Scabies

Scabies is a common skin condition. People get scabies when a mite burrows into the top layer of their skin. This eight-legged bug is so small that you cannot see it on the skin. When your skin reacts to the mite, a very itchy rash develops.

Scabies

HOW DID YOU GET SCABIES?

Scabies is contagious. People get the mites on their skin through direct skin-to-skin contact. The longer the skin-to-skin contact, the more likely you are to have mites transferred to you from someone who is infected. A quick handshake or brief hug usually does not spread mites. Adults often get scabies through sexual contact.

It also is possible to pick up the mites by sharing a towel, bedding, or clothing with someone who has scabies, but this is much less common.

WHO GETS SCABIES?

Anyone can get scabies. It infects people of all ages, races, and income levels. Even people who are very clean and neat can get scabies.

Some people have a higher risk of getting scabies. Because the following people have frequent skin-to-skin contact with others or a weak immune system, they have a greater risk:

• Children
• Mothers of young children
• Residents of nursing homes, assisted-living residences, and extended-care facilities
• People with weak immune systems due to disease or immunosuppressive drugs
• People who have had any organ transplant
• Sexually active adults, especially with many different partners

Scabies among people in nursing homes and extended-care facilities is a common problem. The residents need help with daily activities, so there is frequent skin-to-skin contact with staff. Scabies can spread to staff and then to other residents. People often do not know they have scabies for weeks. By then, many people may have been exposed and could have mites burrowing in their skin.

WHAT ARE THE SIGNS AND SYMPTOMS OF SCABIES?

Common signs and symptoms are:

• Itching, especially at night
• A rash that looks like red bumps, pimples, or hives
• Scratching, which can cause sores that may get infected
• Scratching can be so intense that the person bruises his/her skin

A person who has never had scabies may not develop signs and symptoms for two to six weeks. If a person has had scabies in the past, the itching usually begins within one to four days of contact.

The most common places on the body to find the scabies mites are:

• Hands, especially between the fingers, on the wrists and around the nails
• Skin covered by jewelry, such as under a bracelet, watchband, or ring
• Skin covered by clothing, such as the elbows, buttocks, belt line, groin, penis, or around the nipples

In children, scabies can affect the entire body, including the palms, soles, and scalp. Children, including babies, who have scabies, may be tired and irritable from lack of sleep. Scratching at night can keep them awake. Unlike adults, children often get blisters from a scabies infection.

Crusted scabies (Norwegian scabies)

WHAT IS CRUSTED SCABIES (NORWEGIAN SCABIES)?

Some people get a severe form of scabies. People who get crusted, or Norwegian, scabies have hundreds to thousands of mites in their skin. By contrast, most people who get scabies have 10 to 15 mites burrowing in their skin.

Crusted scabies occurs mostly among people who have weakened immune systems, including HIV disease. Crusted scabies is very contagious.

When people get crusted scabies, they have thick crusts on their skin. These crusts often cover large areas of the body. It also is possible to have crusted scabies only on certain areas of the body, such as the hands and feet or genitalia. The thick crusts tend to crumble easily when touched and look gray in color.

HOW DOES A DERMATOLOGIST DIAGNOSE SCABIES?

To find out if you have scabies, your dermatologist will examine you from head to toe. Your dermatologist may scrape off a tiny bit of skin, put the scrapings on a glass slide, and look at it under a microscope. If your dermatologist sees mites or their eggs, you have scabies.

HOW DOES A DERMATOLOGIST TREAT SCABIES?

If you have scabies, treatment is essential. Treatment should begin as soon as you know you have scabies. Treatment will relieve itching and also prevent you from spreading scabies to others.

Scabies

Everyone with whom you have close contact should receive treatment at the same time. This includes:

• Everyone in your household
• Sexual partners
• Residents and staff at nursing homes or assisted-living residences
• Day care or school classmates, teachers, and other staff

To get rid of scabies, even people who do not have any symptoms should receive treatment. People often pass scabies to others before they know they have it.

Medicine that treats scabies is only available with a doctor’s prescription. Most medicines are applied to the skin. Common medicines are:

• permethrin cream is the most common treatment
• benzoyl benzoate lotion
• crotamiton cream
• lindane lotion
• sulfur ointment is only used to treat scabies in young children and pregnant

If your dermatologist prescribes one of the above medicines, you will likely apply it before bedtime. The same treatment will be repeated in exactly one week to treat any additional mites. Be sure to use the medicine exactly as directed. This will include taking a bath or shower before applying medicine to your skin.

There is also a medicine taken by mouth, called ivermectin. While not approved by the U.S. Food and Drug Administration to treat scabies, it is recommended for infections caused by parasites. Your dermatologist will instruct you if you should take this medicine and how often.

Some people need additional treatment. Your dermatologist may prescribe the following:

• An antihistamine to control the itch and help you sleep
• Pramoxine lotion to control the itch
• An antibiotic to eliminate an infection if present
• A steroid cream to ease the redness, swelling, and itch

Scabies on a child’s hand

Tips for Managing Scabies

• See a board-certified dermatologist as soon as you have symptoms or are told you have been around someone

who has scabies so you can start treatment.

• Make sure that everyone with whom you have had close contact receives treatment. It can take two to six weeks for symptoms to
• If your treatment includes a medicine that you apply to your skin, apply the medicine to clean, dry skin. Be sure to apply it from your neck to your
  • If you wash your hands after applying the medicine, be sure to reapply the medicine to your
• When you begin treatment, wash all bedding, clothes, and towels that have touched your skin during the past six
  • Use the hottest water possible and dry everything in a hot
  • Any items that cannot be placed in a washing machine should be dry cleaned or sealed in a plastic bag for at least one week.
• Vacuum your entire home. After you vacuum, throw away the vacuum bag. If your vacuum does not have a bag, empty the canister. You should wash the canister with hot, soapy water. If you cannot remove the canister, wipe it clean with a damp paper
• Do not treat your pets. The mite cannot survive on animals. Pets do not need

A board-certified dermatologist is a medical doctor who specializes in treating the medical, surgical and cosmetic conditions of the skin, hair and nails. To learn more about scabies, visit aad.org or call toll free (888) 462-DERM (3376) to find a board-certified dermatologist in your area.

All content solely developed by the American Academy of Dermatology.
Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

American Academy of Dermatology

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Web: aad.org

Email: mrc@aad.org

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