Scabies: Itching, Rash, Treatment and Stopping the Spread

5 min read · Conditions · By the Asthra Health Care team

What is scabies?

Scabies is caused by a tiny mite called Sarcoptes scabiei that burrows into the top layer of the skin to lay eggs. The mites are too small to see with the naked eye. The body reacts to the mites, their eggs and their waste, which causes intense itching. Scabies is common in crowded homes, hostels, care homes and schools across India.

It spreads mainly through prolonged skin-to-skin contact, such as sharing a bed, caring for a child, or holding hands for a long time. Less commonly, it spreads through shared clothes, towels and bedding. Scabies has nothing to do with being dirty; anyone can get it.

Signs and symptoms

Itching usually begins two to six weeks after the first infestation, but within a few days if a person has had scabies before. The itching is typically worst at night and after a hot bath. Several family members itching at the same time is a strong clue.

• Intense itching, worse at night
• Small red bumps or blisters
• Thin, wavy grey or brown lines (burrows) on the skin
• Common sites: between fingers, wrists, elbows, armpits, waist, buttocks and genitals
• In babies: palms, soles, face and scalp can be affected

Diagnosis and complications

A doctor usually diagnoses scabies by looking at the rash and burrows and asking about itching in other family members. Sometimes a skin scraping is examined under a microscope to see the mite or eggs. A dermatoscope, a handheld magnifying device, may also help.

Scratching can break the skin and lead to bacterial skin infection, with pus-filled spots, crusts and pain. In people with very weak immunity or the elderly, a severe form called crusted scabies can develop, with thick crusts and huge numbers of mites; it is highly contagious and needs specialist care.

How scabies is treated

Scabies is treated with medicines that kill the mites, most commonly permethrin cream applied to the whole body from the neck down, or in some cases ivermectin tablets. These are used only on a doctor's prescription, and the doctor will explain how to apply the cream and when to repeat the treatment. Ivermectin is not used in young children or pregnant women.

Children, pregnant and breastfeeding women and the elderly need treatment chosen by a doctor. Babies often need the cream applied to the head and face as well. Infected spots may need antibiotics, only on a doctor's prescription. Avoid steroid creams bought without a prescription, as they can make scabies worse and hide the signs.

Treat the whole household

Everyone who lives in the same home or has close contact should be treated at the same time, even if they are not itching yet. If only one person is treated, the mites can pass back and forth between family members. Close contacts outside the home, such as a partner or carer, may also need treatment.

On the day of treatment, wash all clothes, towels and bedsheets used in the last three days in hot water and dry them in strong sunlight. Items that cannot be washed can be sealed in a plastic bag for at least three days, after which the mites die.

After treatment

Itching can continue for two to four weeks after successful treatment, because the skin takes time to settle. This does not always mean the treatment failed. Antihistamine tablets and soothing moisturisers may ease the itching; ask your pharmacist which are suitable. New burrows or new spots appearing after a few weeks may mean the treatment needs repeating.

Common reasons for treatment failure include not applying the cream to every part of the body, washing it off too early, missing the repeat application, and untreated close contacts. Keep nails short, as mites can hide under them, and apply the cream under the nails too. Avoid harsh soaps and antiseptic lotions, which irritate the skin.

When to see a doctor for scabies

See a doctor if you or your child has an itchy rash that is worse at night, especially if others at home are itching too. Return if itching gets worse or new spots appear after treatment. Your doctor or pharmacist can explain how to use scabies treatment correctly.

This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.