Medically reviewed by: Dr Ann Nainan, GP (UK) — MBBS, MRCGP.
Summary: Scabies is a contagious skin condition caused by tiny mites known as the human itch mite (Sarcoptes scabiei). These microscopic scabies mites burrow into the skin, lay eggs, and cause intense itching, especially at night. The female mite burrows just beneath the human skin, creating thin, wavy lines called scabies burrows, which are a hallmark of the infestation. Scabies generally spreads through direct skin-to-skin contact, making skin-to-skin contact the primary route of transmission. The symptoms of scabies include an itchy rash and a pimple-like rash, often found in skin folds such as between the fingers, wrists, and waist. In very young children, the soles of the feet and scalp may also be affected.
To treat scabies, topical treatments like permethrin 5% cream are commonly used. This cream should be applied to the whole body from the neck down and left on for the recommended time to kill scabies mites and mite eggs. Treatment failure can occur if all the mites, including newly hatched mites, are not eradicated or if close contacts are not treated simultaneously. Oral ivermectin is an effective alternative, especially for crusted scabies or when topical therapy is impractical.
Scabies affects people worldwide and is recognised by the World Health Organisation as a neglected tropical disease. Crusted scabies, also known as Norwegian scabies, is a severe form characterised by hyperinfestation with thousands of mites, leading to thick crusts and increased contagiousness. This form requires urgent specialist input and combination therapy to kill all mites and prevent scabies outbreaks.
Diagnosis is typically clinical, based on the scabies consensus criteria, including the presence of scabies burrows, intense itching, and characteristic scabies rash. Skin scrapings examined under a microscope can confirm the presence of mites, eggs, or faecal pellets. Differential diagnosis includes conditions like eczema, bed bugs, and lice, which can mimic scabies symptoms.
Preventing scabies involves avoiding prolonged skin contact with an infested person and promptly treating all close contacts. Decontaminating bedding, clothing, and towels in a hot dryer or sealing them in plastic bags for several daysgenerally helps kill scabies mites. Disease control efforts focus on reducing risk factors such as overcrowding and improving hygiene.
Secondary bacterial infections, often caused by Staphylococcus aureus, can develop from skin sores due to scratching. These infections can lead to complications like rheumatic fever and rheumatic heart disease if untreated. Understanding the clinical features of scabies, including nodular scabies and bullous scabies variants, is essential for effective management.
Table of contents
What is scabies?
Pictures & common sites
Symptoms of scabies
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 is a contagious skin infestation caused by mites that burrow into the skin.
The key symptom is usually intense itching at night, often accompanied by a rash or thin, wavy lines between the fingers, wrists, waist, or genitals.
This page shows clear pictures of scabies, how it spreads, the best treatment (permethrin or ivermectin), and when to see a doctor.
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
Scabies Pictures: Common Sites on the Body
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.
Scabies presents with symptoms such as severe itching and a characteristic rash. If you have never had scabies, it can take 2 to 8 weeks after initial infection for symptoms to appear. The rash looks like small bumps or blisters, often accompanied by microscopic scabies mite burrows. If you scratch, your skin can get sore, leading to skin sores and secondary bacterial infections. 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 prolonged periods (household members, sexual partners, care settings) is the main way scabies spreads.
Less common: fomites (recently used clothing/linens) within a 2–3 day off-host survivability window, where scabies mites generally cannot survive longer.
Animals: do not transmit human scabies (different mite variants)
Who is most at risk?
Close-contact settings: households, dormitories, care homes, and detention facilities are common sites of scabies outbreaks.
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 of scabies is usually clinical and can be confirmed by identifying mites, eggs, or faecal pellets in skin scrapings. Dermoscopy may reveal the “delta-wing jet” sign at the head of the burrow. The scabies consensus criteria help clinicians identify suspected scabies and clinical scabies by assessing scabies burrows, intense itching, and scabies rash.
Treatment failure despite correct use –> worsening rash and symptoms or fever/pain/fluid
Scabies Treatment: Permethrin, Ivermectin & What Works
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 to kill mite eggs and newly hatched mites.
Treat all close contacts simultaneously to prevent reinfestation and spread scabies.
Alternatives or adjuncts: ONLY when a doctor advises this –>
Lindane 1% is generally avoided due to neurotoxicity concerns.
Oral option – Doctor prescribed – never buy and self-treat
Ivermectin (weight-based oral ivermectin, 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
Symptom control
Antihistamines (e.g., sedating option at night)
Moderate-potency topical steroids for eczematisation (short courses)
Antibiotics are used only if a secondary bacterial infection is suspected/confirmed, often due to Staphylococcus aureus.
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, to kill scabies mites generally.
If you can’t wash 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.
Conditions That Look Like Scabies (Bed Bugs, Eczema, Lice)
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.
If scabies is ruled out, conditions like bed bugs, eczema, or other insect bites can cause similar itching and rashes.
FAQs
How long will I itch after treatment? It’s normal to have itching for 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 and helps prevent scabies outbreaks.
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.
Can scabies be mistaken for bed bugs? Yes. Both cause itching, but scabies itch is worse at night and causes burrows, while bed bugs cause grouped bites on exposed skin.
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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