Medically reviewed by: Dr Ann Nainan, GP (UK) — MBBS, MRCGP
Summary: Scabies is a skin condition caused by tiny mites. These mites spread easily from one person to another when people come into contact. The main sign is intense itching, especially at night. You might see thin, wavy lines on the skin, usually between your fingers, on your wrists, around your waist, or near your private parts. To get rid of scabies, most people use a special cream after a doctor checks for it (permethrin 5%). You put it on your whole body and use it again in a week. Everyone you live with should use the cream too, as scabies spreads easily, and they might also have it. You should wash your clothes and bedding from the last 3 days in hot water. After treatment, your skin may still itch for 2 to 4 weeks as it improves.
Table of contents
- What is scabies?
- Pictures & common sites
- Symptoms
- Causes & transmission
- Who is most at risk?
- Diagnosis (and when to seek care)
- Treatment (topicals, oral options)
- Home care & decontamination
- Prevention
- When it’s not scabies
- FAQs
- Medical references and date
- Disclaimer & copyright
What is scabies?
Scabies happens when tiny bugs called mites get into your skin. The female mite makes small tunnels and lays eggs, which makes your skin itchy and gives you a rash. Anyone can get scabies. It does not matter how clean you are. You are more likely to get it if you are close to someone who has it.
Key clinical cues (at a glance):
- Night-time itch is more severe than the visible rash.
- Burrows: thin, wavy/linear tracks; often on wrists, finger webs, waistline, genitals
- Household clustering: others you live with at home, itching, especially at night
Pictures & common sites
Your skin can vary in colour. Clinicians will typically look for some key signs.
- Finger webs, sides of fingers
- wrists, elbows
- Waistline, buttocks
- Nipples, penis, scrotum
- In young children/older people/and immunocompromised individuals, palms, soles, and scalp may be involved.
Symptoms
Scabies video
If you have never had scabies before, it can take 2 to 8 weeks after touching someone with scabies and infection for symptoms to start. The main symptom is usually itching, which is generally worse at night. The rash looks like small bumps or blisters. If you scratch, your skin can get sore, and sometimes break or bleed. You might see thin, wavy lines on the skin, but these can be hard to see.
- Secondary changes: pigmentation (darkening, thickening skin) from scratching; eczematisation
Causes & transmission
- Primary route: touching skin-to-skin contact for more time (household members, sexual partners, care settings)
- Less common: fomites (recently used clothing/linens) within a 2–3 day off-host survivability window
- Animals: do not transmit human scabies (different mite variants)
Who is most at risk?
- Close-contact settings: households, dormitories, care homes, detention facilities
- kids, older people >70, immunocompromised: are at a higher risk of crusted scabies (hyperinfestation; needs urgent specialist input)
- People on immunosuppressants, certain drugs, or with HIV/cancer may present atypically or have more severe infection
Diagnosis (and when to seek care)
Diagnosis is usually clinical (pattern, rash spread, and history). A doctor will take your story and examine the rash. Additional tests include:
- Dermoscopy (special microscope to see the skin) –>may reveal the “delta-win” jet” sign at “he burrow head
- Skin scraping / tape test for mites/eggs –> take a sample and look under the microscope
- Consider differentials to scabies: eczema, contact dermatitis, bed bugs, folliculitis, lice
Seek care urgently if:
- Crusted scabies suspected (thick scale/crusts, minimal itch, widespread involvement)
- Secondary infection –> bacteria spread – looks like (honey-colored crusts, worsening pain/swelling, fever)
- Treatment failure despite correct use –> worsening rash and symptoms or fever/pain/fluid
Treatment
First-line (topical)
- Permethrin 5% cream: apply from your neck down (include under nails, between fingers/toes, umbilicus, buttocks, genitals). Then leave for 8–14 hours; repeat in 7 days, and reapply to any washed areas.
- Treat all close contacts simultaneously to prevent ping-pong reinfection.
Alternatives or adjuncts: ONLY when a doctor advised this –>
- Benzyl benzoate 25%, sulfur 5–10%, crotamiton 10% (variable efficacy/tolerability)
- Lindane 1% is generally avoided in many guidelines because of concerns about neurotoxicity. Use it only if specifically recommended and with caution.
Oral option – Doctor prescribed – never buy and self-treat
- Ivermectin (weight-based, usually two doses 7–14 days apart) is useful when:
- Topicals are impractical (outbreaks, institutional settings)
- Crusted scabies (often in combination with topical scabicides and keratolytics)
- Refractory disease or extensive involvement
(Follow local guidance; avoid in specific pregnancy contexts; consider drug interactions.)
Symptom control
- Antihistamines (e.g., sedating option at night)
- Moderate-potency topical steroids for eczematisation (short courses)
- Antibiotics are only used if secondary bacterial infection is suspected/confirmed. So you have itched your skin, and it has broken down. Bacteria have entered through a break in the skin, causing an infection. Itching persists for 2 to 4 weeks after treatment, even when the mites are gone. This is called post-scabies itch. If you see new burrows or other people at home start itching again, it might mean the scabies has come back, or treatment didn’t work fully.
Taking care of your home
Wash your clothes, bedding, and towels in hot water and dry them in a hot dryer if you have used them in the last 3 days.
If you can’t can these items, seal them in a plastic bag and keep them for at least 3 days.
You do not need to spray or use special cleaners—just clean as you usually would.
Trim your nails, clean under them, and put on clean clothes after each night of treatment.
How to stop scabies from spreading
Treat everyone in your house, or anyone you have close contact with, at the same time.
Try not to have long or close skin contact with others until you finish the first treatment.
If you are in a group home, care home, or similar place, follow the rules for treating everyone and washing clothes and bedding.
Other skin problems that look like scabies
Eczema or dermatitis: Itchy skin, but without the thin lines (burrows) you see in scabies. It often affects the bends of your arms and legs.
Bed bugs: Bites often appear in lines or zigzag patterns, usually on uncovered areas of the skin while sleeping.
Folliculitis: Small, pus-filled spots that grow where hair comes out of your skin.
Head lice or body lice: Tiny bugs and their eggs are found on hair, usually on your head or body, not in the same places as scabies.
FAQs (patient-friendly, snippet-ready)
How long will I itch after treatment?
It’s not itching to last 2 to 4 weeks while your skin heals. If the itch or rash gets worse, you see new lines, or other people at home start itching, see your doctor—it might mean the scabies is still there.
Do we need to treat everyone in the house?
Yes. Same-day treatment for close contacts reduces the risk of reinfestation.
Permethrin or ivermectin—what’s what?
Both treatments work well, but most guidelines recommend permethrin 5% as the first choice. Ivermectin is especially helpful for outbreaks, crusted scabies, or when creams cannot be used properly, according to the NHS, CDC, and WHO.
Do I need to fumigate the house?
No. Focus on washing/bagging items used in the last 72 hours.
Is it contagious after the first treatment?
Contagiousness drops quickly after the proper first application/dose, but complete the full protocol and treat contacts.
Mini FAQ
- Key sign? Night itch with thin burrows in warm skin folds.
- First-line? Permethrin 5% neck-down; repeat in 7 days.
- Contacts? Treat simultaneously.
- Laundry? Hot-wash/dry items from the last 72 hours or bag for 72 hours.
- Still itching? 2–4 weeks can be normal; new burrows/new cases need review.
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