What is Scabies? Symptoms, Causes, & Treatment

Scabies is a contagious skin condition caused by tiny mites that burrow under your skin. These microscopic creatures create tunnels in your skin's outer layer, leading to intense itching and a distinctive rash that often worsens at night.

While the thought of mites living under your skin might feel unsettling, scabies is completely treatable and more common than you might think. Millions of people worldwide deal with scabies each year, and with proper treatment, you can eliminate these mites and find relief from the uncomfortable symptoms.

What is Scabies?

Scabies happens when female mites called Sarcoptes scabiei burrow into your skin to lay eggs. These mites are so small you can't see them with the naked eye, measuring less than half a millimeter in length.

The female mites create tiny tunnels just beneath your skin's surface, where they lay 2-3 eggs daily for about 6-8 weeks. When these eggs hatch, the new mites work their way to the skin's surface and repeat the cycle.

Your body's immune system reacts to these mites and their waste products, which causes the intense itching and rash. This allergic reaction typically takes 2-6 weeks to develop if it's your first time having scabies, but only 1-4 days if you've had it before.

What are the Symptoms of Scabies?

The most telling sign of scabies is severe itching that becomes much worse at night or after a hot shower. This happens because the mites are more active in warm temperatures, and your body's natural rhythms make you more sensitive to itching during nighttime hours.

Here are the main symptoms you might experience:

• Intense itching, especially at night
• Small red bumps or blisters on your skin
• Thin, irregular lines on your skin (burrow tracks)
• Rash that may look like small red dots, hives, or eczema
• Sores from scratching the affected areas
• Thick crusts on the skin (in severe cases)

The rash typically appears in specific areas where your skin is thin and warm. You'll most commonly see it between your fingers, on your wrists, elbows, armpits, waist, and genital area.

In infants and young children, scabies often affects the head, face, neck, palms, and soles of the feet. Adults rarely get scabies in these areas, which helps doctors distinguish it from other skin conditions.

What are the Types of Scabies?

Most people develop classic scabies, but there are a few different forms of this condition. Understanding these variations can help you recognize what you might be dealing with and what to expect from treatment.

Classic scabies is the most common form, affecting healthy people with normal immune systems. You'll typically have 10-15 mites on your entire body, and the symptoms develop as your immune system responds to their presence.

Crusted scabies (also called Norwegian scabies) is a more severe form that affects people with weakened immune systems. This type involves thousands or even millions of mites, creating thick, crusty patches of skin that contain many live mites.

Nodular scabies develops when your immune system creates small, firm bumps (nodules) in response to the mites. These nodules can persist for weeks or months even after the mites are eliminated, particularly in areas like the armpits, groin, and genital region.

What Causes Scabies?

Scabies spreads through direct, prolonged skin-to-skin contact with someone who has the condition. The mites can't jump or fly, so they need close physical contact to move from one person to another.

Sexual contact is one of the most common ways scabies spreads among adults, but any prolonged touching can transmit the mites. This includes holding hands for extended periods, sleeping in the same bed, or caring for someone with scabies.

You can also catch scabies from contaminated items, though this is less common. The mites can survive away from human skin for 2-3 days, so sharing bedding, clothing, or towels with an infected person can sometimes spread the condition.

Crowded living conditions increase your risk because they create more opportunities for close contact. This is why scabies outbreaks sometimes occur in nursing homes, childcare centers, prisons, and refugee camps.

When to See a Doctor for Scabies?

You should see a healthcare provider if you have intense itching that worsens at night, especially if you notice small bumps or lines on your skin. Early treatment can prevent the condition from spreading to others and save you weeks of discomfort.

Seek medical attention promptly if you develop signs of a secondary bacterial infection from scratching. These signs include increased redness around sores, warmth, pus, red streaking from the affected area, or fever.

Contact your doctor immediately if you have a weakened immune system and suspect scabies. People with conditions like HIV, cancer, or those taking immunosuppressive medications can develop crusted scabies, which requires more aggressive treatment.

If you've been treated for scabies but your symptoms haven't improved after 2-4 weeks, return to your healthcare provider. Sometimes treatment needs to be repeated, or you might have developed a secondary infection that needs additional care.

What are the Risk Factors for Scabies?

Anyone can get scabies regardless of age, gender, or cleanliness level. However, certain situations increase your chances of exposure to the mites that cause this condition.

Living in crowded conditions creates the most significant risk because it increases opportunities for prolonged skin contact. This includes college dormitories, military barracks, nursing homes, and households with many family members.

Having a weakened immune system puts you at higher risk for developing the more severe crusted form of scabies. This includes people with HIV/AIDS, cancer patients undergoing chemotherapy, organ transplant recipients, and those taking corticosteroids long-term.

Sexual activity with multiple partners increases exposure risk, as does caring for elderly relatives or working in healthcare settings. Children in daycare centers also face higher risk due to frequent close contact during play and care activities.

What are the Possible Complications of Scabies?

The most common complication from scabies is secondary bacterial infection from scratching the itchy areas. When you scratch, you can create open wounds that allow bacteria like Staphylococcus or Streptococcus to enter your skin.

These bacterial infections can cause additional symptoms you'll want to watch for:

• Increased pain and tenderness around affected areas
• Pus-filled sores or honey-colored crusts
• Red streaking extending from the rash
• Swollen lymph nodes
• Fever and feeling generally unwell

In rare cases, untreated bacterial infections can lead to more serious conditions like cellulitis or blood poisoning. This is why it's important to avoid scratching and seek treatment promptly.

People with crusted scabies face additional complications because they're highly contagious and can easily spread the condition to family members, caregivers, and healthcare workers. The thick crusts can also make treatment more challenging and time-consuming.

How is Scabies Diagnosed?

Your doctor will start by examining your skin and asking about your symptoms, particularly the intense nighttime itching. They'll look for the characteristic rash pattern and burrow tracks, especially in common areas like between your fingers and on your wrists.

To confirm the diagnosis, your doctor might perform a skin scraping. They'll gently scrape a small sample from a burrow or bump and examine it under a microscope to look for mites, eggs, or mite waste products.

Sometimes doctors use a technique called dermoscopy, where they apply mineral oil to your skin and examine it with a special magnifying device. This can help them see the burrow tracks more clearly and identify active mites.

In cases where the diagnosis isn't clear, your doctor might suggest a trial treatment. If your symptoms improve with scabies medication, this confirms the diagnosis even if mites weren't found in the skin sample.

What is the Treatment for Scabies?

Prescription medications called scabicides kill the mites and their eggs. Your doctor will choose the best option based on your age, health status, and severity of the infestation.

Permethrin cream is the most commonly prescribed treatment for classic scabies. You'll apply this 5% cream to your entire body from the neck down, leave it on for 8-14 hours, then wash it off. Most people need just one application, though some require a second treatment after a week.

Ivermectin tablets offer an alternative, especially for people who can't tolerate topical treatments or have crusted scabies. Adults typically take two doses separated by 1-2 weeks, and the medication works by paralyzing and killing the mites.

For crusted scabies, doctors often combine both permethrin cream and ivermectin tablets. This more aggressive approach helps eliminate the massive number of mites present in this severe form of the condition.

Everyone in your household needs treatment at the same time, even if they don't have symptoms yet. This prevents reinfection and stops the cycle of transmission between family members.

How to Take Home Treatment During Scabies?

While you're treating scabies, washing all clothing, bedding, and towels in hot water (at least 122°F) helps eliminate any mites that might be hiding in fabrics. Dry these items on high heat for at least 20 minutes.

Items that can't be washed should be sealed in plastic bags for at least 72 hours. The mites will die without human contact during this time, making the items safe to use again.

Vacuum your mattresses, carpets, and upholstered furniture thoroughly, then dispose of the vacuum bag immediately. While mites don't live long away from human skin, this extra step provides peace of mind.

Keep your fingernails short and clean to minimize damage from scratching. Consider wearing gloves at night if the itching is severe, as this can prevent you from scratching in your sleep.

Cool compresses and calamine lotion can provide temporary relief from itching. Antihistamines like diphenhydramine might also help you sleep better during treatment.

How Should You Prepare for Your Doctor Appointment?

Before your appointment, make a list of all your symptoms and when they started. Note whether the itching is worse at certain times of day and which areas of your body are most affected.

Write down any recent close contact you've had with others, including household members, sexual partners, or situations involving prolonged skin contact. This information helps your doctor understand how you might have been exposed.

Bring a list of all medications you're currently taking, including over-the-counter products and supplements. Some medications can affect which scabies treatments are safe for you to use.

Prepare questions about treatment options, how long it takes to work, and what to expect during recovery. Ask about treating other household members and preventing reinfection.

If possible, avoid using lotions or creams on the affected areas before your appointment, as these can make it harder for your doctor to see the rash clearly.

What's the Key Takeaway About Scabies?

Scabies is a treatable skin condition that affects millions of people worldwide. While the intense itching and rash can be uncomfortable and disruptive, prescription medications can eliminate the mites effectively when used properly.

The most important thing to remember is that scabies requires prescription treatment – over-the-counter remedies won't eliminate the mites. Early treatment prevents complications and stops the spread to family members and close contacts.

Everyone in your household needs treatment simultaneously, even without symptoms. This coordinated approach, combined with proper cleaning of clothing and bedding, ensures complete elimination of the mites.

With appropriate treatment, most people see significant improvement within 1-2 weeks, though some itching may persist for several weeks as your skin heals from the allergic reaction.