Scabies Information

Scabies is caused by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of skin where it lives and lays eggs. Scabies can spread quickly under crowded conditions where close body and skin contact is frequent. 

If you have symptoms of scabies or you think you were exposed to scabies, please call your healthcare provider for examination and treatment.

Crusted Scabies

Crusted scabies (formerly known as Norwegian scabies) usually presents with thickened, rough patches of skin that may be cracked and can be associated with redness of the skin. Patients with crusted scabies may not have the usual signs & symptoms of scabies. They may have mild itching or even no itching at all. Patients with crusted scabies should receive quick treatment because the risk of complications, such as sepsis, and to prevent spread of scabies. 

People who have an increased risk of developing crusted scabies include:

  • the elderly
  • people who are immunocompromised, such as people living with HIVS/AIDS
  • people with conditions that prevent them from itching and/or scratching, like a spinal cord injury, loss of sensation, mental or behavioral conditions.

Crusted scabies is very contagious due to the large numbers of mites present with infestation. Outbreaks of scabies are more common with crusted scabies. It spreads easily through brief, direct contact and by contact with infested clothing, bedding and furniture. 

About Scabies

Symptoms

The most common symptoms of scabies are intense itching (especially at night) and a pimple-like rash. Common areas where symptoms occur include:

  • between the fingers,
  • in the skin folds of the wrist, elbow, knee or armpit,
  • on the penis, nipples, waist, buttocks and shoulder blades.

You may see tiny burrows on the skin, caused by the female mite tunneling just beneath the surface of the skin.

Infants & very young children often experience a rash on the head, face, neck, palms and soles of the feet.

How it spreads

  • direct, extended, skin-to-skin contact with a person who has scabies or
  • less commonly, sharing clothing, towels or bedding used by a person with scabies

Prevention

When a person is infested with scabies mites for the first time, symptoms usually take 4-8 weeks to develop. However, the person can still transmit scabies even if they do not have symptoms. To prevent scabies, avoid direct skin-to-skin contact with a person who has scabies. Avoid sharing items such as clothing or bedding used by a person who has scabies.

Control

Treat all household members and close contacts at the same time as the person with scabies. This should help prevent possible re-exposure and reinfestation.

  • wash all clothing, towels and bedding used next to the skin during the 3 days before starting treatment. Items should be machine washed using hot water (more than 122°F for 10 minutes to kill mites & eggs), dried on the hot cycle or dry-cleaned
  • seal items that you cannot wash in a closed plastic bag for several days (at least 72 hours) to a week. Scabies mites usually do not survive more than 2-3 days away from human skin.

Children and adults can return to childcare, school or work the day after treatment.

Diagnosis

Your healthcare provider can sometimes diagnose scabies on physical examination findings, but will likely try to confirm scabies by finding the mite, mite eggs or feces. They may scrape your skin or use a needle to get a sample to view under a microscope to confirm scabies.

Treatment

The first time a person gets scabies they usually have no symptoms at the beginning. Symptoms can take 4-8 weeks to develop; however, they can still spread scabies during this time. If you suspect scabies, seek medical attention. Your healthcare provider can prescribe a cream, lotion or pill that kills scabies mites.

To prevent the spread to others:

  • Treat other household members with whom you have had direct skin contact or have shared a bed, towels, or clothing at the same time.
  • Wash bedding, clothing, and towels in hot water and dry in a hot dryer. Temperatures in excess of 50°C or 122°F for 10 minutes will kill mites and eggs.
  • Dry-clean items that can’t be washed or seal them in a closed plastic bag for at least 72 hours to a week.
  • Avoid skin-to-skin contact with others until treatment is complete.
  • Notify people you had direct skin-to-skin contact with during the previous two months and encourage them to seek treatment.

Products use to treat scabies (scabicides) kill scabies mites; some also kill mite eggs. Scabicides require a healthcare provider's prescription. Carefully follow the instructions contained in the box or on the label. Scabicide lotion or cream should be applied to all areas of the body from the neck down to the feet and toes. 

The itching of scabies is due to a hypersensitivity reaction (allergy) to mites and their feces, so itching may continue for several weeks after treatment even if all mites and eggs are killed. If itching is still present 2-4 weeks after treatment or if new burrows or rash appear, retreatment may be needed.


Resources

CDC About Scabies

CDC: Clinical Care of Scabies (for healthcare providers)

CDC: Clinical Overview of Crusted Scabies