This combination lotion is indicated for the treatment of scabies and pruritus (itching). It is also used to relieve itching and skin irritation caused by sunburn, dry eczema, itchy dermatitis, allergic rashes, hives, nettle rash, chickenpox, insect bites and stings, heat rash, and personal itching.

This lotion is a combination of Permethrin and Crotamiton. Permethrin is a photostable synthetic pyrethroid with broad-spectrum insecticidal activity and low toxicity in mammals. Crotamiton is used for the treatment of scabies and also helps relieve itching associated with various skin conditions.

Mode of Action Permethrin is rapidly absorbed by insects through the mouth, respiratory tract, or intact cuticle. Its primary target is the nervous system. It mainly acts on sodium channels in the nerve membrane and prolongs sodium permeability during membrane depolarization. This causes sensory hyperexcitability, incoordination, paralysis, and eventually death of the parasites. It is believed that its action against mites is similar. Crotamiton helps relieve itching and discomfort associated with skin irritation and scabies infestation.

Pharmacokinetics Permethrin is approved only for topical use. Limited data are available regarding systemic absorption after skin application. Some metabolism occurs in the skin before entering systemic circulation. Less than 0.5% of the applied dose is absorbed within the first 48 hours. The absorbed portion is rapidly metabolized, mainly in the liver, and excreted primarily through urine. Crotamiton penetrates the skin quickly. Small but measurable amounts may be found in plasma, reaching maximum levels within 4–10 hours and then decreasing rapidly.

Adults (including the elderly): After the patient has taken a warm bath, the skin should be well dried and Crotam Plus rubbed into the entire body surface (excluding the face and scalp) until no traces of the preparation remain visible on the surface. The application should be repeated once daily, preferably in the evening, for a total of 3-5 days. Depending on the response, special attention should be paid to sites that are particularly susceptibly to infestation by the mites (e.g. interdigital spaces, wrists, axillae and genitalia). Areas where there is pus formation should be covered with a dressing impregnated with this lotion. While the treatment is in progress the patient may take a bath shortly before the next application. After completion of the treatment, a cleansing bath should be taken followed by a change of bed linen and underclothing.

Children: Application as described for adults but in children under 2 years of age this lotion should not be applied more than once a day.

Treatment procedure: Before application of this lotion the skin should clean, cool and dry. For adults and children over 2 years: Apply the lotion to the whole body from the neck down, rubbing lightly into the skin until the lotion disappears. It is important to include all skin surfaces, such as between the fingers and toes, under the nails and on the soles of the feet. For babies under 2 years: Apply to the face, neck, ears and scalp as well, only avoiding the area immediately around the eyes and mouth. Leave lotion on for at least 8 hours, before washing off. Reapply to any area that may be washed during the 8 hours treatment time (such as after washing the hands).

Treatment procedure: Before application of Crotam Plus lotion the skin should clean, cool and dry.

For adults and children over 2 years: Apply the lotion to the whole body from the neck down, rubbing lightly into the skin until the lotion disappears. It is important to include all skin surfaces, such as between the fingers and toes, under the nails and on the soles of the feet.

For babies under 2 years: Apply to the face, neck, ears and scalp as well, only avoiding the area immediately around the eyes and mouth. Leave lotion on for at least 8 hours, before washing off. Reapply to any area that may be washed during the 8 hours treatment time (such as after washing the hands).

Patients of >2 month of age can use the lotion.

As scabies is highly contagious other members of the family should use this medicine as preventive in the same way.

Treatment of eczematous-like reactions with corticosteroids should be avoided before using Permethrin and Crotamiton lotion, as it may suppress the immune response to the mite and potentially worsen scabies infestation.

This lotion is contraindicated in patients with known hypersensitivity or allergy to permethrin, its components, other pyrethroids, or pyrethrins.

In patients with scabies, mild skin discomfort such as burning, stinging, or tingling may occur shortly after application. Other temporary reactions may include redness (erythema), swelling (edema), eczema, and rash. These reactions are generally considered part of the natural course of scabies rather than true drug side effects.

There is insufficient experience to confirm the safety of Permethrin and Crotamiton during pregnancy; therefore, its use is not recommended, especially during the first trimester. It is not known whether the active ingredients pass into breast milk, so nursing mothers should avoid applying it on the nipple area.

Healthcare workers who frequently apply this lotion may use gloves to prevent possible skin irritation. Contact with the eyes should be strictly avoided, as it may cause eye irritation. If accidental eye contact occurs, rinse immediately with plenty of water.

There are no reported cases of overdose with Permethrin and Crotamiton lotion. However, excessive application may lead to localized irritation or more severe skin reactions.

Local antipruritic and parasiticidal preparations

Keep out of reach of children. Store in a dry place below 25°C and protect from light.