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Scabies is a contagious skin condition caused by tiny mites which burrow into the skin.

The main symptom of scabies is intense itching that is worse at night. It also causes a skin rash on areas where the mites have burrowed.

Read more about the symptoms of scabies.

See a slideshow of other rashes and skin conditions.

Scabies mites

Scabies mites are called Sarciotes scabiei. They feed using their mouths and front legs to burrow into the outer layer of the skin (the epidermis),  where they lay eggs.

After three to four days, the larvae (baby mites) hatch and travel to the surface of the skin where they mature into adults.

Scabies like warm places, such as skin folds, between the fingers, under fingernails or around the buttock or breast creases. They can also hide under watch straps, bracelets, or rings.

Read more about the life cycle of the scabies mite.

How is scabies spread?

Scabies is usually spread through:

  • long periods of skin-to-skin contact with an infected person
  • sexual contact with an infected person

Scabies can also be passed by sharing clothing, towels and bedding with someone who is infected, but this is rare.

It can take up to eight weeks for the symptoms of scabies to appear after the initial infection. This is known as the incubation period.

Read more about the causes of scabies.

Scabies outbreaks

Scabies is widespread in densely populated areas with limited access to medical care, and is most common in the following tropical and subtropical areas:

  • Africa
  • Central and South America
  • Northern and Central Australia
  • Caribbean Islands
  • India
  • Southeast Asia

In developed countries, scabies outbreaks can sometimes occur in places where there are lots of people, such as schools, nurseries and care homes.

In the UK, most scabies outbreaks occur during the winter. This may be a result of people spending more time indoors and in closer proximity to each other at this time of year.

It's difficult to know exactly how many cases of scabies there are in the UK. This is because many people don't visit their GP and treat the condition with non-prescription medicines.

Treating scabies

You should visit your GP if you think you have scabies. It is not usually a serious condition but does need to be treated.

The two most widely used treatments for scabies are permethrin cream and malathion lotion (brand name Derbac M). Both medications contain insecticides that kill the scabies mite.

Permethrin 5% cream is usually recommended as the first treatment. Malathion 0.5% lotion is used if permethrin cream proves ineffective.

If your partner has been diagnosed with genital scabies, to avoid re-infection you should visit your nearest sexual health clinic so you can be checked and, if necessary, treated.

You should avoid having sex and other forms of close bodily contact until both you and your partner have completed the full course of treatment.

Read more about diagnosing scabies and treating scabies.

Complications of scabies

Scabies can sometimes lead to a secondary skin infection if the skin becomes irritated and inflamed through excessive itching.

A rare but more severe form of scabies, can develop in cases where there are a lot of mites in the skin. This is called crusted scabies and can affect older people and those with a lowered immune system.

Read more about complications of scabies.

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The main symptoms of scabies are intense itching and a rash in areas of the body where mites have burrowed.

The itching is often worse at night when skin is warmer. It may take four to six weeks before itching starts because this is how long it takes for the body to react to mite droppings.

If you have had a previous scabies infection, the symptoms will start within one to two days. This is because your immune system will have learnt to respond to a scabies infection.

The rash

The scabies rash is made up of tiny red spots. If you scratch the rash, you may also develop crusty sores.

Burrow marks can be found anywhere on the body. They're short (1cm or less), wavy, silver-coloured lines on the skin, with a black dot at one end that can be seen with a magnifying glass.

iIn adults burrow marks often appear in the following areas:

  • the folds of skin between fingers and toes
  • the palms of the hands
  • the soles and sides of the feet
  • the wrists
  • the elbows
  • around the nipples (in women)
  • around the genital area (in men)

The rash usually affects the whole body, apart from the head. The following areas can be particularly affected:

  • the underarm area
  • around the waist
  • the inside of the elbow
  • the lower buttocks
  • the lower legs
  • the soles of the feet
  • the knees
  • the shoulder blades
  • the female genital area
  • the groin
  • around the ankles

Elderly people, young children and those with a low immune system (immunocompromised) may also develop a rash on their head and neck.

Men usually have one or more very itchy, lumpy, 3 to 10mm spots on the skin of the genitals (on the penis and scrotum).

In infants and young children, burrow marks tend to appear in different places on their body, including on the:

  • face
  • head
  • neck
  • scalp
  • palms of the hands
  • soles of the feet

Scabies mites leave small red blotches and silver coloured lines on the skin. These marks are caused by the mites burrowing into the skin.

In infants with scabies, blisters and pustules (small blisters that contain pus) may develop on the soles of the feet and palms of the hands.

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Scabies is a skin condition caused by the parasite Sarcoptes scabiei.

The intense itching associated with scabies is thought to be caused by the immune system reacting to the mites and their saliva, eggs and faeces (poo).

The scabies mite life cycle

A scabies infestation starts when a female mite burrows into your skin.

Male mites move between different burrow sites looking to mate. After mating, the male mite dies and the female begins to lay eggs which hatch around three to four days later.

After hatching, the young mites move to the surface of the skin where they mature into adults after 10-15 days. Male mites stay on the surface of the skin, while female mites burrow back into the skin to create a new burrow. The life cycle is then repeated.

Without effective treatment, the scabies mite life cycle can continue indefinitely. Scabies mites are resistant to soap and hot water and cannot be scrubbed out of the skin.

How scabies is spread

Scabies mites cannot fly or jump, so they can only move from one human body to another if two people have direct and prolonged physical contact. For example, scabies mites can be transmitted by:

  • holding hands with an infected person for a prolonged period of time
  • having sex with an infected person
  • sharing clothing, towels and bedding with an infected person (although this is rare)

It is unlikely that scabies will be transmitted through brief physical contact, such as shaking hands or hugging.

Scabies mites can survive outside the human body for between 24 and 36 hours, which makes it possible to become infected by coming into contact with contaminated clothes, towels or bed linen. However, it is rare to get the condition in this way.

Scabies infestations can spread quickly because people are usually unaware they have the condition until two to three weeks after the initial infection. There is an increased risk of catching scabies in confined environments, such as schools and nursing homes, where people are in close proximity to one another.

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Your GP will usually be able to diagnose scabies from the appearance of your skin and by looking for burrow marks made by the Sarcoptes scabiei mite.

However, as scabies is spread very easily, it is often possible to make a confident diagnosis if more than one family member has the same symptoms.

Your GP will also want to rule out other skin conditions that may be causing your symptoms, such as eczema or impetigo (a highly contagious bacterial skin infection).

Ink test

The burrows of scabies mites can be identified by using an ink test. Ink is rubbed around an area of itchy skin before being wiped off with an alcohol pad. If scabies burrows are present, some of the ink will remain and will have tracked into the burrows, showing up as a dark line.

To confirm the diagnosis, a skin sample may be gently scraped from the affected area so it can be examined under a microscope for evidence of scabies mites, their eggs and faeces (poo).

Check up

Visit your GP if you think you have scabies. If you think you have genital scabies or your partner has been diagnosed with it, visit your nearest sexual health clinic where you will be examined and, if necessary, treated.

If you decide to treat yourself, you will need to have a full sexual health check to make sure you do not have any sexually transmitted infections (STIs).

To prevent re-infection, it is important that all members of your household are treated, as well as any sexual partners you have had over the last six weeks (in the case of genital scabies). If you have had genital scabies in the past, anyone you have had sex with in the previous 48 hours will need to be treated.

If you are embarrassed about contacting previous sexual partners, your GP surgery or local sexual health clinic may be able to inform them they have been exposed to scabies on your behalf, without disclosing your identity.

Sexual health clinics

Some sexual health clinics operate on a walk-in basis, whereas others may require you to book appointments. Ring first to find out.

When you attend a clinic, you'll be asked for your name, date of birth and contact details. These details are confidential and will not be passed on to your GP unless you request it.

You'll also be asked about your sexual history, including:

If you're attending a clinic for scabies, you may be offered tests for other STIs.

Read more about sexual health clinics.

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See your GP immediately if you contract scabies and have not had a previous infection. If you delay treatment, you risk passing scabies on to someone else.

As other, more serious skin conditions can sometimes cause similar symptoms to scabies, your GP will need to rule these out.

If you have scabies, your partner will also need to be treated regardless of whether or not they have any symptoms. This is because it's highly likely that scabies will have been transmitted through close bodily contact, such as during sex.

To reduce the chances of reinfection, avoid having sex and other forms of prolonged close bodily contact, such as holding hands, until both you and your partner have completed the full course of treatment.

If you've been diagnosed with scabies, you may be advised to visit your nearest sexual health clinic to be checked and, if necessary, treated for other sexually transmitted infections (STIs).

Lotions and creams

Lotions and cream are commonly used to treat scabies. Your GP, pharmacist or nurse will be able to advise you about which treatment to use.

Applying the cream or lotion

To prevent re-infection, all members of your household and any close contacts, including recent sexual partners (see diagnosing scabies for further details) should be treated at the same time as you, even if they do not have any symptoms.

The cream or lotion should be applied to the skin of all of your body, excpet your head. Before you apply it, make sure your skin is cool and dry. Don't apply it after having a hot bath.

If you apply it when the body is hot, it will quickly be absorbed into the skin and will not remain on the area where the scabies burrows are present. You should also:

  • read the patient leaflet that comes with the product for details about where to apply the cream or lotion; some products need to be applied to the whole body, including the scalp and face, whereas others must only be applied from the neck down
  • pay particular attention to the areas that are difficult to reach, such as the back, the soles of the feet, between fingers and toes, under fingernails and the genitals
  • use a cotton bud or old toothbrush to apply the treatment under fingernails and toenails (afterwards, put the cotton bud or toothbrush in a bag and throw it away)
  • leave the treatment on the skin for 8-24 hours (depending on the preparation used) before washing it off thoroughly; follow the manufacturer's guidance regarding how long to leave on the cream or lotion
  • immediately re-apply the cream or lotion to any areas of skin that are washed during the period of application
  • wash bed linen, nightwear and towels after the first application
  • repeat the treatment procedure seven days after the first application to ensure it is successful; the second application will ensure any mites hatched from existing eggs are killed

You should contact your GP if the itching does not improve after two weeks of treatment and you notice new burrows on your skin.

It can take a month after treatment fopr the general itching to subside completely, and longer for the lumpy genital lesions to resolve. Your GP may recommend repeating the treatment or they may prescribe a different lotion.

You should also speak to your GP or pharmacist if you experience any persistent side effects.

Infection control

On the day you first apply the cream or lotion you should wash all bed linen, nightwear and towels at a temperature above 50C (122F).

If you are unable to wash certain items, place them in a plastic bag for at least 72 hours. After this time, the scabies mites will have died.

If you're unable to wash certain items, place them in a plastic bag for at least 72 hours. After this time, the scabies mites will have died.

In cases of crusted scabies, you should clean the floors in your house and thoroughly vacuum your carpets and furniture (including armchairs and sofa).

If you have been diagnosed with scabies, avoid close and prolonged physical contact with others until you have applied the cream or lotion. You should also avoid close contact with other household members until their treatment has been completed.

Children and adults can return to school or work after the first treatment has been completed.


Your GP should be able to prescribe treatment such as a mild steroid cream, to help reduce itchiness. Menthol cream or gel, available without a prescription at pharmacies, may also help relieve itchy skin.

Oral sedative antihistamines are also available from your local pharmacy and can be used to control itching and help you to get a better night’s sleep. As this type of antihistamines can cause drowsiness, so avoid driving or operating heavy machinery if you are affected in this way. Non-sedating antihistamine don't help relieve the itching of scabies. Check with your GP or pharmacist if you are unsure.

You may continue to experience itchiness for a couple of weeks after your treatment has been completed. This is because your immune system will still be reacting to the presence of dead mites and their droppings. Visit your GP if you are still experiencing itchiness for longer than six weeks after your treatment has been completed.

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A secondary infection and crusted scabies are two possible complications of scabies.

Secondary infection

Repeatedly scratching itchy skin caused by scabies may break the skin's surface. This will make you more vulnerable to developing a bacterial skin infection, such as impetigoAntibiotics may be recommended to control a secondary infection.

Scabies has been known to make some pre-existing skin conditions, such as eczema, worse. However, other skin conditions should settle down after the scabies infection has been successfully treated.

Crusted scabies

Crusted scabies (also sometimes known as Norwegian scabies) is a more severe form of scabies where thousands or even millions of scabies mites are present.

Normal scabies can develop into crusted scabies after a skin condition. The condition affects all parts of the body, including your head, neck, nails and scalp. However, unlike normal scabies, the rash associated with crusted scabies does not itch.

In crusted scabies, the increase in the number of mites causes thick, warty crusts to develop on the skin. The condition is often mistaken for psoriasis (a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales).

Crusted scabies affects people with a weakened immune system (the body’s natural defence against illness and infection). This includes:

  • the very young
  • people with brain disorders (neurological disorders, such as Parkinson’s disease)
  • people with Down’s syndrome
  • pregnant women
  • elderly people
  • people with a condition that affects their immune system, such as HIV or AIDs
  • people who are taking steroids to treat other medical conditions
  • people who are having chemotherapy treatment

Research has found that a healthy immune system appears to interrupt the reproductive cycle of the scabies mite. For example, most people with scabies will only have 5-15 mites on their body at any one time.

However, if your immune system is weakened, the number of scabies mites can increase significantly. People with crusted scabies can have thousands or millions of scabies mites in their body at any one time.

Due to the high number of scabies mites, crusted scabies is highly contagious. Even minimal physical contact with a person with crusted scabies, or with their bed linen or clothes, can lead to infection. However, contact with someone with crusted mites will only lead to the normal type of scabies in people with a healthy immune system.

Crusted scabies can be treated using insecticide creams or a medicine called ivermectin, which is taken by swallowing a tablet. Ivermectin kills the mites by stopping their nervous system from working.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 04/03/2015 11:24:13

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