Te waihakihaki Scabies

Scabies is a skin condition caused by a parasitic mite (a living thing). Scabies usually produces a very itchy rash.

Scabies mites

The scabies mite is so small that it cannot be seen by the naked eye. The female mite burrows under the skin and lives there. It lays eggs and leaves behind poos and chemicals that irritate the skin. The skin becomes inflamed and itchy.

The scabies mite lives on human skin, and does not live on cats, dogs or other animals. It can survive for up to 4 days on other surfaces like bedding or clothing. Most of the time mites will die if they have been off human skin for over 2 days. But if it is cold they might last up to 4 days.

Symptoms of scabies

An itchy rash usually develops between a few days and 6 weeks after a person has caught scabies. The itch mostly affects the arms, legs and trunk. It is usually worse at night or after a hot shower.

The rash commonly appears between the fingers and toes, around the wrists, in the groin, around the nipples and under the armpits. It does not usually affect the face and scalp unless the person is a young child or infant.

Images of scabies rash — DermNet

You can be infected with scabies without having any symptoms.

Diagnosing scabies

Scabies is very hard to diagnose because its symptoms can vary widely between people. It can be confused with: 

  • allergies
  • fleas
  • bed bugs
  • skin infections
  • eczema or other skin diseases
  • a reaction to a medication.

Your healthcare provider usually diagnoses scabies after examining your skin. Sometimes they might arrange for a skin scraping to be tested.

Treating scabies

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Members of the household need to be treated with creams or lotions called scabicides. The most common one is permethrin, which is available on prescription from you healthcare provider. Permethrin is safe for infants and pregnant or breastfeeding people.

Follow the specific instructions on the medication package. The instructions are likely to include these steps.

  1. Apply the lotion to every member of the household. People who live outside the house who have close skin contact with members of the household should also apply the lotion. It is important that everyone applies the lotion at the same time, even if they do not have a rash or itch.
  2. Massage the cream over the whole body, including the ears, scalp, hair, neck and face. This is particularly important for young children who are more likely to have scabies above their neck. Avoid the eyes and mouth. Pay special attention to between the toes and fingers and under the nails. Use a soft brush to get under the nails. When anyone washes their hands in the next 12 hours, they must reapply the lotion.
  3. Wash the cream off 10 to 12 hours later.
  4. Reapply permethrin 1 week after the first application even if the members of your household do not have any symptoms.

Household members can return to work or school one day after treatment.

Treat all fabric items that household members have worn or touched in the last 4 days.

Linen, towels, flannels, clothes and soft toys

Where possible, wash all items. Dry them in a clothes dryer for at least 10 minutes or iron them with a hot iron.

The scabies mite is not small enough to go through the weave of sheets. You do not need to wash mattresses, pillows and underblankets if you have used sheets and pillowcases.

Footwear and blankets

Treat them using one of the following methods:

  • set them aside for 4 days in sealed plastic bags
  • place them in large bags, spray fly spray inside the bags and seal the bags for 2 hours
  • freeze the items overnight.

Other

Vacuum carpeted floors and upholstered furniture.

Spray fly spray over furniture and beds where sheets have not been used and avoid human contact for 4 days.

Things that could stop the treatment working

There are several things that could stop the treatment working or make it look like the treatment has not worked.

  • If you do not follow all the treatment steps, you might not get rid of the scabies.
  • Someone who has not been treated could reinfect the household.
  • Even if the treatment worked well, the itch usually continues for up to 6 weeks. If you have completed the treatment correctly for the whole household, try to wait until the itch goes away.
  • The treatment might not have worked because the diagnosis was wrong, and the rash and itch have another cause.

After treatment

Go back to see your healthcare provider 2 to 3 weeks after treating your household if the rash and itch have not improved.

Go back to see your healthcare provider if the itch does not go away after 6 weeks or comes back.

Clinical review

This content was written by HealthInfo clinical advisers. It has been adapted for Health Information and Services.

Clinical advisers — HealthInfo (external link)