Scabies

Symptoms | What Can I Do? | Seeking Medical Care | Treatment

Scabies is a highly contagious skin condition caused by infestation with the Sarcoptes scabiei mite. It’s not linked to poor hygiene – anyone can get it, regardless of cleanliness or lifestyle.

The human itch mite is a microscopic parasite that burrows into the top layer of the skin, where it lives and lays eggs. The body’s immune response to the mites, their eggs, and their faeces causes the intense itching and rash typical of scabies.

Scabies spreads primarily through prolonged skin-to-skin contact, and it can also be transmitted through sexual contact, which is why it’s sometimes classified as a sexually transmitted infection (STI). Less commonly, mites can be passed through infested bedding, clothing, or towels. Off the body, mites can survive for up to 2–3 days.

Animal scabies (e.g. dog or cat mange) cannot reproduce on human skin but may cause temporary itching or a rash, which typically resolves without treatment.

Symptoms

Scabies causes intense itching, which is often worse at night. You may notice a widespread rash of red spots, particularly in skin folds such as:

• Between the fingers and toes

• On the wrists, elbows, and ankles

• Around the waist, nipples, buttocks, and groin

In children and older adults, the rash may also appear on the head, neck, palms, and soles. The rash is often accompanied by scratch marks, and tiny spots or burrows (silver-grey or skin-coloured lines with a small dot) may be visible. These are where the mites have burrowed into the skin.

Small red bumps or fluid-filled blisters may also be seen, especially around the burrows. These may resemble pimples.

A severe form known as crusted (Norwegian) scabies can occur in people who are immunocompromised or unable to feel or respond to itch (e.g. due to paralysis or cognitive impairment). This form produces thick, crusty plaques and scales, with little or no itching. It is highly contagious, due to a large number of mites present (thousands to millions, compared to the usual 10–15).

What can I do?

If you have scabies, it’s essential that you and everyone in your household or anyone you’ve had close skin contact with (including sexual partners) are treated at the same time — even if they don’t have symptoms. This helps to prevent re-infestation.

To reduce the spread:

• Wash bedding, clothing, and towels used in the 72 hours before treatment at 60°C or higher, and dry thoroughly.

• Items that cannot be washed should be sealed in a plastic bag for at least 3 days.

• Do not use insecticide sprays or fumigants—these are not effective for treating scabies.

• Avoid close physical contact (including sex) until 24 hours after completing treatment.

Should I seek medical care?

If you suspect you have scabies, you should see a GP or speak to a pharmacist. Over-the-counter products are not sufficient for treating scabies effectively in the UK.

A pharmacist may recommend a prescription-only cream or lotion, such as permethrin or malathion. If symptoms persist or if scabies is suspected in infants, young children, or during pregnancy, medical advice from a GP is essential.

Early treatment is important to relieve symptoms, stop the spread to others, and prevent complications like secondary skin infections.

Treatment

Scabies is sometimes misdiagnosed as eczema or another skin condition due to its similar appearance, but once properly identified, it can be treated effectively.

Scabicides (medicines that kill scabies mites and their eggs) are the main treatment and are typically available by prescription in the UK. The most commonly used treatment is permethrin 5% cream, although alternatives like malathion lotion may be used if permethrin is unsuitable.

Important treatment steps:

• The cream or lotion must be applied to the entire body, including the scalp, neck, soles of the feet, and under the nails.

• All close contacts (household members, sexual partners) must be treated at the same time, even if they don’t have symptoms, to prevent reinfestation.

• Repeat the treatment after 7 days to ensure that newly hatched mites are also killed.

• Itching may continue for 2 to 4 weeks after successful treatment – this is a common reaction. However, if symptoms persist longer or new burrows or spots appear, consult your GP.

Additional care may include emollients to soothe the skin, and mild steroid creams to ease itching and inflammation if needed.