⚡ Quick Answer — What is Ascabiol?
Ascabiol is gamma benzene hexachloride (lindane) topical lotion in a 100 ml bottle — a second-line scabicide and pediculicide reserved for cases where permethrin and ivermectin have failed or are unavailable. Apply head-to-toe (neck-down), leave on 6–8 hours only (NOT overnight), then wash off thoroughly. Lindane was withdrawn from the US market in 2009, the EU in 2008, and Canada in 2004 over neurotoxicity (seizures) and environmental persistence. Prefer Permiforce Cream (permethrin 5%) or Iverjohn (oral ivermectin) first.
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What is Ascabiol?
Ascabiol is gamma benzene hexachloride (lindane) topical lotion supplied in a 100 ml bottle. Ascabiol is supplied by a WHO-GMP-certified manufacturer. Note: while the brand name “Ascabiol” historically referred to a benzyl-benzoate product in some markets, this product’s active ingredient is gamma benzene hexachloride (lindane). Lindane is an organochlorine compound that has been used as a scabicide and pediculicide since the 1950s. Modern guidelines reserve it for the narrow situations where first-line agents (permethrin and ivermectin) have failed or are unavailable, because the safety margin is much narrower than for permethrin.
How does lindane work?
Lindane is absorbed through the parasite’s cuticle and binds to GABA-A and glycine receptors in arthropod nervous tissue. The result is hyperexcitability, convulsions, and death of the mite or louse. Unfortunately the same receptor targets exist in mammals, which is why systemic absorption from human skin (~10 % of applied dose, more in young children and broken skin) can produce neurotoxic side effects — paraesthesia, headache, dizziness, and at toxic levels, seizures.
Indications (second-line only)
- Scabies — when permethrin 5% (Permiforce Cream) and oral ivermectin (Iverjohn / Verpin) have failed or are contraindicated
- Head lice resistant to permethrin and where ivermectin lotion (Ivrea Shampoo) is not an option
- Pubic lice in adults where modern alternatives are not available
How to apply Ascabiol
| Step | What to do |
|---|---|
| 1. Bath / shower | Have a cool or lukewarm bath; dry the skin completely. Do not apply to hot, damp, or freshly bathed skin — this raises absorption sharply. |
| 2. Apply thin layer | Apply a thin layer to the whole body neck-down (avoid face). For scabies, work into all skin folds — between fingers, under nails, in armpits, around waist, genitals, behind knees. Use no more than ~30 mL for an average adult body. |
| 3. Leave 6–8 hours | Maximum 6–8 hours. Do NOT leave on overnight. Do not exceed this window — toxic absorption begins to climb steeply. |
| 4. Wash off thoroughly | Wash off completely with cool / lukewarm water and soap. Change into clean clothes. Wash bedding and worn clothes at ≥ 60 °C. |
| 5. Repeat ONLY if needed at day 7 | A single application is usually sufficient. Repeat once at day 7 only if active disease persists. Never apply more than two courses. |
Side effects and toxicity
Local reactions are common:
- Burning, stinging, redness, dryness, dermatitis
- Eczematous flare
- Headache, dizziness, paraesthesia (numbness/tingling)
Serious / systemic — stop use and seek urgent medical help:
- Seizures (rare; risk much higher with overuse, broken skin, or in young children)
- Severe headache, confusion, or muscle twitching
- Severe rash, blistering, or extensive irritation
Contraindications and absolute avoid
- Children under 6 years — much greater absorption per kg; FDA black-box concerns
- Pregnancy and breastfeeding — lipid-soluble; crosses placenta and into breast milk
- Broken, eczematous, or psoriatic skin — absorption is dramatically higher
- Premature infants, low birth weight, malnourished children
- Patients with seizure disorders or on lower-seizure-threshold drugs (theophylline, tricyclic antidepressants, bupropion, clozapine)
- Hepatic impairment
- Concurrent oils / moisturisers on the skin — they enhance absorption; remove before applying
Drug interactions
Avoid simultaneous topical or systemic drugs that lower seizure threshold. Lindane is metabolised hepatically and absorbed enough to interact with hepatic enzyme inducers and inhibitors when used over large surface areas or with extended contact.
Storage
Store below 25 °C, away from heat and direct sunlight, in the original tightly capped bottle. Keep out of reach of children — paediatric ingestion is a medical emergency.
Frequently Asked Questions
Why is lindane still available if it was withdrawn?
Lindane was withdrawn or restricted in the US (FDA 2009 second-line restriction), the EU (2008), Canada (2004), and is listed under the Stockholm Convention as a persistent organic pollutant. It remains available in some markets for narrow second-line use where first-line agents (permethrin / ivermectin) cannot be used. Ascabiol is supplied for those situations under medical guidance.
Why only 6–8 hours of contact?
Beyond 8 hours, the percentage of the applied dose absorbed through skin rises sharply — and so does the risk of CNS toxicity (paraesthesia, headache, in extreme cases seizure). Permethrin can be left on overnight because mammalian sodium channels recover quickly; lindane cannot.
Can I use lindane if I’m pregnant?
No. Lindane crosses the placenta and is excreted in breast milk. Permethrin 5% (Permiforce Cream) is the safe choice during pregnancy.
Is it safe in children?
Avoid in children under 6 years — they have a higher surface-area-to-weight ratio and absorb proportionally more. In children 6+, use only a single application under medical guidance and only if first-line therapies have failed.
What if lindane gets in my eyes or mouth?
Rinse eyes with copious water for 15 minutes and seek medical advice. If swallowed, do not induce vomiting; contact a poison control centre immediately. Lindane is more toxic by ingestion than by skin absorption.
How is Ascabiol different from permethrin?
Different mechanism (GABA receptor blockade vs sodium-channel modulation), different safety margin (much narrower for lindane), and different first-line status (permethrin is recommended; lindane is reserved second-line). Choose lindane only if permethrin and ivermectin have both failed or are contraindicated.
Can I use lindane on cracked or eczematous skin?
No — broken skin can absorb 5–10× more drug. Treat the dermatitis first, or use permethrin / oral ivermectin instead.
Will my itch go away after treatment?
Itch from scabies persists for 2–4 weeks after a successful course because the immune response continues against retained mite antigens. This is not treatment failure. New burrows or new lesions after 14 days does suggest failure — switch to permethrin + oral ivermectin combination.
Do I need to treat household members?
Yes for scabies — close contacts may be in the asymptomatic 4–6 week incubation phase. For lindane specifically, treat them with permethrin (preferred) rather than another lindane course, to minimise repeat exposure to a restricted compound.
Can I shower the next day?
Yes — once Ascabiol is washed off after the 6–8 hour contact period, normal washing resumes. Do not re-apply for at least 7 days, and only if active infestation persists.
Other Lice & Scabies Treatments
After completing a scabies course with Ascabiol (gamma benzene hexachloride lotion), patients who also discover head lice require a separate pediculicidal course; Ivrea Shampoo (ivermectin 1% shampoo) achieves single-application clearance without adding further lindane-class exposure to the overall treatment burden.
- Permiforce Cream — permethrin 5% cream — first-line scabies
- Perlice Cream — permethrin 1% lotion — first-line head lice
- Iverjohn — oral ivermectin 3 / 6 / 12 mg — first-line oral antiparasitic
- Verpin — ivermectin 6 mg tablets — alternative oral
- Ivrea Shampoo — topical ivermectin 1% — for permethrin-resistant lice
Medical Disclaimer
This page is for educational purposes and is not a substitute for medical advice. Resistant or atypical infestations, persistent itch despite proper application, infested children < 2 years old, immunocompromised patients (crusted/Norwegian scabies risk), and pregnancy / breastfeeding cases need clinical assessment. Severe widespread skin infection, fever, or systemic symptoms after a course of treatment require urgent medical review. Always discuss treatment in pregnancy or breastfeeding with a clinician.



























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