Patient information from BMJ

Scabies

Last published:Mar 14, 2022

Scabies is a skin infection that makes you extremely itchy. It's caused by tiny creatures called mites that burrow under your skin.

What is scabies?

You catch scabies by being in close contact with someone who is infected. Generally this means skin contact, such as with a sexual partner, or close contact with someone in your household. You wouldn't usually catch scabies just by shaking hands, for example.

The mites can only live on people. They can survive for a while on sheets, towels, and clothes, but not for very long. It is possible to catch scabies from clothes, towels, and bedding, but it's not very likely.

You might feel upset or embarrassed by the thought of mites living in your skin. But anyone can get scabies.

What are the symptoms?

Scabies makes you itch because the mites cause an allergic reaction. But it can take several weeks before this happens. You'll also get a rash, which looks like tiny insect bites or spots. If you scratch a lot you might get crusty sores as well.

Scabies can make your whole body feel itchy. But you will probably notice a rash in just a few places. Children are more likely to get a rash over most of their body. The itching might be worse at night.

You won't usually be able to see the mites that cause scabies. They're about the size of the point of a pin. They make tunnels under your skin and lay their eggs in them. Sometimes you can see the tunnels. They look like fine silvery lines on your skin.

People with a weak immune system, such as older people and people with HIV, can get a more serious type of scabies, called crusted scabies or Norwegian scabies. The rash looks scaly or crusty and covers a much larger area of skin than ordinary scabies.

What treatments work?

If you think you have scabies, see your doctor or nurse. You will need a treatment to kill the mites. Because scabies spreads very easily, the people you live with will need treatment too, even if they don't have symptoms. If you have a sexual partner they'll also need treatment.

Most treatments for scabies come as creams or lotions that you rub on your skin. Permethrin cream is often the first treatment doctors recommend trying. Research suggests that it works better than the other available treatments.

When you use permethrin you need to cover your whole body from your neck down to the soles of your feet, including in between your fingers and toes, in your groin, and under your nails.

You then wash the treatment off after eight to 14 hours. You might need to repeat the treatment in 10 to 14 days. If you don't use the treatment properly it might not work.

Other creams and lotions for scabies include malathion, benzyl benzoate, lindane, sulfur, and ivermectin. Ivermectin also comes as a tablet. Some people prefer ivermectin tablets if they find it hard to use the creams and lotions properly.

If you use this treatment your doctor will probably recommend taking two doses of ivermectin tablets, one to two weeks apart.

If you have the severe form of scabies your doctor will probably prescribe ivermectin tablets as well as one of the creams listed above. Your doctor might also recommend using another treatment, called urea cream, to help the medicine get into your skin.

What will happen to me?

Treatment will usually kill the scabies mites. Your doctor will also advise you to wash all your bedding and clothes in hot water (at least 60°C [140°F]) and dry them in a dryer on high heat. Any items that cannot be washed should be placed in a sealed bag for one week.

If the first treatment you try doesn't work your doctor might prescribe a different type of treatment.

You might still have itching for a few weeks after treatment has killed the mites, while your skin heals. Your doctor might recommend using an antihistamine to help with the itching.

Scabies doesn't cause any long-term health problems. But there's a chance your skin could get infected with bacteria if you scratch the itch.