Scabies

Overview

Scabies is a skin rash. A tiny mite called Sarcoptes scabiei causes it. The mite burrows into the skin, causing intense itching. The need to scratch may be stronger at night.

Scabies can spread through close, long-term person-to-person contact. This may be within a family, child care group, school class, or a place where people live together, such as a nursing home or prison. Because scabies spreads easily, healthcare professionals often treat the whole family or any close contacts.

Scabies is easy to treat. Medicated skin creams or pills kill the mites that cause scabies and their eggs. But itching may go on for weeks after treatment.

Symptoms

Scabies symptoms include:

• Intense itching and often worse at night.
• Thin, wavy tunnels made up of tiny blisters or bumps on the skin.

Scabies is often in the skin folds. But scabies can appear on many parts of the body. In adults and older children, scabies is most often found:

• Between the fingers and toes and on the soles of the feet.
• Around the waist.
• On the insides of the wrists, in the armpits and on the inner elbows.
• On the chest and buttocks.
• Around the nipples and belly button.
• Around the genitals.

In infants and young children, scabies most often are on the:

• Fingers.
• Scalp and face.
• Palms of the hands.
• Soles of the feet.

If you've had scabies before, symptoms may start within a few days after getting the mites. If you've never had scabies, it can take up to six weeks for symptoms to start. You can still spread scabies even if you don't have symptoms yet.

When to see a doctor

Talk to your healthcare professional if you have symptoms of scabies.

Many skin conditions, such as dermatitis or eczema, also cause itching and small bumps on the skin. Your healthcare professional can find the cause of your symptoms and prescribe the right treatment.

Causes

A tiny, eight-legged mite causes scabies. The female mite burrows just under the skin. It makes a tunnel where it lays eggs.

The eggs hatch, and the mite larvae travel to the surface of the skin, where they become adults. These mites can then spread to other areas of the skin or to the skin of other people. The itching comes from the body's allergic reaction to the mites, their eggs and their waste.

Close skin-to-skin contact and, less often, sharing clothing or bedding with a person who has scabies can spread the mites.

Pets don't spread scabies to humans. The scabies mites that affect animals don't survive or reproduce in people.

Risk factors

Risk factors for scabies include:

• Being in a child care group or school.
• Living in crowded places, such as nursing homes and prisons.

Complications

A common complication of scabies is a bacterial infection. Scratching too much can break the skin and let in bacteria that cause the infection.

A worse type of scabies, called crusted scabies, may affect certain people including:

• Young children.
• People who live in a group setting.
• People with weakened immune systems, such as those with HIV or lymphoma, or people who have had organ transplants.
• Older people.

Crusted scabies makes the skin crusty and scaly. It affects large areas of the body. It spreads easily and can be hard to treat. People with crusted scabies need quick treatment with both a prescription pill and a skin cream.

People with crusted scabies have high numbers of mites. Crusted scabies might not itch, or itching may be mild.

Prevention

To prevent scabies from coming back and to keep the mites from spreading to other people, take these steps:

• Wash all clothes and linens. Heat kills the mites and their eggs. Use hot, soapy water to wash all clothing, towels and bedding used in the three days before beginning treatment. Dry with high heat. Dry-clean items you can't wash at home.
• Starve the mites. Place items you can't wash in sealed plastic bags. Leave them in an out-of-the-way place for a week. Mites die after a few days without food.
• Clean and vacuum. It's a good idea to clean your home to prevent scabies from spreading. This is especially true for people with crusted scabies. Vacuum furniture, carpets and floors to remove scales and crusts that may have scabies mites.

Diagnosis

To diagnose scabies, your healthcare professional looks at your skin for symptoms of mites. Your healthcare professional also may scrape a sample of sores on your skin to look at under a microscope. This shows if there are mites or eggs.

Treatment

Scabies treatment involves killing the mites and eggs with a medicated cream or pill. There are several you can get with a prescription.

Because scabies spreads so easily, your healthcare professional may suggest treating all the people in your home and other close contacts. They need treatment even if they don't have symptoms of scabies.

Treatment for scabies often includes:

• Permethrin cream. Permethrin is a skin cream that kills mites that cause scabies and their eggs. Most often, you put the cream on your whole body, from the neck down. You leave it on for 8 to 14 hours, so it's best to use it overnight. You may need two treatments to get rid of the mites. You may need more treatment if you get new symptoms. It's safe for most adults, people who are pregnant or breastfeeding, and children over 2 months old.
• Sulfur cream. Sulfur cream is a scabies treatment that you put on overnight. You rinse it off in the morning and put it on again for 5 to 7 nights in a row. Keep using the cream if symptoms don't go away. Sulfur is safe to use in pregnancy and in children under 2 months old.
• Ivermectin. You can take ivermectin as a pill to treat scabies when prescription creams don't work. Healthcare professionals often prescribe it for people with crusted scabies or lowered immune systems. It's not for people who are pregnant or breastfeeding, or for children who weigh less than 33 pounds (15 kilograms).

These medicines kill mites fast, but itching may not stop for weeks.

Healthcare professionals may prescribe other skin treatments for people who can't use these medicines or don't get relief from them.

Lifestyle and home remedies

Your skin might itch for weeks after scabies treatment. Taking allergy pills by mouth or using skin creams you can get without a prescription, such as calamine lotion, may ease itching.

Preparing for an appointment

Make an appointment with your healthcare professional if you or your child has symptoms of scabies.

Here's some information to help you get ready for your appointment.

Things to do before your appointment

Make a list of:

• Symptoms you or your child has, and when they began.
• Possible sources of infection, such as other family members who have had a rash.
• Key medical information, including other health issues and the names of medicines and their dosages that you or your child takes.
• Questions to ask your healthcare professional.

Some basic questions to ask about scabies include:

• What's the most likely cause of these symptoms?
• What treatment do you suggest?
• How soon will my symptoms improve with treatment?
• Are there home remedies or self-care steps that I can use to ease symptoms?
• Can I or my child spread this to other people? For how long?
• How can I keep from spreading scabies to others?

What to expect from your doctor

Your healthcare professional may ask you questions, such as:

• Have the symptoms gotten worse over time?
• If you or your child has a rash, what parts of the body are affected?
• Have you been in close contact with anyone who has had a rash, an itch or both within the past several weeks?
• Are you pregnant or breastfeeding?
• Is your child in school or a child care group?

What you can do in the meantime

Before your appointment, try medicines you can get without a prescription to ease itching. Allergy pills and calamine lotion may help. Ask your healthcare professional which medicines are safe for your child.