Elimite (Permethrin) vs Alternatives: Which Lice & Scabies Treatment Is Best?

Quick Summary

• Elimite is a prescription 5% permethrin cream, ideal for scabies and resistant lice.
• Over‑the‑counter 1% permethrin (e.g., Nix) works for common head lice but may need a second application.
• Silicone‑based dimethicone (LiceMD) kills lice physically and is safe for all ages.
• Ivermectin lotion offers an oral‑free option for stubborn cases, but costs more.
• Price, age restrictions and side‑effect profiles differ enough to let you pick the right tool.

Choosing the right Elimite alternative can save time, money, and uncomfortable itching.

When you need a fast fix for head lice or scabies, Elimite is a prescription‑only cream containing 5% permethrin, a synthetic pyrethroid that paralyzes insects. It’s approved in the UK under the name Permethrin 5% cream and is often the go‑to for dermatologists. The standard regimen is a single 8‑hour application, then washing off. Clinical trials in 2023 showed a 96% cure rate for scabies and a 92% success rate for head lice after one use.

Nix is an over‑the‑counter 1% permethrin lotion marketed primarily for head lice. It’s sold in pharmacies without prescription and is applied for 10 minutes before washing out. Because the concentration is lower, a second treatment 7‑9 days later is usually recommended to catch newly hatched nits. A 2022 meta‑analysis found an average 85% eradication after two applications.

LiceMD uses dimethicone, a medical‑grade silicone that coats and suffocates lice. Since it works mechanically rather than chemically, resistance is rare. The product comes as a spray that stays on the hair for 10 minutes, then you rinse. Studies from 2021 report a 94% cure rate after a single use, and it’s safe for children as young as 6 months.

Ivermectin lotion 0.5% is a prescription‑only topical product that interferes with nerve signaling in lice and scabies mites. It’s applied for 8‑10 hours and then washed off. Compared with permethrin, ivermectin shows similar efficacy but shines in cases where insects have developed pyrethroid resistance. The downside is a higher price tag-about £30 per pack in 2025.

Benzyl benzoate is a classic oil‑based scabicide often sold as a 25% solution for home use. It requires a soaking pre‑treatment, followed by a 24‑hour application before washing. While effective (≈90% cure), it can cause skin irritation and is not ideal for infants.

Pros & Cons at a Glance

• Elimite: Highest strength, prescription ensures proper use; higher cost.
• Nix: Easy to buy, cheap, but may need repeat treatment.
• LiceMD: No chemical resistance, safe for babies; spray can be messy.
• Ivermectin: Works on resistant strains; pricey and prescription‑only.
• Benzyl benzoate: Inexpensive, long‑standing scabicide; can irritate skin.

How to Choose the Right Product

1. Identify the problem. If you’re dealing with scabies, you need a 5% cream or a strong scabicide; for head lice, 1% permethrin or dimethicone usually suffices.
2. Check age restrictions. Babies under 6months can’t use Nix or dimethicone sprays; Elimite works from 2years, ivermectin from 12months.
3. Consider resistance. In areas with documented pyrethroid resistance, dimethicone (LiceMD) or ivermectin are safer bets.
4. Budget matters. Over‑the‑counter options cost £5‑£12, while prescription products range £20‑£35.
5. Safety profile. If you have eczema or very sensitive skin, avoid benzyl benzoate and consider the milder dimethicone.

In practice, many clinicians start with Elimite for confirmed scabies because the single‑dose regimen simplifies compliance. For a quick school‑outbreak of head lice, parents often reach for Nix or LiceMD depending on what they have at home.

Common Questions

Next Steps & Troubleshooting

If symptoms persist after the recommended course:

• Re‑evaluate the diagnosis - itchy rash could be eczema, allergic reaction, or a different parasite.
• Check application technique - missed areas are a common cause of failure.
• Consider a switch to a different class (e.g., from permethrin to dimethicone or ivermectin) if resistance is suspected.
• Seek medical advice for a prescription refill or alternative regimen.

Armed with this comparison, you can pick the product that matches your situation, budget, and safety needs.