Overview

Scabies is a parasitic infestation caused by a microscopic mite, Sarcoptes scabiei, that burrows into the skin and lays eggs, causing intense itching and a rash.

Scabies spreads easily in close-contact environments like shelters, schools and overcrowded households.

Scabies can be treated with medication. To avoid re-infestation, it is necessary to decontaminate household items like bedding and clothing.

Scabies infestation may be complicated by bacterial infection, leading to skin sores and severe conditions like septicemia (a severe blood infection), heart disease and chronic kidney disease.

Transmission

The scabies mite spreads from person to person through direct physical contact. Contact must be for an extended period of time. Brief contact like shaking hands or hugging seldom transmits the mite.

It can also spread through contact with clothes, bedding or linen used by someone with scabies.

Symptoms

People who have never had scabies usually notice symptoms 4 to 6 weeks after contact with an infected person. Those who have had scabies before may notice symptoms within a few days to a week.

The first symptom will be the appearance of a red, lumpy rash. Burrow markings (dots) may also be seen. The most common symptom is a rash which is itchy, especially at night. The rash can appear anywhere on the body but is usually on the hands, wrists, elbows, breasts, armpits, waistline and groin. The rash often appears between fingers, in joint folds, at the beltline and other body folds.

Infants and young children may develop a more widespread rash, including on the palms, soles of the feet, ankles and sometimes the scalp.

Elderly persons and those with weak immune systems may not feel itchy.

If not treated quickly, continued scratching can cause skin sores which could become infected with bacteria on the skin such as Staphylococcus.

Bacterial skin infections can lead to serious conditions like septicemia (a severe blood infection), heart disease and chronic kidney disease.

Treatment

Treating scabies requires individual treatment and decontamination of household items.

Individuals with scabies should be treated with anti-scabies lotions or creams such as 5% permethrin.

How to use the cream

Read the package directions carefully before using.

Wash and dry skin thoroughly.

Massage the cream into the skin from the head to the soles of the feet, paying special attention to creases in the skin, hands, feet, between fingers and toes, underarms and groin.

Scabies rarely infests the scalp of adults, although the hairline, neck, side of the head and forehead may be infested in both older people and infants.

Infants should be treated on the scalp, side of the head and forehead.

Leave the cream on the skin for 8 to 14 hours, then wash off by taking a shower or bath.

Change into clean clothes.

Itching commonly intensifies for 1 to 2 weeks with effective treatment and can last up to 4 weeks. Inform individuals who are being treated about this.

Two or more applications 1 week apart may be necessary to eliminate the mites. If someone has severely crusted scabies sores they may require further treatment for bacterial infection.

For children over 2 months, apply once. For children under 2 months, consult a doctor.

Storage: Store the medicine in a closed container at room temperature, away from heat, moisture and direct light. Do not freeze. Keep out of reach of children.

If cream is not available

Seek medical advice from community health workers or local health authorities for alternative treatments and guidance.

Maintain as much physical cleanliness as possible. If water is limited, a wet cloth can be used to gently clean the skin.

Keep fingernails trimmed and clean to reduce the risk of skin infections caused by scratching.

Avoid scratching as much as possible to prevent secondary infections. If necessary, apply gentle pressure with a clean cloth to relieve itching.

If clean clothes are not available, try to air and sun-dry clothes and bedding regularly to reduce the presence of mites. Sunlight helps kill mites.

Share information and preventive tips with others in the community to help manage and control the spread of scabies.

Decontaminating household and personal items

Because people in the early stage of an infestation may be without symptoms, and because treatments for scabies do not kill the parasite’s eggs, best results are obtained by treating the whole household simultaneously and repeating treatment as per medication guidelines to prevent re-infestation.

To decontaminate household items and prevent scabies from reinfecting or spreading to other household members:

Mites should be starved; they generally do not survive more than 2–3 days away from human skin.

Wash bedding, clothing and towels used by infested people at any point 3 days before treatment began in hot, soapy water and dry at high heat.

Items that cannot be laundered should be sealed in a closed plastic bag for at least 3 days, and up to 1 week.

Clean furniture and carpets in rooms used by people with scabies.

If cleaning materials are not available, remove as much dirt and debris as possible. Regular airing out and sun-drying of items and living spaces can help reduce the presence of mites.

Individuals decontaminating household items should wear gloves and avoid skin contact with the items to prevent infection. If gloves are not available, use a piece of cloth or other barrier when handling potentially infested items.

Sources

Scabies. Geneva: World Health Organization; 2023 (https://www.who.int/news-room/fact-sheets/detail/scabies).