellent.
Factory-treated clothing, where permethrin is bonded into the fabric during manufacturing, is another option. These items are sold at outdoor retailers and maintain their repellent effect through multiple washes, while spray-on treatments need to be reapplied periodically.
Side Effects to Know About
OTC permethrin is generally well tolerated, but some people experience mild itching, redness, numbness, or tingling at the application site. These reactions are common and typically fade on their own. A rash can also develop in some cases.
More serious reactions are rare but worth recognizing. Difficulty breathing, worsening skin irritation that doesn’t improve, or pus-filled sores at the treatment site all warrant prompt medical attention. People with known allergies to pyrethrins (the natural compounds permethrin is derived from) or ragweed should be cautious, since cross-reactivity can occur.
Both the OTC 1% and prescription 5% formulations are approved for children as young as two months old, making permethrin one of the safer options for very young children who need lice or scabies treatment.