Most common places for scabies

Scabies

Is this your child’s symptom?

  • A very itchy rash caused by the scabies mite
  • A mite is a tiny, invisible bug that burrows under the skin
  • A doctor has told you your child has scabies or
  • Your child has had close contact with another person who has it

Symptoms of Scabies

  • Widespread little red, bumpy rash that mainly involves the skin folds.
  • Intense itching is the main symptom. If it doesn’t itch, it’s not scabies.
  • Appearance. The small red bumps are often in short straight or wavy lines. These are the burrows/tunnels of the mite. The bump or water blister is where the mite entered the skin.
  • Location. Classic scabies is found in skin creases such as finger webs. Hands and wrists are the most common sites. Armpits, groin, scrotum, buttocks, navel, waist, and ankles can be involved.
  • The face and neck are usually spared. In infants, the rash can involve the face and scalp.
  • The rash usually looks the same on both sides of the body.

Cause of Scabies

  • Scabies mite
  • Scabies comes from skin-to-skin contact with someone who has scabies.
  • After contact, a person will come down with scabies rash in 4 to 6 weeks.
  • Itching is the first symptom.
  • The rash and itching are the body’s allergic reaction to mites in the skin.
  • Can occur in anyone and does not mean poor hygiene.
  • Scabies mites do not carry any disease.

Prevention of Spread to Others

  • Scabies is very contagious and prevention is difficult.
  • It’s best to treat everyone who has had close contact.

When to Call for Scabies

Call Doctor or Seek Care Now

  • Spreading red area or streak with fever
  • Your child looks or acts very sick

Call Doctor Within 24 Hours

  • Spreading red area or streak, but no fever
  • You think your child needs to be seen

Call Doctor During Office Hours

  • Your child had close contact with someone with scabies and not treated
  • Yellow soft scab that drains pus or gets bigger, not better with antibiotic ointment
  • Severe itching not better after 48 hours of steroid cream and allergy medicine
  • Rash goes away with treatment and then returns
  • After 4 weeks, itch is still present
  • You have other questions or concerns

Self Care at Home

  • Scabies infection

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Scabies

  1. What You Should Know About Scabies:
    • Scabies are easy to treat. Itching is the problem.
    • The itching normally lasts for 2 weeks after the scabies mites are killed.
    • Treatment with the anti-scabies cream does not help the itch.
    • The itching is an allergic reaction. The body reacts to the dead mites and eggs in the skin. It continues until all the skin containing the dead mites is shed. This usually takes 2 weeks.
    • Continuing to have the itch does not mean that the treatment didn’t work. It also doesn’t mean that it needs to be repeated.
    • Here is some care advice that should help.
  2. Treating Close Contacts:
    • Scabies is easily spread to others. The symptoms don’t start for an average of 30 days.
    • Therefore, everyone living in the house should be treated before they develop a rash.
    • Close contacts only need to be treated once with the scabies cream.
  3. Anti-Scabies Medicine (Prescription):
    • Scabies is treated with a prescription cream. (Currently, the most common product is Elimite).
    • If applied correctly, it’s almost 100% effective at curing scabies.
    • Apply the cream from the chin to the toes. Cover every square inch of the body. Don’t forget the navel, between the toes, under the fingernails and all the creases.
    • Areas that don’t seem infected still need to be covered with the cream.
    • Caution: Infants less than 1 year old also need the cream applied to the head. Put it on the scalp, forehead, temples, ears and neck. Avoid putting it around the eyes and mouth.
    • Bedtime is usually the best time to apply it.
    • Eight to 12 hours later give your child a bath with warm water. This will remove the cream.
    • One treatment is usually effective. For severe rashes, repeat the treatment 1 week later.
    • Approved for as young as 2 months old.
  4. Steroid Cream for Itching:
    • For relief of itching, apply 1% hydrocortisone cream (such as Cortaid). No prescription is needed.
    • Do this 3 times per day to the most itchy spots.
  5. Allergy Medicine for Itching:
    • For severe itching, an oral allergy medicine (such as Benadryl) should help.
    • Age Over 1 Year: Give Benadryl 4 times per day. No prescription is needed.
    • Age Over 2 Years: Another option is to give cetirizine (such as Zyrtec) each morning. Use Benadryl at bedtime. No prescription is needed.
  6. Cool Baths for Itching:
    • For flare-ups of itching, give your child a cool or lukewarm bath. Bathe for 10 minutes.
    • Can add baking soda 2 ounces (60 mL) per tub.
    • Avoid all soaps. Reason: Soaps make the itching worse.
  7. Cut Nails for Itching:
    • Discourage scratching.
    • Cut the fingernails short. Reason: Prevents a skin infection from bacteria.
  8. Cleaning the House:
    • Live scabies mites are in clothing your child has worn in the last 3 days.
    • Machine wash all your child’s sheets, pillowcases, underwear, pajamas, and other recently worn clothing. Use hot water. High dryer temps also kill mites.
    • Put items that can’t be washed (such as blankets) into plastic bags. You need to keep them in the bags for 4 days to kill the mites. Scabies cannot live off the human skin for more than 3 days.
  9. What to Expect:
    • One treatment with a prescription anti-scabies cream usually helps. This usually kills all the scabies mites and eggs. Make sure you leave it on for 8-12 hours.
    • The rash will heal up and go away in 2 weeks. There shouldn’t be any new rash after treatment.
    • The itching may last up to 4 weeks. Reason: It’s an allergic reaction to the dead scabies.
  10. Return to School:
    • Your child can return 24 hours after one treatment with the anti-scabies cream.
  11. Call Your Doctor If:
    • Rash looks infected (draining pus, scabs become larger)
    • Itching becomes worse or lasts over 4 weeks
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 02/01/2020

Last Revised: 03/14/2019

Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.

Scabies is a very contagious skin condition that’s common around the world. Although the infections are uncomfortable, they usually can be treated easily.

Causes

Scabies isn’t like other skin conditions. Whereas most skin problems are caused by allergies, viruses or genetics, scabies infections come from mites. A microscopic mite called the human itch mite (Sarcoptes scabiei var. hominis) burrows into the upper layer of a person’s skin, where it lives and lays two to three eggs each day.

Scabies is more common in places that have limited health care and large populations, such as Central and South America, Africa, northern and central Australia, the Caribbean, India and Southeast Asia, according to the U.K. National Health Service. Nursing homes, prisons, extended-care facilities and child care facilities often can have scabies outbreaks because of the close contact of the people there.

Any contact with the human itch mites can transmit these critters. For example, they can be transmitted sexually, or they can be passed on when people share infested bedding and clothing. People can even transmit the mites when shaking or holding hands, according to the Illinois Department of Public Health.

“Transmission of scabies is usually from person to person by direct contact,” said Karnika Kapoor, a primary care physician at Medical Offices of Manhattan. “Transmission from parents to children, and especially from mother to infant, is routine. In typical conditions, mites can survive off a host for 24 to 36 hours.”

A scabies infection often appears as little red bumps or blisters on the skin. (Image credit: Joe Miller/CDC)

Symptoms

Though scabies has very few symptoms, it can be very uncomfortable. The prominent symptoms of scabies are itching and little red bumps or blisters on the skin (on the fingers and webbing between the fingers and areas with skin folds), Kapoor said. “Itching is often severe and usually worse at night,” she said.

In infants and young children, the bumps may form around the neck, scalp, face and palms, as well as on the soles of the feet.

If a person has had scabies before, the symptoms may develop within a few days. For people who haven’t had it previously, it may take as long as six weeks for symptoms to begin. However, anyone who is infected with scabies is contagious even if he or she does not have symptoms, according to the Mayo Clinic.

A subtype of scabies called crusted scabies, or Norwegian scabies, is more severe than other types because it can infect people with compromised immune systems, such as people who have AIDS or transplant patients. People with healthy immune systems are able to fight off scabies to a certain extent. Those with a compromised immune system can’t fight it off as well and it evolves into crusted scabies. This type of scabies causes crusty areas on the skin that contain large amounts of mites and eggs, according to the Centers for Disease Control and Prevention (CDC).

Diagnosis & Treatment

Good timing and adequate communication are essential to the success of scabies treatment, Kapoor said. A medical professional may suspect scabies if the patient has one or more of the following symptoms:

  • Widespread itching that is worse at night.
  • Itchy eruptions with characteristic lesions and distribution.
  • Other household members with similar symptoms.

The doctor also may examine a sample of the patient’s skin under a microscope, to look for eggs or mites in the skin.

The human itch mite (Sarcoptes scabiei var. hominis) is a microscopic bug that burrows into the skin and lays eggs. (Image credit: Bohart Museum of Entomology)

When scabies has been diagnosed, treatment is simple. Kapoor said there are two main methods for treating it. One way is to apply a cream containing an insecticide called permethrin. Patients massage it thoroughly into the skin from the neck to the soles of the feet, including areas under the fingernails and toenails, Kapoor said. The other method is to take an oral prescription medication called ivermectin, she added.

A doctor may prescribe Lindane lotion or Crotamiton (Eurax) creams instead of permethrin, or he or she may recommend antihistamines because they can help control the itching. Itching often persists for one to two weeks even after successful treatment because the mites, mite feces and mite eggs have irritated the skin and it needs time to recover.

People who live with or otherwise come into close contact with the person who is infected with scabies also must be treated. The infected person also must wash, in hot water, all of the clothes and linens that everyone in the household has used recently, in order to prevent reinfection with the mites. The mites can live for 48 to 72 hours without human contact, according to the American Academy of Dermatology.

Additional resources

Scabies

Human scabies is not a reportable disease in Oklahoma; however, the Oklahoma State Department of Health will work with facilities to provide educational materials if an infestation of human scabies is identified. Scabies is caused by a parasitic insect, the human itch mite (Sarcoptes scabiei var. hominis). These microscopic mites burrow in the upper layers of the skin where they live and lay eggs.

The symptoms of scabies include a red, pimple-like rash and itching, which can be more severe at night. Nodules or vesicles may also be seen. Tiny burrows can sometimes be seen as crooked grayish-white or skin colored thread-like lines on the skin surface. Common sites for scabies are between the fingers, wrists, elbows, armpits, shoulder blades, breasts, waist, buttocks, and genitalia. In children younger than 2 years of age, a rash can appear on scalp, face, neck, palms, and soles. Scratching of pimples or vesicles can cause sores that can develop secondary bacterial infections.

When a person is exposed to scabies for the first time, symptoms may not appear for up to 2 months after being infected. People who have had scabies previously may show symptoms as soon as 1-4 days. It is important to remember that an infected person can still transmit scabies to others even when there are no apparent symptoms. Scabies are transmitted through prolonged skin-to-skin contact with a person infected with scabies. Scabies can be easily transmitted to sexual partners or to other household members. The use of shared items – such as clothing, towels, or bedding of an infected person – can spread scabies infection. Scabies spreads more rapidly in crowded, institutionalized settings such as child care facilities, nursing homes, extended-care facilities, and prisons. Suspected scabies should be reported to your healthcare practitioner immediately so that prompt diagnosis and treatment can reduce the chance of spread.

Scabies are treated through a scabicide lotion. While some of these lotions are available “over-the-counter”, a physician should be consulted for correct diagnosis before treatment. Package instructions on the medication should be followed carefully. People who have been in close contact with the infected person should also be treated to prevent reinfestation. All clothing, linens, and bedding should be washed in hot water. Furniture and carpet should be thoroughly vacuumed. Items that cannot be washed should be placed and sealed in a garbage bag for at least 72 hours. Fumigation is not necessary.

Symptoms can sometimes continue after treatment. If itching lasts more than two weeks after treatment or if new burrows or rash appear, a physician should be consulted to determine if retreatment is necessary. A person who has correctly completed one treatment for scabies (along with laundering clothing and bedding) can safely return to work, school, or daycare.

Scabies in a Long Term Care Center:

Who should I notify if I feel my family member has scabies?
You should speak with a nurse at the facility. A skin scrapping by a physician is recommended to confirm a person has scabies.

Who should I contact if a scabies infestation is occurring at the long term care facility my family member lives at?
Long term care centers notify the Acute Disease Service about suspect scabies infestations to obtain information about control of scabies within an institutional setting. We provide educational material to the facility on controlling and preventing an infestation. The facility also notifies the long term care service at the Oklahoma State Department of Health.

Scabies at a School:

Who should I notify if I feel my family member has scabies?
You should notify the school nurse and your health care provider. A skin scraping by a health care provider is recommended to confirm a person has scabies. Notify the school nurse if a skin scraping was performed.

Is the school required to send a letter home if an individual with scabies is in the same classroom as my child?
Speak to your school officials to ask when a letter would be sent home to notify parents about a child with scabies. The Oklahoma State Department of Health Acute Disease Service does not require a letter to be sent home.

Resources:

Scabies Fact Sheet (55kB.pdf)

Reference Table for Scabies Treatment (127kB.pdf)

Long Term Care Facility Resources:

Guidelines for Controlling Crusted Scabies Outbreaks in Institutional Settings (323kB.pdf)

Guidelines for Controlling Non-Crusted Scabies Outbreaks in Institutional Settings (308kB.pdf)

Other Resources:

Scabies (CDC)

Scabies in Institutional Settings (CDC)

How to Know if That Rash Is Scabies

“I have had people with absolutely no rash who are just itchy,” says Amy Kassouf, MD, a dermatologist at the Cleveland Clinic in Ohio. “It’s really an allergic reaction to the mite that makes you so itchy. Not everyone shows that as a rash.”

While the itching may be unpleasant, treating it is usually fairly straightforward, as long as you follow the recommended steps. When you go to your doctor for treatment, they may recommend an antihistamine and permethrin, which is applied to the skin to kill the mites. Usually, you apply it at bedtime.

“People can itch even if treated, but they will feel progressively better,” says Beth Goldstein.

Two applications of permethrin are recommended. Five to seven days after the first treatment, you’ll need a second treatment with permethrin to kill off mites that have hatched in the interim. This second step is important to prevent having to start the treatment cycle again.

RELATED: What Bit Me?

Getting the Entire Household Scabies Free

In families or households where one person has scabies, you’ll need to be proactive about treating everyone for scabies — even if they don’t have symptoms. That goes for babysitters or frequent visitors like grandparents, too.

“When one family member in a household gets diagnosed, in order to effectively treat that household, you have to treat everyone who lives there — not just the people who have rashes or are itchy,” says Gehris.

“If you don’t successfully treat it, it’s going to continue,” says Dr. Adam Goldstein.

That’s especially important for families to keep in mind. In addition to treating the person with scabies, the bedding, clothes, and towels need to be washed in hot water and dried on a hot setting, or dry-cleaned to rid them of the parasites.

Items that cannot be washed should be sealed in a plastic bag for 72 hours or more to kill the mites. This effectively decontaminates things like toys and other objects handled by the infected person or household members, in order to keep the mites from continuing to spread, notes the Centers for Disease Control and Prevention.

Additional reporting by Deborah Shapiro.

Scabies: Diagnosis and treatment

How do dermatologists diagnose scabies?

A dermatologist can often diagnose scabies by visually examining a patient’s skin from head to toe.

To make sure that a patient has scabies, a dermatologist may remove some skin. This is painless. Your dermatologist will put the skin on a glass slide and look at the slide under a microscope. If your dermatologist sees scabies mites or their eggs, it is certain that you have scabies.

How do dermatologists treat scabies?

To get rid of scabies, treatment is essential. Medicine that treats scabies is only available with a doctor’s prescription.

Who needs treatment?

The person diagnosed with scabies and everyone who has had close contact with that person need treatment. Even people who do not have any signs or symptoms must be treated. This is the only way to prevent new outbreaks of scabies weeks later. People who should be treated include:

  • Everyone who lives with the person

  • Recent sexual partners

Most people can be cured with a medicine that they apply to their skin. These medicines are often applied to all skin from the neck down. Infants and young children often need treatment for their scalp and face, too. A dermatologist will provide specific instructions to follow.

Most medicine is applied at bedtime. The medicine is then washed off when the patient wakes up. You may need to repeat this process one week later.

It is important to follow your dermatologist’s instructions. Treating the skin more often than instructed can worsen the rash and itching.

Medicines that may be prescribed include:

  • 5% permethrin cream: This is the most common treatment for scabies. It is used to treat patients 2 months of age and older and women who are pregnant.

  • 10% crotamiton cream

  • 25% benzyl benzoate lotion

  • Sulfur (5%-10%) ointment

  • 1% lindane lotion

Treatment for widespread scabies

Scabies that covers much of the body and crusted scabies often require stronger medicine. A patient with this type of scabies may receive a prescription for ivermectin. This medicine can be prescribed to children and patients who are HIV-positive. Some patients need only to take one dose, but many need to take two or three doses to cure scabies. The pills are usually taken once every two weeks.

When scabies infects many people at a nursing home, extended-care facility, and other institution, ivermectin may be prescribed to everyone who has a risk of catching scabies.

Other signs and symptoms

Some patients need other treatment, too. Your dermatologist may prescribe:

  • Antihistamine: To control the itch and help you sleep.

  • Pramoxine lotion: To control the itch.

  • Antibiotic: To wipe out an infection.

  • Steroid cream: To ease the redness, swelling, and itch.

Outcome

Treatment can get rid of the mites, eliminate symptoms such as itch, and treat an infection that has developed. For the first few days to a week, the rash and itch can worsen during treatment. Within four weeks, your skin should heal.

If your skin has not healed within 4 weeks, you may still have mites. Some people need to treat two or three times to get rid of the mites. Be sure to see your dermatologist for treatment. You should never use a scabicide used to treat crops or livestock.

People who develop crusted scabies, also known as Norwegian scabies, often need repeat treatments to get rid of the mites.

To get rid of the mites and prevent getting scabies again, you have to do more than treat the skin or take a pill. You will need to wash clothes, bedding, and towels to get rid of mites that may have fallen off your skin. You also should vacuum your entire home.

Related AAD resources

  • Ask a Dermatologist: How do I get rid of scabies?

Centers for Disease Control. “Scabies: Medications.” Last accessed August 2, 2017.

Chosidow O. Clinical practices. “Scabies.” N Engl J Med 2006; 354: 1718-27.

Czelusta A, Yen-Moore A, Van der Straten M et al. “An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients.” J Am Acad Dermatol 2000; 43: 409-32; quiz 33-6.

Elston DM. “Controversies concerning the treatment of lice and scabies.” J Am Acad Dermatol 2002; 46: 794-6.

Habif, Campbell, Chapman, et al. In: Dermatology DDxDeck. 2006. China. Mosby Elsevier. Card #92: “Scabies.”

Jacobson CC, Abel EA. “Parasitic infestations.” J Am Acad Dermatol 2007; 56: 1026-43.

Steen CJ, Carbonaro PA, Schwartz RA. “Arthropods in dermatology.” J Am Acad Dermatol 2004; 50: 819-42, quiz 42-4.

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