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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Scabies is a contagious condition caused by tiny mites that burrow into the skin and cause intense itching and rashes.
While scabies isn’t dangerous, it can seriously impact your quality of life. Treating it quickly will reduce the chance of passing it to others (Gilson, 2020).
If you think you might have a case of scabies, here’s everything you need to know about the condition, including symptoms, causes, and how to treat it.
How common is scabies?
An estimated 300 million people are infected with scabies each year. It’s often seen in developing countries and places where poverty, homelessness, poor hygiene, and nutritional deficiencies are common.
You’re also at a higher risk of contracting scabies living in crowded living quarters like military barracks, prisons, nursing homes, hospitals, and long-term care facilities (Gilson, 2020).
The most prominent symptom of scabies is intense itching accompanied by a rash that sometimes appears in a line. The itching usually gets worse at night.
You may also notice small bumps or blisters where mites have burrowed under the skin and laid eggs. Scabies can be difficult to diagnose because the rash looks similar to insect bites, pimples, or eczema (Tarbox, 2018).
And while scabies isn’t particularly dangerous, scratching the itchy lesions can result in a skin infection caused by bacteria that normally live on your skin. This infection, known as impetigo, may require antibiotics to treat (Romani, 2015).
How does scabies spread?
Scabies is transmitted by direct skin-to-skin contact––including sexual contact. It also spreads through contact with things like clothing, sheets, and furniture that has been used by someone with scabies (Dressler, 2016).
Common sites of infestation
Scabies usually takes about 10 minutes of skin-to-skin contact to spread. It is also more likely to infect spots where the skin is thin, including areas like (Gilson, 2020; Tarbox, 2018):
- Palms and between the fingers
- On feet and between the toes
- Around the beltline
- Underneath jewelry or watches
In young children, scabies rashes may be seen on the face, neck, and scalp (Anderson, 2017).
How is scabies diagnosed?
Even an experienced medical professional may have trouble diagnosing scabies.
Scabies isn’t common in the United States and can easily be mistaken for other skin conditions. One study found that 45% of people with scabies had been misdiagnosed by a healthcare provider (Anderson, 2017).
To test for scabies, a healthcare provider will start with a simple skin examination. If eggs, droppings, or mites are found, it can help confirm the diagnosis. They might also ask you if you’ve been in a situation in which you could have been exposed to scabies (Gilson, 2020).
Luckily, the treatment for scabies is highly effective. You’ll most likely receive a prescription for a lotion called permethrin, which cures more than 90% of cases (Strong, 2007).
Rubbing it on the skin once a week for two weeks is usually very effective at killing the mites. If you don’t apply it properly, though, scabies can persist and continue to cause problems.
Topical permethrin isn’t always enough––there is some evidence that scabies has developed resistance to the treatment. (Anderson, 2017).
Another equally effective treatment is a pill called ivermectin. You only take ivermectin once or twice, making it convenient and safe for most people (Gilson, 2020).
If you have an underlying health condition that weakens your immune system, a simple case of scabies can develop into something more serious: crusted scabies.
Typical scabies cases involve just 10-15 mites, but crusted scabies involve millions of mites and can cause a more severe infection. Because of the vastly higher density of mites, it takes far less time to transmit crusted scabies (Dressler, 2016).
This condition causes severe skin lesions that are less like individual bites and more like large red patches. Lesions can easily become infected with other bacteria, and the resulting infection can be very dangerous. Treatment usually involves a combination of topical and oral treatments (Hasan, 2020).
If you’ve been in the presence of someone who has been diagnosed with scabies, the best thing to do is get tested and treated quickly.
Make sure the bedding, towels, and clothes of infected individuals are machine-washed in hot water and then thoroughly dried on high heat.
Mites can survive for about 72 hours without a host, so avoid touching anything an infected person has come in close contact with during the past three days (Tarbox, 2018; Matsuura, 2019). It’s also helpful to isolate yourself until the infection has resolved.
If you’ve been near someone diagnosed with scabies, spent time in a nursing home or other crowded facility, and experienced an itchy rash that worsens at night, you should visit a healthcare professional to see if you have scabies.
Remember, getting diagnosed and treated quickly helps stop scabies from spreading, so make sure those itchy nights stop with you.
- Gilson, R. L., & Crane, J. S. (2020). Scabies. In StatPearls. StatPearls Publishing. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31335026/
Tarbox, M., Walker, K., & Tan, M. (2018). Scabies. JAMA, 320(6), 612. doi: org/10.1001/jama.2018.7480. Retrieved from https://jamanetwork.com/journals/jama/fullarticle/2697011
Anderson, K. L., & Strowd, L. C. (2017). Epidemiology, Diagnosis, and Treatment of Scabies in a Dermatology Office. Journal of the American Board of Family Medicine, 30(1), 78–84. doi: org/10.3122/jabfm.2017.01.160190. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/28062820/
Romani, L., Steer, A. C., Whitfeld, M. J., & Kaldor, J. M. (2015). Prevalence of scabies and impetigo worldwide: a systematic review. The Lancet. Infectious Diseases, 15(8), 960–967. doi: org/10.1016/S1473-3099(15)00132-2. Retrieved from https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00132-2/fulltext
Dressler, C., Rosumeck, S., Sunderkötter, C., Werner, R. N., & Nast, A. (2016). The Treatment of Scabies. Deutsches Arzteblatt International, 113(45), 757–762. doi.org/10.3238/arztebl.2016.0757. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27974144/
Matsuura, H., Senoo, A., Saito, M., & Fujimoto, Y. (2019). Norwegian scabies. Cleveland Clinic journal of medicine, 86(3), 163–164. doi.org/10.3949/ccjm.86a.18081. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30849040/
Hasan, T., Krause, V. L., James, C., & Currie, B. J. (2020). Crusted scabies; a 2-year prospective study from the Northern Territory of Australia. PLoS Neglected Tropical Diseases, 14(12), e0008994. doi: org/10.1371/journal.pntd.0008994. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781478/pdf/pntd.0008994.pdf
Strong, M., & Johnstone, P. (2007). Interventions for treating scabies. The Cochrane Database of Systematic Reviews, 2007(3), CD000320. doi: org/10.1002/14651858.CD000320.pub2. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17636630/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.