Scabies

Date Updated: 08/25/2020

Overview

Scabies is an itchy skin condition caused by a tiny burrowing mite called Sarcoptes scabiei. Intense itching occurs in the area where the mite burrows. The urge to scratch may be especially strong at night.

Scabies is contagious and can spread quickly through close physical contact in a family, child care group, school class, nursing home or prison. Because scabies is so contagious, doctors often recommend treatment for entire families or contact groups.

Scabies can be readily treated. Medications applied to your skin kill the mites that cause scabies and their eggs. But you may still have some itching for several weeks after treatment.

Symptoms

Scabies signs and symptoms include:

Itching, often severe and usually worse at night
Thin, irregular burrow tracks made up of tiny blisters or bumps on your skin

The burrows or tracks typically appear in folds of skin. Though almost any part of the body may be involved, in adults and older children scabies is most often found:

Between the fingers
In the armpits
Around the waist
Along the insides of the wrists
On the inner elbows
On the soles of the feet
Around the breasts
Around the male genital area
On the buttocks
On the knees

In infants and young children, common sites of infestation usually include the:

Scalp
Palms of the hands
Soles of the feet

If you've had scabies before, signs and symptoms may develop within a few days of exposure. If you've never had scabies, it can take as long as six weeks for signs and symptoms to begin. You can still spread scabies even if you don't have any signs or symptoms yet.

When to see a doctor

Talk to your doctor if you have signs and symptoms that may indicate scabies.

Many skin conditions, such as dermatitis or eczema, are associated with itching and small bumps on the skin. Your doctor can help determine the exact cause and ensure that you receive proper treatment. Bathing and over-the-counter preparations may ease itching, but they won't eliminate scabies.

Causes

The eight-legged mite that causes scabies in humans is microscopic. The female mite burrows just beneath your skin and makes a tunnel where it deposits eggs.

The eggs hatch, and the mite larvae work their way to the surface of your skin, where they mature and can spread to other areas of your skin or to the skin of other people. The itching of scabies results from your body's allergic reaction to the mites, their eggs and their waste.

Close physical contact and, less often, the sharing of clothing or bedding with an infected person can spread the mites.

Animals and humans all are affected by their own distinct species of mites. Each species prefers one specific type of host and doesn't live long away from that preferred host.

Humans may have a temporary skin reaction from contact with the animal scabies mite. But people generally can't develop full-blown scabies from this source, as they might from contact with the human scabies mite.

Complications

Vigorous scratching can break your skin and allow a secondary bacterial infection, such as impetigo, to occur. Impetigo is a superficial infection of the skin that's caused most often by staph (staphylococci) bacteria or occasionally by strep (streptococci) bacteria.

A more severe form of scabies, called crusted scabies, may affect certain high-risk groups, including:

People with chronic health conditions that weaken the immune system, such as HIV or chronic leukemia
People who are very ill, such as people in hospitals or nursing facilities
Older people in nursing homes

Crusted scabies, also called Norwegian scabies, tends to make skin crusty and scaly, and affects large areas of the body. It's very contagious and can be hard to treat.

Normally, someone with scabies has about 10 to 15 mites. In contrast, someone with crusted scabies may be infested with millions of mites.

Prevention

To prevent re-infestation and to prevent the mites from spreading to other people, take these steps:

Clean all clothes and linen. Use hot, soapy water to wash all clothing, towels and bedding used within three days before beginning treatment. Dry with high heat. Dry-clean items you can't wash at home.
Starve the mites. Consider placing items you can't wash in a sealed plastic bag and leaving it in an out-of-the-way place, such as in your garage, for a couple of weeks. Mites die after a few days without food.

Diagnosis

To diagnose scabies, your doctor examines your skin, looking for signs of mites, including the characteristic burrows. When your doctor locates a mite burrow, he or she may take a scraping from that area of your skin to examine under a microscope. The microscopic examination can determine the presence of mites or their eggs.

Treatment

Scabies treatment involves eliminating the infestation with medications. Several creams and lotions are available with a doctor's prescription.

Your doctor will likely ask you to apply the medication to your whole body, from the neck down, and leave the medication on for at least eight to 10 hours. Some treatments require a second application, and treatments need to be repeated if new burrows and a rash appear.

Because scabies spreads so easily, your doctor will likely recommend treatment for all household members and other close contacts, even if they show no signs of scabies infestation.

Medications commonly prescribed for scabies include:

Permethrin cream. Permethrin is a topical cream that contains chemicals that kill scabies mites and their eggs. It is generally considered safe for adults, pregnant women, and children age 2 months and older.
Ivermectin (Stromectol).Doctors may prescribe this oral medication for people with altered immune systems, for people who have crusted scabies, or for people who don't respond to the prescription lotions and creams. Ivermectin isn't recommended for women who are pregnant or nursing, or for children who weigh less than 33 pounds (15 kilograms).
Crotamiton (Eurax, Crotan). This medication is available as a cream or a lotion. It's applied once a day for two days. The safety of this medication hasn't been established in children, adults 65 and older, or women who are pregnant or nursing. Frequent treatment failure has been reported with crotamiton.

Although these medications kill the mites promptly, you may find that the itching doesn't stop entirely for several weeks.

Doctors may prescribe other topical medications, such as sulfur compounded in petrolatum, for people who don't respond to or can't use these medications.

Lifestyle and home remedies

Itching may persist for some time after you apply medication to kill the mites. These steps may help you find relief from itching:

Cool and soak your skin. Soaking in cool water or an oatmeal bath, or applying a cool, wet washcloth to irritated areas of your skin may minimize itching.
Apply soothing lotion. Calamine lotion, available without a prescription, can effectively relieve the pain and itching of minor skin irritations.
Take antihistamines. At your doctor's suggestion, you may find that over-the-counter antihistamines relieve the allergic symptoms caused by scabies.

Preparing for an appointment

Make an appointment with your family doctor or pediatrician if you or your child has signs and symptoms common to scabies.

Here's some information to help you get ready for your appointment and know what to expect from your doctor.

Information to gather in advance

List any signs or symptoms you or your child has had, and for how long.
List any possible sources of infection, such as other family members who have had a rash.
Write down key medical information, including any other health problems and the names of any medications you or your child is taking.
Write down questions you want to be sure to ask your doctor.

Below are some basic questions to ask your doctor about scabies.

What's the most likely cause of these signs and symptoms?
What treatment approach do you recommend?
How soon will symptoms improve with treatment?
When will you see me or my child again to be sure the treatment is working?
Are there any home remedies or self-care steps that could help relieve symptoms?
Am I or is my child contagious? For how long?
What steps should be taken to reduce the risk of infecting others?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

What signs and symptoms have you noticed?
When did you first notice these signs and symptoms?
Have these signs and symptoms gotten worse over time?
If you or your child has a rash, what parts of the body are affected?
Has anyone else with whom you have frequent, close contact had a rash, an itch or both within the past several weeks?
Are you currently pregnant or nursing?
Are you or is your child currently being treated or have you or your child recently been treated for any other medical conditions?
What medications are you or your child currently taking, including prescription and over-the-counter drugs, vitamins and supplements?
Is your child in child care?

What you can do in the meantime

In the time leading up to your appointment, try at-home and over-the-counter (OTC) remedies to help reduce itching. Cool water, antihistamines and calamine lotion may provide some relief. Ask your doctor what OTC medications and lotions are safe for your child.