What is scabies?
Scabies is a skin infestation caused by a tiny mite called Sarcoptes scabiei. Approximately 3 million cases of scabies occur annually in the United States, with over 200 million cases worldwide each year. The mites burrow into the upper layer of skin, where they live and lay eggs, causing intense itching and a pimple-like rash.
Scabies is highly contagious and spreads quickly through close physical contact, making it common among sexual partners, household members, and in crowded living conditions. Similar to pubic lice (crabs), scabies is a parasitic infestation rather than a bacterial or viral infection.
Symptoms & Causes
Scabies symptoms typically appear 4 to 8 weeks after initial infestation. However, if you’ve had scabies before, symptoms can develop within 1 to 4 days.
Common symptoms include:
- Intense itching - Often worse at night
- Pimple-like rash - Small red bumps or blisters
- Thin, irregular burrow tracks - Tiny raised lines on the skin, often grayish-white
- Sores from scratching - Can become infected with bacteria
Common locations:
Scabies mites tend to burrow in specific areas:
- Between fingers and toes
- Wrists and elbows
- Armpits
- Waist and belt line
- Genital area
- Buttocks
- Around the nipples (in women)
In adults, scabies rarely affects the face, scalp, or neck, though infants and young children may have infestations in these areas.
How do you get scabies?
Scabies spreads through prolonged skin-to-skin contact with an infested person. This includes:
- Sexual contact - The most common way scabies spreads among adults
- Close physical contact - Hugging, holding hands, or sleeping in the same bed
- Sharing personal items - Bedding, towels, or clothing (less common)
A quick handshake or hug is usually not enough for transmission. The mites need extended contact to crawl from one person to another.
Scabies can spread easily between sexual partners and household members. If one person in a household has scabies, everyone living there should be treated at the same time.
Testing & Treatment
Testing for scabies
Scabies is usually diagnosed through a physical examination. A healthcare provider may:
- Visual inspection - Look for characteristic burrows and rash
- Skin scraping - Gently scrape a small area of skin to examine under a microscope for mites, eggs, or fecal matter
- Ink test - Apply ink to the skin and wipe it off; ink remaining in burrow tracks confirms scabies
Because scabies can look similar to other skin conditions like eczema or dermatitis, proper diagnosis is important.
Treatment for scabies
Scabies is treated with prescription medications called scabicides that kill the mites and their eggs. Common treatments include:
- Permethrin cream (5%) - Applied to the entire body from the neck down and left on for 8-14 hours before washing off
- Ivermectin - An oral medication, sometimes used for severe cases or when cream treatments haven’t worked
- Other topical treatments - Sulfur ointment or crotamiton may be prescribed in some cases
Important treatment steps:
- Apply medication to clean, dry skin
- Treat the entire body, not just areas with visible rash
- All household members and sexual partners should be treated at the same time
- Wash all bedding, clothing, and towels in hot water and dry on high heat
- Items that can’t be washed should be sealed in a plastic bag for at least 72 hours
Itching may continue for 2 to 4 weeks after treatment, even if the mites are dead. This is a reaction to the mites and their waste in the skin and doesn’t mean treatment has failed.
Preventing scabies
To prevent scabies:
- Avoid prolonged skin contact with anyone who has scabies
- Treat all contacts - Sexual partners and household members should be treated simultaneously
- Wash bedding and clothing in hot water if exposed
- Avoid sharing personal items like towels and bedding with an infested person
Telling your partner
If you have scabies, you should tell your current partners and anyone else that you’ve had sex with in the last 6 months. They can have scabies without knowing it, so they should get tested as well.
TellYourPartner.com helps you send an anonymous scabies text, so you can let partners know they’ve had contact with an infection without revealing your name.