Scabies

Scabies | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Skin, hair and nails Scabies Scabies About scabies Symptoms of scabies Causes of scabies Diagnosing scabies Treating scabies Complications of scabies About scabies Scabies is a contagious skin condition caused by tiny mites that burrow into the skin. The main symptom of scabies is intense itching thats worse at night. It also causes askin rash on areas where the mites have burrowed. Read more about the symptoms of scabies . Scabies mites Scabies mites are called Sarcoptes scabiei. They feed using their mouths and front legs to burrow into the outer layer of skin (epidermis), where they lay eggs. After 3to 4days, the baby mites (larvae) hatch and move 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 scabies is spread Scabies is usually spread through prolonged periods of skin-to-skin contact with an infected person, or through sexual contact. Its also possible but rare for scabies to be passed on by sharing clothing, towels and bedding with someone whos infected. It can take up to 8weeks 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 populatedareas 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 andcare homes. In the UK, most outbreaks of scabies occur in the winter. This may be because people tend to spend more time indoors and closer to each other at this time of year. Its difficult to know exactly how many cases of scabies there are in the UK. This is because many people dont visit their GP and treat the condition with non-prescription medicines. Treating scabies Visityour GP if you thinkyou have scabies.Its not usually a serious condition, but it does need to be treated. The 2most widely used treatments for scabies are permethrin cream andmalathion lotion.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 permethrinis ineffective. If your partnerhas been diagnosed with genital scabies, to avoid reinfection you should visit your nearest sexual health clinic so you can be checkedand, if necessary, treated. Avoid having sex and other forms of close bodilycontact 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 your skin becomes irritated and inflamed through excessive itching. Crusted scabies is arare but more severe form of scabies, wherea large number ofmites are in the skin. This can develop inolder people and those with a lowered immunity. Read more about complicationsof scabies . Symptoms of scabies The main symptoms of scabies are intense itching and a rash in areas of the body where the mites have burrowed. The itching is often worse at night, when your skin is warmer.It may take 4to 6weeks before the itching starts because this is how long it takes for the body to react to mite droppings. Symptoms will start within 1to 2days if youve had a scabiesinfection in the past. This is because your immune system will have learned to respond to a scabies infection. What does a scabies rash look like? The scabiesrash consists of tiny redspots. Scratching the rash may cause crusty sores to develop. Burrow marks can be found anywhere on the body. Theyre 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. Scabies cause burrow marks of short, wavy and silver-coloured lines. Source: https://dermnetnz.org/ A scabies rash often appears on the palms of the hands. Source: https://dermnetnz.org/ Where does a scabies rash develop? In adults, burrow marks often appear in the following areas: the folds of skin betweenfingers and toes the palms of the hands the soles and sides of the feet the wrists the elbows around thenipples (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 theknees 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 1or more very itchy, lumpy, 3 to 10mm spots on the skin of the genitals (on the penisand scrotum). In infants and young children, burrow marks tend to appear in differentplaces on their body, including onthe: 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 onthe soles of the feet and palms of the hands. Causes of scabies 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. 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, whichhatch around 3to 4days later. After hatching, the young mites move to the surface of the skin, where they mature into adults after 10 to 15 days. Male mites stay on the surface of the skin, whilefemale mites burrow back into the skin to create a new burrow. The life cycle is then repeated. Without effective treatment, the life cycle of the scabies mite can continue indefinitely. Scabies mites are resistant to soap and hot water and cant be scrubbed out of the skin. How scabies is spread Scabies mites cant fly or jump, which means they can only move from one human body to another if 2people have direct and prolonged physical contact. For example, scabies mites can be transmitted by: holding hands with aninfected person for a prolonged period of time having sex with aninfected person sharingclothing, towels and bedding with an infected person (althoughthis is rare) Its 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 24 to 36 hours, making infection by coming into contact with contaminated clothes, towelsor bed linen a possibility. However, itsrare for someone to be infected in this way. Scabies infestations can spread quickly because people are usually unawaretheyhave the condition until 2to 3weeks after the initial infection. Theres an increased risk of catching scabies in confined environments, such as schools and nursing homes, where people are in close proximity to one another. Diagnosing scabies Your GP should be able to diagnose scabies from the appearance of your skin, and by looking for the burrow marks of the Sarcoptes scabiei mite. However, as scabiesis spread very easily, its 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). Read more about the symptoms of scabies . 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 soit can be examined under a microscope for evidence of scabies mites, their eggs and faeces (poo). Where to get help with scabies 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 youll be examined and, if necessary, treated. If you decide to treat scabies yourself, youll need to have a full sexual health check to make sure you dont have any sexually transmitted infections (STIs) . To prevent reinfection, its important that all members of your household are treated, as well as any sexual partners youve had over the last 6weeks (in the case of genital scabies). If youve had genital scabies in the past, anyone youve had sex with in the previous 48 hours will need to be treated. If youre embarrassed about contacting previous sexual partners, your GP surgery or local sexual health clinic may be able to inform them that theyve been exposed to scabies on your behalf without disclosing your identity. Sexual health clinics Some sexual health clinics operate on a walk-in basis. Others work byappointment only. Its therefore a good idea to call first. When you attend a clinic, youll be asked for your name, date of birth and contact details. These details will be treated confidentially and wont be passed on to your GP without your agreement. Youll also be asked about your sexual history, including: when you last had sex whether you used condoms whether youve had an STI in the past whether youre taking any medication If youre attending a clinic for scabies, you may also be offered tests for STIs. Treating scabies See your GP immediately if you have scabies and you havent had a previous infection. Delaying treatment places other people at risk. As other more serious skin conditions can sometimes cause similar symptoms to the symptoms of 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 its highly likely that scabies will have been transmitted through close bodily contact, such as duringsex. To reduce the risk of reinfection, avoid having sex and other forms of prolonged close bodily contact, such as holding hands,until both you and your partner have completedthefull course of treatment. If youve 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 creams 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 reinfection, all members of your household and any close contacts, including recent sexual partners, should betreated at the same time as you, even if they dont have any symptoms. The cream or lotion should be applied to theskin ofall of your body, except your head.Before you apply it, make sure your skin iscool and dry. Dont apply it after having a hot bath. If you apply it when your body is hot, it will quickly be absorbed into your skin and wont remain on the area where the scabies burrows are. When using a cream or lotion to treat scabies, you should also: read the patient leaflet that comes with the cream or lotion for details of where to apply it  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 difficult-to-reach areas, like your back, the soles of your feet, in between your fingers and toes, under fingernails, and on your genitals use a cotton bud or old toothbrush to apply the treatment under fingernails and toenails  put the cotton bud or toothbrush in a bag and throw it away afterwards leave the treatment on your skin for 8 to 24 hours (depending on the preparation used) before washing it off thoroughly  follow the manufacturers instructions regarding how long to leave the cream or lotion on for reapply the cream or lotion immediately 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 process 7 days after the first application to ensure its successful  the second application will ensure any mites hatched from existing eggs are killed It can take a month after treatment for the general itching to subside completely, and longer for the lumpy genital lesions to resolve. Your GP may recommend repeating thetreatment or they may prescribe a different lotion. Speak to your GP if: the itching hasnt improved after 2 weeks of treatment and you notice new burrows on your skin you experience any persistent side effects Managing a scabies infection On the day you first apply the cream or lotion, you shouldwash all bed linen, nightwearand towels ata temperature above 50C (122F). If youre unable to wash certain items,place them in a plastic bag for at least 72 hours. After this time, the scabiesmites will have died. In cases of crusted scabies, you should cleanthe floors in your house and thoroughly vacuum your carpetsand furniture, including the armchairs and sofa. If youve been diagnosed with scabies,avoid close and prolonged physical contact with others until youve applied the cream or lotion. You should alsoavoid close contact with other members of your household until their treatment has been completed. Children and adults can return to school or work after the first treatmenthas been completed. Treating the itch Your GP should be able to prescribe treatments, such as a mild steroid cream,to reduce the itchiness. Menthol cream or gel, availablefrom pharmacies without a prescription, may alsohelp relieve itchy skin. Oralsedative antihistamines are also available from your local pharmacy and can be used to control itching and help you get a better nights sleep. As this type of antihistamine can cause drowsiness, you should avoid driving or operating heavy machinery if youre affected in this way. Non-sedating antihistamines dont help relieve the itching of scabies.Check with your GP or pharmacistif youreunsure. 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 youre still experiencing itchiness 6weeks after completingyour treatment. Complications of scabies A secondary infection and crusted scabies are 2possible complications of scabies. Secondary infection Repeatedly scratchingitchy skincaused byscabies may break the skins surface. This willmake youmore vulnerable to developing a bacterial skin infection, such as impetigo . Antibiotics may be recommended to control a secondary infection. Scabies has been known tomake some pre-existing skin conditions, such as eczema ,worse. However, other skin conditions should settle down afterthe scabies infection has been successfully treated. Crusted scabies Crusted scabies, also known as Norwegian scabies, is a more severe form of scabies. This means thousands or even millions of scabies mites are present. Normal scabies can develop into crusted scabiesafter a skin reaction. 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 usually doesnt itch. In crusted scabies, the increase in the number of mites causes thick, warty crusts to develop on the skin. Its 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 bodys natural defence against infection andillness). This includes: the very young people with brain disorders (neurological disorders, such as Parkinsons disease ) people with Downs 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 a healthy immune system appears to interrupt the reproductive cycle of the scabies mite . For example, most people with scabies will only have 5 to 15 mites on their body at any one time. However, if you have a weakened immune system, the number of scabies mites can increase significantly. People with crusted scabies can have thousands or millions of scabies mites on their body at any one time. Because ofthe 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 withsomeone with crusted scabies willonly 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 working. Source: NHS 24 - Opens in new browser window Last updated: 05 February 2024 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Impetigo Self-help guide: Rash Other health sites BAD: scabies BAD: impetigo BASHH: sexual health Brook: advice for under 25s NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852