Scabies

This factsheet is for people who have scabies, or who would like more information about it.

Scabies is an intensely itchy skin condition that is caused by tiny mites. It’s highly contagious and spreads through close physical contact. With the right treatment, it can be cured quickly.

About scabies

Scabies is caused by mites called Sarcoptes scabiei. The mites, which are less than half a millimetre long, burrow into the upper layers of your skin where they live and lay their eggs. The saliva and faeces (droppings) of the mites causes an allergic reaction, which results in a rash and intense itching.

In the UK, about one in 1,000 people see their GP about scabies every month. The number of people affected by the condition is rising. It’s particularly common among those who live in cities and mostly affects people during the winter months. Scabies can occur at any age, but it’s most common in children.

There are two types of scabies.

• Classical scabies. This is the most common type of scabies, which comes up in a pimple-like, intensely itchy rash on your skin.
• Crusted (or Norwegian) scabies. This is a rare type of scabies that usually only affects people who have a weakened immune system, such as those who have HIV/AIDS, or who are taking medicines that suppress their immune system. You're also more likely to develop Norwegian scabies if you are elderly, have learning difficulties, or have a condition such as dementia or Down's syndrome. Thick crusts appear usually on your hands and feet, but may not itch at all.

This factsheet is about classical scabies.

Symptoms of scabies

The most common symptom of scabies is a pimple-like rash that is intensely itchy. The itching is often worse at night or when your skin is hot, for instance after a bath or shower.

You can get scabies on your hands (particularly between your fingers), wrists, ankles and buttocks. If you are a man, you can get it on your penis or scrotum. If you're a woman, you may get it on the skin of your nipples. As well as itching and redness, you may have small nodules or bumps on your skin, which can sometimes be filled with pus. You may also be able to see tiny burrow marks in your skin. These look like thin, scaly, zigzagging lines that are greyish-white or skin-coloured. The burrow marks are very short in length (less than 1cm), but can most often be seen on the webbing between your fingers and on your hands, feet and wrists. They may, however, be obscured by the rash.

Children can get scabies on the palms of their hands and soles of their feet. In young babies, scabies may trigger widespread eczema, especially on their abdomen (tummy), chest and back. They can also develop pinkish-brown nodules.

If you have scabies for the first time (known as the primary episode), your symptoms may take two to six weeks to appear. However, if you’ve had scabies before, your symptoms may appear within a couple of days of infection.

If you have any of these symptoms, see your GP.

Complications of scabies

The scabies rash can develop into a skin infection, such as cellulitis, folliculitis, boils or impetigo. If you have eczema or psoriasis, scabies can make your condition worse.

Scabies can leave you with feelings of guilt and shame, but it’s important to remember that the condition doesn’t reflect your personal hygiene.

Rarely, people may start imagining bites or continue to feel itchy even after the infection is cleared – this is known as delusions of parasitosis.

Causes of scabies

Scabies is highly contagious and is spread easily by direct skin-to-skin contact. However, you’re unlikely to catch it through a brief handshake or a hug. You’re also unlikely to get scabies from clothing or bedding unless it was used by someone with scabies immediately beforehand. 

Diagnosis of scabies

Your GP will ask about your symptoms and examine you. He or she will also ask if any family members, or people you are in close contact with, have recently had an itchy rash. Your GP will look for burrow marks in your skin and may take a skin scraping to look for mites under a microscope. 

Treatment of scabies

Medicines

Scabies is treated with an insecticide cream or lotion. When you are treated for scabies, all your close contacts such as family members or people you live with will also need to be treated at the same time, even if they don't have any symptoms.

Your GP will usually prescribe permethrin (5%) cream or malathion (0.5%) lotion. It’s important to follow the instructions carefully and use the insecticide cream or lotion in the correct way.

• Before you apply the treatment, make sure your skin is cool and dry. Don’t use the cream or lotion immediately after a shower or bath.
• You will need to apply the insecticide cream or lotion all over your body, starting from your neck down. Make sure you cover every part of your body; especially your armpits, genitals, the webs between your fingers, and underneath your fingernails. You may need to ask someone to help you apply the cream to your back.
• In children aged up to two, the elderly and those with weakened immune systems, the treatment should also be applied to their scalp, neck, face and ears.
• You will need to leave the cream for 12 hours, so it’s a good idea to put it on overnight. The lotion should be left on for 24 hours. If you wash your hands with soap and water within this time, you will need to reapply the treatment.
• Once the treatment time has passed, wash the cream or lotion off thoroughly with plain, cool water.
• You will usually need to repeat the treatment a week later to make sure you are free from infection.
• Machine wash all your bed clothes and linen at a hot temperature (50°C or above) on the day you start your treatment. Any clothing that can’t be washed at a hot temperature can be placed in a plastic bag and left for 72 hours, after which the scabies mites will have died.
• Don’t have any close body contact with others until you and all those close to you have completed treatment.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Your skin may continue to feel itchy for two to three weeks after treatment. This is normal and doesn't mean that the treatment hasn't worked. Your GP may recommend crotamiton or hydrocortisone (1%) cream or antihistamine tablets to ease your symptoms. However, if the itching continues beyond this it’s likely you still have scabies and should see your GP. If you have a skin infection, he or she may also prescribe antibiotics.
 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.