Scabies is caused by the human itch mite (Sarcoptes scabiei), a tiny, eight-legged parasite that burrows into the upper layer of the skin in order to feed and live. Female mites also lay eggs there. When this happens, the skin often breaks out into an itchy, pimple-like rash in an allergic reaction to the mites, their eggs, and their waste.
Though scabies is pretty unpleasant to think about, the good news is that it’s very treatable. Scabies treatment involves topical remedies and, depending on how severe the infestation is, oral medication. All these medications are currently available only by prescription, so it’s vital to see your healthcare provider in order to solve the problem.
Once treatment is started and the mites are eliminated, the itching and scabies rash symptoms should resolve within a few weeks.
Scabies typically causes intense itching, which can be worse at night — so much so that it may be hard to sleep. This itching is the earliest and most common symptom of scabies.
Scabies can occur anywhere on the body, but the mites tend to prefer certain areas, including: the hands (especially the skin between the fingers and around the nails), armpits, elbows, wrists, and areas of skin that are usually covered by clothing, such as shoulder blades, the groin area, breasts, the area around the beltline, and the buttocks. Skin that’s covered by jewelry, such as watches, bracelets, or rings, is also often affected.
In young children and infants, itching and rash may affect the head, face, neck, palms, and the soles of the feet, but this typically doesn’t occur in adults and older kids.
What Does Scabies Look Like?
Not everyone infested with mites has a scabies rash, but many people do. The rash consists of small, red bumps that may look similar to pimples or small insect bites, and the bumps are often in a line. These aren’t “scabies bites” so much as an allergic reaction the skin has to the presence of the mites. This reaction can also resemble other rashes, but your doctor or dermatologist can determine whether it’s scabies. Some people infested with the mites have scaly patches that look like eczema.
You may also notice tiny, snaking, raised lines — about a centimeter long — that are caused by the female scabies mites burrowing under the skin. These burrows are grayish white or skin-colored, and while they can be difficult to find, they tend to appear in the webbing between fingers; in the folds of the wrist, knee, or elbow; and in the groin area, breasts, and shoulder blades.
In someone who’s never had scabies, it can take as long as four to eight weeks before symptoms begin to appear. It’s important to be aware that a person is capable of spreading mites during this period even when they show no signs of scabies. Symptoms in people who have had previous scabies infestations tend to show up much more quickly, within one to four days.
Crusted scabies, sometimes called Norwegian scabies, is a severe form of infestation found almost exclusively in those with severely weakened immune systems. It’s much less common than regular scabies, but more contagious. Most people who get scabies have about 10 to 15 mites in their skin. Crusted scabies is an infestation with an extremely large number of mites — sometimes up to two million.
It affects people whose bodies can’t develop resistance to the mites, and the mites multiply quickly. This includes people who have a weakened immune system, such as those with HIV or chronic leukemia, as well as elderly people.
People with crusted scabies may not experience the typical scabies rash or itch so intensely, but they’re highly contagious to other people. Thick, grayish crusts develop that tend to crumble easily when touched. These are especially common on folds of the skin, such as in the armpit, groin, and finger-web spaces. But these crusts, filled with mites, can also fall off. The mites can live inside the crust for up to a week without human contact, which is part of what makes crusted scabies so contagious in certain environments.
Scabies is contagious, and it’s usually spread by having direct, prolonged skin-to-skin contact with an affected person. The exposure generally has to be sustained: A handshake or hug typically doesn’t spread the mites, but holding hands for 5 or 10 minutes can. (The exception is crusted scabies, where an infested person can transmit the mites even with very brief contact.) In adults, scabies is often spread through sexual encounters. And it’s easily spread within households.
While the mites live for one to two months on human skin, they can survive for up to four days on inanimate objects such as bedsheets, clothing, and towels. That makes it possible to get scabies through contact with an infested item, although it’s less common. This kind of indirect infection more often happens with crusted scabies.
If you suspect you have scabies, you must get checked out by a healthcare provider in order to treat the condition properly and avoid spreading it. A doctor will perform a visual exam to look for the scabies rash on your body and for burrows.
Other conditions can produce skin reactions that look similar. To be sure it’s scabies, your doctor may want to confirm the presence of a mite, its eggs, or its fecal matter. This can be done by taking a scraping of skin to examine under a microscope or by using a needle to extract a mite from its burrow.
Successful treatment of scabies means getting rid of the mites. This involves using a medication known as a scabicide. While some over-the-counter creams and products can help reduce or alleviate symptoms like itching, they won’t kill mites. Scabicides are currently only available by prescription.
Medication Options
For common, noncrusted scabies, patients may be prescribed a topical medication.
Permethrin (Acticin, Elimite) cream is the most commonly prescribed. It’s applied to your entire body, from the neck down, on clean, dry skin and left on for about 8 to 14 hours before being washed off. One treatment should kill any live mites, but you’ll probably need to repeat the process in a week to get rid of any newly hatched mites.
Crotamiton (Croton, Eurax) cream, spinosad (Natroba) topical suspension, or sulfur ointment may also be considered, depending on the needs of the patient.
Treatment of crusted scabies calls for an oral antiparasitic medicine, ivermectin (Stromectol), along with topical medication. Depending on the severity of the infestation, these pills are taken in three, five, or up to seven doses.
In addition to a scabicide, your doctor may prescribe an antihistamine or steroid cream to help reduce itching and inflammation of the skin.
Adults can usually go back to work and children to school the day after treatment.
Complementary Therapies
No over-the-counter or “natural” remedies have been proven to kill scabies mites.
However, researchers have been looking into the effectiveness of essential oils as an alternative in treating scabies. These contain compounds considered to have antiparasitic, antioxidant, antimicrobial and anti-inflammatory properties. So far, these are mainly lab studies, not human clinical trials. But oils including tea tree, clove, and lemon appear to hold promise.
Experimental research is underway to develop a vaccine to prevent scabies, though it would likely take years before it would be available. There is currently no surefire way to avoid getting scabies, other than to avoid close contact with an infested person and certain items they’ve used, such as clothing, bedding, and towels.
To ensure successful treatment and reduce the chance of reexposure, bedding, clothing, and towels used by a person with scabies or anyone they came in close contact with must be washed in hot water and dried with high heat. You can also dry-clean these items or seal them in a plastic bag for at least 72 hours to kill any mites that may still be around. When you start treatment, vacuum your home, too.
When someone has scabies, their sexual partners and any members of their household need to get treated as well — and at the same time — so that reinfestation doesn’t occur.
If you’re sexually active, wait to have sex until you and your partner have both finished treatment. While condoms can prevent other sexually transmitted infections, they’re not an effective barrier when it comes to the skin-to-skin contact through which scabies spreads.
With proper treatment that kills the mites, scabies goes away. Once treatment starts, this typically takes one to two weeks. You may continue to itch for several weeks as your body’s allergic reaction to the mites resolves. If the itching lasts more than two to four weeks, or if you notice new burrows or the pimple-like scabies rash, you might need retreatment.
Because it’s a contagious infection, you can contract scabies again.
A scabies infestation can lead to complications when secondary infections develop. The nonstop scratching can result in open sores that can get infected with bacteria, often staph (staphylococci) or sometimes strep (streptococci), causing another skin infection called impetigo. While impetigo usually isn’t dangerous, if it’s not controlled with antibiotics, it can lead to serious complications.
According to the World Health Organization (WHO), an estimated 400 million people are affected by scabies every year. Infections happen in all parts of the world, though the WHO notes that the highest rates of scabies and scabies-related secondary infections occur in hot, tropical climates, especially in overcrowded communities.
But scabies can happen to anyone, regardless of geographic location, socioeconomic status, race, gender, or age. Some people, though, are particularly susceptible to scabies. This includes children, mothers of young children, sexually active young adults, elderly people who live in nursing homes, and hospital patients. People whose immune systems are compromised and people who have had organ transplants are also at greater risk.
Scabies outbreaks affect residents of facilities such as nursing homes and rehabilitation centers, dormitories, and prisons — basically any institutional setting where close body contact is frequent. Environments such as childcare centers and camps are also at risk for outbreaks.
Scabies is a common parasitic skin infection caused by the human itch mite.
The mites burrow into your skin to feed and lay eggs, setting off an allergic reaction that causes a pimply rash and intense itching.
Scabies mites are mainly spread through close, skin-to-skin contact but can also be transmitted by infested clothing, bedding, or towels.
The most effective treatments are topical or oral medicines that kill the mites.
