We report a 65-year-old male with chemical necrotising fasciitis after self-injection of permethrin insecticide. The patient also developed persistent hypoglycemia secondary to massive insulin overdose. There was no evidence of systemic toxicities from the insecticide poisoning. Multiple debridement and skin grafting were performed over his right forearm due to extensive tissue damage. He eventually recovered with impairment of his right hand function. The clinical features and the management of this uncommon route of insecticide poisoning are discussed. (Hong Kong j.emerg.med. 2011;18:441-445)
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