Scabies

Itching is the main symptom of scabies, and it is often worse at night. It can take about a month from the beginning of the infestation for the symptoms to appear.

A person affected by scabies will usually have a mixture of scratch marks and tiny red spots on their skin. Scratched areas may develop crusty sores which can become infected and develop into small pus-filled spots. A widespread rash like eczema is common.

The scabies rash usually spreads across the whole body, apart from the head and neck. It often affects skin between the fingers, around the wrists, under the arms, and around the waist, groin, and bottom. Sometimes older people and young children may develop a rash on their head, neck, palms, and soles of their feet.

People with a weakened immune system can sometimes get a rare and very contagious type of scabies, called crusted scabies. The main symptom is a crusted, flaky rash that often affects the elbows, knees, hands, and feet.

The mites that cause scabies are smaller than a pinhead. They are usually spread by direct skin-to-skin contact with someone who already has scabies and sometimes, but rarely, from shared clothing, towels, or bedding. People affected by scabies have an average of about a dozen adult mites on/in their skin; a few may carry many more. Anyone can get scabies as it is very easily spread between people. It is not caused by being dirty or unhygienic.

For people who have Crusted scabies, there are thousands of scabies mites on the skin in this variant and it is therefore highly contagious.

The clinician will usually be able to diagnose scabies based on the history provided and examination of the skin. You may have been in contact with someone who has been diagnosed with scabies and has the typical symptoms.

Scabies is not usually a serious condition, but it does need to be treated. It clears up quickly and completely; but if it is not treated, it can last for months or even years. Prompt treatment of all those affected, and any possible contact, is required to manage symptoms and prevent complications and spread.

The best way to treat scabies and avoid recurrence is to ensure that all family members, friends, and other close contacts (see below) are treated correctly at the same time, even if symptoms are not present.

Who should be considered a ‘contact’?

Contacts will include all household members and sexual partners. It could also include any other skin contacts such as members of sports teams and individuals who do not live in an affected household but provide care, e.g. visiting family members, child minders and adult day care providers. Not all individuals with scabies have itch and rash.

Asymptomatic people will re-infest their contacts if they are not treated at the same time. It is important to recognise that some will feel shame or guilt, which may have an impact on use of treatments, however, anyone can be infested by scabies. Informing and reassuring relevant contacts so that they can receive effective treatments is vital to stop the spread of scabies.

Treatment options

Several treatments are available including topical (applied to the skin) and oral (tablets). Effective topical treatments include permethrin cream and malathion (spray). These can be prescribed, bought over the counter, or purchased from on-line pharmacies without a prescription.

The doctor may suggest different options for resistant cases, women who are pregnant or breast-feeding and for babies.

Advice for application of topical treatments

The mites may be anywhere on the skin, so the treatment must be applied to ALL areas of the skin, and not just to the itchy parts.

Treatment is best applied at night – see below for tips on how to use:

1. Remove all clothes.

2. Wash before treatment with cool (not hot) water, ensuring the skin creases and areas under nails are cleaned thoroughly. It is best to cut nails short.

3. Apply treatment to clean, cool and dry skin.

4. Apply to ALL areas of the skin, including all of the body, neck, scalp, and face (only avoiding areas around the eyes). The product advice may suggest not treating the scalp and face, but it is best that all these areas are treated.

5. Certain areas of skin need particular attention for treatment to be successful – ensure the product is applied generously to:

• skin between fingers and toes – ideally, remove all jewellery, or make sure to apply to the skin under jewellery – apply the product to soles of feet last
• genital skin
• skin behind ears
• nipples
• under fingernails and toenails (using a soft toothbrush can help with this).

6. Once applied, leave 10-15 minutes for the product to dry before dressing. Treatment should be left on the skin for at least 12 hours.

7. Some people may benefit from a further application 12 hours later; this will ensure the medication is on their skin for 24 hours. If any skin is washed during this time (most likely to be the hands), the product should be reapplied.8. The product should be washed off without soap initially, i.e. just water. Once completely showered, soap and/or moisturisers or emollients can be used.

8. Once treatment has been used you can return to all normal activities.

9. Treatments should be repeated as above 7 days later to ensure both the scabies mite, and the scabies eggs have been destroyed.

In most cases, the mites will not survive for long on bed linen, towels, and clothes. Normal washing of these is recommended at the same time as treatment. Any item that cannot be washed should be placed in sealed bags for 3 days.

When scabies has been caught from a sexual partner, a full sexually transmitted infection (STI) check should be considered if appropriate.

WHAT SHOULD I DO IF MY SYMPTOMS DO NOT IMPROVE?

Even after the mites have been killed by treatment, the itching usually carries on for a few weeks before settling. Scabies treatments applied to the skin can cause skin irritation: this can be one cause of an ongoing rash and itch. Moisturisers (emollients), topical corticosteroids (steroid creams or ointments) and antihistamine tablets may be used if needed. A recurrence of scabies is, unfortunately, quite common, especially if not all contacts are treated at the same time. If scabies is ongoing or recurrent, then all cases and all relevant contacts will need further treatment. If skin problems do not settle 6-8 weeks after treatment or if there are any ongoing concerns, then a review of the skin by a health care professional should be arranged.

• If your child is under 2 years old and has symptoms of scabies or someone else in your household has scabies
• If you have scabies and think your skin may also be infected (e.g. spreading red patches) or have another skin condition, such as eczema
• If you have a crusted, flaky rash on your elbows, knees, hands, or feet
• If you have used pharmacy treatment for scabies and your skin is still itching 2 to 4 weeks after treatment has finished

Complications of scabies

Scratching the rash can cause skin infections like impetigo.

Scabies can make conditions like eczema or psoriasis worse.

Useful information about …

Scabies- NHS: https://www.nhs.uk/conditions/scabies/

Scabies- British Association of Dermatology: https://cdn.bad.org.uk/uploads/2021/12/19174008/Scabies-update-PIL-Oct2023.pdf

Scabies- British Paediatric Association of Dermatology: https://bspad.co.uk/scabies/

Your GP may ask for specialist advice if:

• Treatment is required in a child under 2 months of age. Scabies is rare in this age group, and Specialist advice should be sought, for example from a paediatric dermatologist.
• Crusted scabies is suspected. People with crusted scabies should be isolated and admission to hospital may be required.

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

• Waiting times

• Find services near you