Scabies is an itchy skin infestation caused by a tiny mite that burrows into the top layer of skin. It spreads through prolonged skin-to-skin contact, so it often passes between family members, partners and people in care homes. It is very treatable, but everyone affected needs treating at the same time.
Symptoms
- Intense itching, usually worse at night.
- A rash of small red bumps, often between the fingers, on the wrists, elbows, armpits, waist, buttocks and genitals.
- Thin, wavy burrow lines on the skin, especially on the hands.
- In babies and young children, the rash can also affect the scalp, face, palms and soles.
The first time someone gets scabies, symptoms take 2 to 6 weeks to appear, but they can spread it during that time. If they get it again, symptoms start within a few days.
How scabies is treated
Scabies needs a diagnosis and prescription treatment from a doctor in the US. The main options are:
- Permethrin 5% cream: applied to the whole body from the neck down (including the scalp in young children), left on for 8 to 14 hours, then washed off. A second treatment is usually given 7 to 14 days later.
- Ivermectin tablets: sometimes prescribed instead, usually as two doses about a week apart. A doctor works out the dose from body weight. Read more about ivermectin and its uses.
- Other prescription creams and lotions are available if these aren’t suitable.
Over-the-counter head lice products don’t treat scabies.
Treat close contacts at the same time
Everyone in the household and any sexual partners should be treated on the same day, even if they don’t itch yet. Otherwise the mites can pass back and forth.
Cleaning at home
- Wash clothes, towels and bedding used in the 3 days before treatment in hot water and dry them on high heat.
- Seal items that can’t be washed in a plastic bag for at least 3 days. Mites die within 2 to 3 days away from human skin.
- Vacuum carpets and furniture. Insecticide sprays aren’t needed.
Why the itch can last after treatment
Itching often continues for 2 to 4 weeks after successful treatment, because the skin is still reacting to the dead mites. This doesn’t mean the treatment failed. A moisturiser, and an antihistamine such as cetirizine at night, can help.
See a doctor again if
New burrows or new spots appear after 2 weeks, the itching is getting worse after 4 weeks, or the skin looks infected (yellow crusts, pus, spreading redness). A thick, crusted rash, especially in older or immunocompromised people, can be crusted scabies, which is highly contagious and needs urgent medical treatment.
More in our Lice and Parasites guide: all our articles on this topic in one place.
This article is for general information only and isn’t a substitute for advice from a doctor or pharmacist. Always read the label before using any medicine.
