Scabies
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is scabies?
Scabies is caused by tiny mites burrowing into the skin, producing intense itch that is characteristically worse at night. It spreads by prolonged skin to skin contact. Everyone in the household must be treated at the same time, even without symptoms, or the infestation simply returns.
Causes
- Sarcoptes scabiei mite burrowing into the skin
- Prolonged skin to skin contact
- Sexual contact
- Rarely shared bedding or clothing
- Crowded living conditions
Symptoms
- Intense itching, markedly worse at night
- A widespread pimple like rash
- Thin silvery burrow lines, often between the fingers
- Common at wrists, elbows, armpits, waist and groin
- Sores from scratching
- In babies, the palms, soles, scalp and face
- Itch continuing for weeks after successful treatment
Risk factors
- Close household or sexual contact with an infested person
- Care homes and institutional settings
- Crowded housing
- Weakened immune system for crusted scabies
- Young children and older adults
Diagnosis
- Clinical diagnosis from the rash and severe night itch
- Identifying burrows, sometimes with dermoscopy
- Skin scraping for microscopy where uncertain
- Checking household and sexual contacts
Treatment
- Permethrin 5 percent cream applied to the whole body
- A second application seven days later
- Oral ivermectin for crusted scabies or treatment failure
- Simultaneous treatment of all household and sexual contacts
- Antihistamines or steroid cream for the itch
- Antibiotics if the skin becomes infected
Self care
- Apply cream to the entire body from the jawline down, including under nails
- In babies and older adults include the scalp, face and ears
- Leave the cream on for the full time stated, usually 8 to 12 hours
- Reapply to hands after washing them
- Wash bedding, towels and clothing at 50 degrees or higher
- Seal unwashable items in a bag for 72 hours
- Expect the itch to persist for two to four weeks after treatment
When to see a doctor
Book an appointment if:
- Suspected scabies, since prescription treatment is needed
- Itch persisting more than four weeks after treatment
- New burrows or spots appearing after treatment
- Skin becoming infected with pus or crusting
- Thick crusted scaly patches, which need urgent treatment
- Scabies in a baby under 2 months
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Treat all household and close contacts at the same time
- Wash and dry bedding and clothing on a hot cycle
- Avoid close skin contact until treatment is complete
- Prompt treatment in care homes to prevent outbreaks
Outlook
Scabies clears with correct treatment, though the itch commonly continues for two to four weeks afterwards as the skin reacts to dead mites. That is not treatment failure. Reinfestation is common when contacts are not treated simultaneously, which is the usual reason it seems to keep returning.
Common questions
Why am I still itching after treatment?
The itch is an allergic reaction to the mites and their debris, which persists while the skin clears. Two to four weeks of continued itching is normal and does not mean the treatment failed.
Does scabies mean poor hygiene?
No. It spreads through skin contact regardless of cleanliness and affects all social groups. Crusted scabies is more common with weakened immunity, not with poor washing.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.