Scabies

Overview

Scabies is a skin condition caused by tiny mites (very small bugs) that burrow into the top layer of your skin and lay eggs. This leads to intense itching and a rash, especially at night.

Yes, scabies is common all over the world. It can affect anyone, but outbreaks happen more often in places where people live closely together, like nursing homes, schools, and prisons.

Scabies can affect anyone of any age, race, or lifestyle. It is more common in young children and people with weakened immune systems.

Symptoms

Common symptoms

• Intense itching, especially at night or after a hot bath or shower.
• A pimple-like rash, often seen between fingers, on wrists, elbows, armpits, waist, buttocks, and genitals.
• Thin, wavy, tunnel-like lines on the skin where the mite has burrowed (these can be hard to see).
• Sores or scratches from scratching, which can become infected.

Symptoms in children

• Rash and itching may be more widespread, often affecting the scalp, face, neck, palms of the hands, and soles of the feet.
• Children may be irritable or have trouble sleeping because of the itching.
• Small blisters or bumps may appear on the palms and soles.

Symptoms in older adults

• Itching may be less intense but still bothersome.
• Rash can be harder to see because of thinner, drier skin, but burrows may still be present.
• Scabies in older adults can look like eczema or other skin conditions, so a doctor's check is important.

Causes

Main causes

• Tiny mites called Sarcoptes scabiei burrow into the top layer of skin to lay eggs.
• The mites spread through close, prolonged skin-to-skin contact with an infected person.
• Less commonly, scabies can spread through sharing infested bedding, clothes, or towels, but this is rare because mites cannot survive long away from the skin.

Risk factors

• Living in crowded conditions, such as nursing homes, dormitories, or prisons.
• Having close physical contact with someone who has scabies, including sexual contact.
• Having a weakened immune system, which increases the risk of a severe form called crusted scabies.
• Being a young child, as scabies is common in daycare and school settings.

When to see a doctor

See a doctor urgently if:

• If you have a rash and intense itching that is not getting better after using an over-the-counter anti-itch cream for a few days.
• If you have a skin infection (red, swollen, warm, or oozing pus) along with the rash.
• If you have a weakened immune system and think you have scabies.

Book a routine appointment if:

• Any persistent itchy rash that does not go away with home care should be checked by a doctor.
• If you have been in close contact with someone diagnosed with scabies, even if you have no symptoms yet, see a doctor to discuss preventive treatment.

Diagnosis

A doctor usually diagnoses scabies by looking at your skin and asking about your symptoms, especially the pattern of itching and rash. They may also ask about close contacts.

Tests that may be done

• Skin scraping: A doctor gently scrapes a small area of the rash to get a sample of skin and looks at it under a microscope for mites, eggs, or mite droppings.
• Dermoscopy: A special magnifying tool (dermatoscope) can help see burrows and mites on the skin.
• Ink test: Sometimes a doctor puts a drop of ink on a burrow track and wipes it off; if ink remains in the track, it confirms a burrow.

What to expect at your appointment

The exam is quick and usually painless. A skin scraping might feel a little uncomfortable but not painful. You may get results the same day, or the sample may be sent to a lab. Treatment is often started based on the appearance alone, without waiting for test results, especially if scabies is likely.

Treatment

Scabies is treated with a cream or lotion that kills the mites. You apply it to all areas of your body from the neck down (and sometimes the head and neck for children and older adults). Treatment is usually done at night and left on for 8–14 hours, then washed off. Everyone in your household and close contacts should be treated at the same time, even if they have no symptoms. One treatment is usually enough, but a second application may be recommended after a week.

Self-care at home

• Wash all bedding, towels, and clothes used in the past 3 days in hot water (at least 50°C) and dry them on the hottest setting.
• Items that cannot be washed (like stuffed animals or pillows) can be sealed in a plastic bag for at least 3 days to kill the mites.
• Avoid close physical contact with others until 24 hours after your first treatment.
• Try not to scratch — keep your nails short and consider wearing cotton gloves at night to prevent damage to your skin.
• Use cool compresses or over-the-counter antihistamines (talk to your pharmacist) to help with itching, but remember the itching can continue for a few weeks even after successful treatment.

Medical treatments

Doctors prescribe a medicated cream or lotion (called a scabicide) that kills the mites. In some cases, especially for crusted scabies, oral medication (taken by mouth) may be used. Your doctor will choose the treatment that is right for you based on your age, health, and the type of scabies.

When is surgery considered?

Surgery is not used to treat scabies.

Living with this condition

During treatment, you will need to apply the cream carefully and follow the instructions exactly. You may feel tired because of poor sleep from itching. Gentle skin care, like using mild soap and moisturizer, can help. Avoid sharing towels or bedding until after treatment.

Lifestyle tips

• Wash all clothes, bedding, and towels on high heat. Vacuum carpets and furniture, though mites do not live long off the skin.
• Avoid close contact with others until you have completed your first treatment session (usually 24 hours after applying the cream).
• Inform anyone you have had close contact with so they can get treated too, to prevent re-infection.

Diet and exercise

There is no specific diet or exercise needed for scabies. However, eating a balanced diet and staying well hydrated can help your skin heal. Gentle exercise may help reduce stress, but avoid activities that cause sweating until the rash improves, as sweat can worsen itching.

Mental health and emotional wellbeing

The constant itching and visible rash can be distressing and embarrassing. You may feel anxious or self-conscious. It can also affect your sleep and mood. Remember that scabies is a common medical condition that has nothing to do with cleanliness. Talk to a trusted friend, family member, or healthcare provider if you feel overwhelmed.

Prevention

You can reduce the risk by avoiding close skin-to-skin contact with someone who has scabies until they have been treated. If someone in your home has scabies, treat all household members and close contacts as advised by your doctor. Wash shared items thoroughly.

Vaccines

There is no vaccine for scabies.

Screening programmes

There is no routine screening for scabies. However, if you have been in close contact with a confirmed case, it is wise to see a doctor for a check-up, even if you have no symptoms, because you can still spread the mites before symptoms start.

Complications

If left untreated

• Severe itching that can lead to skin damage and bacterial infections (like impetigo or cellulitis), which may require antibiotics.
• In people with weakened immune systems, scabies can develop into crusted scabies (also called Norwegian scabies), a more contagious and severe form with thick crusts of skin containing many mites.
• Constant scratching can cause open sores that become infected, leading to more serious complications like kidney inflammation (rare).

Long-term outlook

The outlook is very good with proper treatment. Scabies is completely curable. The mites die quickly after treatment, and the rash and itching usually improve within a few weeks. Even after the mites are gone, your skin may take a few more weeks to fully heal, but you are no longer contagious after 24 hours from your first treatment. With appropriate care and treatment of close contacts, scabies will not come back.

Find support

International organisations

• International Alliance of Dermatology Patient Organizations (IADPO) ↗

Local organisations

• British Association of Dermatologists (BAD) Patient Information ↗ · United Kingdom
• NHS – Scabies overview ↗ · United Kingdom

Helplines

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.