Crotamiton

General

Measures to Avoid Reinfestation and Transmission

• To avoid reinfestation or transmission of scabies, clothing and bed linen that may have been contaminated by the infested individual during the 3 days prior to treatment should be decontaminated (machine-washed in hot water and dried in a hot dryer or dry-cleaned).103 104

• Items that cannot be laundered or dry-cleaned should be removed from body contact for ≥72 hours.103

• Fumigation of living areas is not necessary and is not recommended.103 104

Administration

Topical Administration

Apply topically to skin as 10% cream or lotion.115

Do not apply to face, eyes, mouth,115 urethral meatus, or mucous membranes.a For external use only; do not administer orally or intravaginally.115

Shake lotion before using.115

Before applying crotamiton for the treatment of scabies, the patient should bathe or shower with soap and water,115 taking care to scrub and remove scaling or crusted detritus, then towel dry.a

Apply thin layer of the cream or lotion uniformly and massage thoroughly into all skin surfaces below the chin (particularly all creases and folds) including the entire trunk and extremities from the neck to the toes (including the soles of the feet).115 Trim fingernails short and apply the cream or lotion underneath the fingernails with a toothbrush; wrap the toothbrush in paper and properly discard to prevent potential oral crotamiton exposure and toxicity.115

Remove the cream or lotion 48 hours after the last application by bathing.103 115

Sexual contacts of patients receiving treatment for scabies and other individuals (household, family) who have had close personal contact with the patient within the previous month should be examined and treated.104

The CDC recommends that scabies epidemics in institutional settings (e.g., nursing homes, hospitals, residential facilities and communities) be managed in consultation with an expert.104 The entire population at risk should be treated during institutional outbreaks.104 119

Pruritus does not indicate treatment failure and is not usually considered an indication for retreatment;103 such pruritus results from a hypersensitivity reaction of the host to the mite103 104 and may persist for several weeks despite successful treatment.103 Oral antihistamines and/or topical corticosteroids may be used to help relieve pruritus.103 Topical or oral anti-infectives are indicated for treatment of secondary bacterial infections of excoriated skin lesions.103

Dosage

Pediatric Patients

Cream or lotion: Apply a thin, uniform layer and massage thoroughly into all skin surfaces below the chin (particularly to all creases and folds) including the entire trunk and extremities from the neck to the toes (including the soles of the feet and underneath the fingernails).115 A proportionately smaller amount is applied in children compared to the amount applied in adults (30 g usually is sufficient in adults).a Wash off by bathing 48 hours after the last application.115

The manufacturer recommends a second application 24 hours after the first treatment.115 Frequent treatment failures reported;103 109 some clinicians suggest several applications are necessary to cure scabies.105 109 CDC recommends that patients who do not respond to crotamiton should be retreated with an alternative regimen.104

Lotion has been applied to the scalp and left on for 24 hours before being washed off.103

Adults

Cream or lotion: Apply a thin, uniform layer and massage thoroughly into all skin surfaces below the chin (particularly to all creases and folds) including the entire trunk and extremities from the neck to the toes (including the soles of the feet and underneath the fingernails).115 Usually, 30 g of the cream is sufficient for one application.115 Wash off by bathing 48 hours after the last application.115

The manufacturer recommends a second application 24 hours after the first treatment.115 Frequent treatment failures reported;103 109 some clinicians suggest several applications are necessary to cure scabies.105 109 CDC recommends retreating patients who do not respond to crotamiton with an alternative regimen.104

Lotion has been applied to the scalp and left on for 24 hours before being washed off.103

Cream or lotion: Massage gently into affected areas until completely absorbed; repeat application as needed.115

Absorption

Bioavailability

Absorbed systemically following topical application to skin.117

Elimination

Elimination Route

In a study in healthy adults using radiolabeled crotamiton 10% lotion applied topically twice daily (0.229 mL applied on an area of the forearm 229 cm2), 4.8–8.8% of the dose (measured as radioactivity) was eliminated in urine.117

Half-life

Following topical application to skin, absorption half-life is 2.7 hours and rate of elimination is 30.9 hours.117

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Eurax: 10% (60 g)

Lotion, External:

Eurax: 10% (60 g, 454 g)

Crotamiton has scabicidal activity against Sarcoptes scabiei; mechanism of action unknown. Antipruritic effects mediated by inhibition of histamine, serotonin, and PAR-2 (Sekine 2012).

Absorption

Amount of systemic absorption following topical use has not been determined

Topical: For external use only; avoid eyes and mucous membranes. Shake lotion well before using. Take a bath or shower prior to application. Apply from neck down to toes. Trim fingernails and apply under nails (can use toothbrush, which should be disposed of after use). Take a cleansing bath 48 hours after the final application. Contaminated clothing and bed linens should be washed on hot cycle or dry-cleaned and all clothing and bedding should be changed the day after application.

Frequency not defined.

Central nervous system: Localized warm feeling

Dermatologic: Contact dermatitis, pruritus, skin rash

Hypersensitivity: Local hypersensitivity reaction

Local: Local irritation

Other warnings/precautions:

• Appropriate use: For external use only; avoid contact with face, eyes, mucous membranes, and urethral meatus. Do not apply to acutely inflamed, raw, or weeping skin. Discontinue use if severe irritation or sensitization occurs.

Animal reproduction studies have not been conducted; use during pregnancy only if clearly needed.

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber severe skin irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.