Epidermal parasitic skin diseases (EPSD) are common in the tropics and sub-tropics. They are caused by mites, lice and other blood-sucking insects. In resource-poor countries they are associated with considerable morbidity. Hitherto, EPSD are treated with insecticides with a neurotoxic mode of action. The efficacy of this treatment is variable, and the development and spread of resistant mites and lice is alarming. A new concept for treating EPSD is presented which is based on the topical application of dimeticones, silicone oils of low viscosity which rapidly kill insects and mites by a physical mode of action. They creep into the respiratory system and block oxygen supply. The physical mode of action makes the development of resistant parasite strains very unlikely. Due to their safety and efficacy, dimeticones are promising candidates for population-based intervention programmes targeted against EPSD in resource-poor settings.