Scabies
Updated: 03.08.2023
Reviewed: 19.12.2023
Approved by: General Practitioner, Dr Binita Parmar
Scabies is a skin condition primarily caused by tiny mites that burrow into the skin of humans. It sometimes digs under the skin, and lays eggs, causing a severe itchy rash. Scabies only has humans as hosts and dies within a few days outside the host at room temperature.
How widespread Scabies is in society varies, and often comes in waves at decades intervals.
How is Scabies transmitted?
Scabies is transmitted by close skin contact between people. It can also be transmitted by sexual contact, or being in close proximity to each other. Less commonly, it is transmitted through objects such as blankets, towels, clothes and objects.
Symptoms
Typical symptoms of scabies include an itchy rash on the body. The location of the rash varies from person to person and age. In adults, it is usually most common between the fingers, wrists, genital area, abdomen, and inner thighs. In children, the scalp, face, palms, and soles of the feet are often affected, whilst older individuals may experience a more generalised rash all over the upper body.
Scabies causes intense itching, often leading to scratching and worsening of the rash.
The itching is an allergic reaction to the presence of the mites and typically occurs 2-4 weeks after infestation. The itching is usually most intense at night and can worsen when the body becomes warm, such as during exercise, after a hot shower, or when getting under the covers.
Examination
If you have itching, rash or other changes on the skin, it is always a good idea to see a doctor. The doctor will ask you a number of questions to get closer to the diagnosis, this includes allergies and medications you may be taking. The doctor will then examine the rash, often looking at the whole body to get an idea of how widespread it is. Some doctors have their own "skin microscope" where you can see details in the skin better, and sometimes you will then be able to see the typical times Scabies digs under the skin, and in some cases, you can also find living scabies under the skin. If the skin is very itchy and sore, it can be difficult to find these typical signs. Blood tests or rash samples are not required.
Treatment
Scabies is treated with a cream or lotion that is applied to the entire body, from the face to the toes. It is important to follow the instructions carefully and avoid showering or washing hands for at least 12 hours. The treatment is repeated after 7 days to kill any remaining eggs. The itching may persist for a longer time and can last for 2-4 weeks after the completion of treatment. To relieve itching, antihistamine tablets and topical steroid creams can be used. These medications can be prescribed by the doctor who examines you. If there is no improvement after 2 courses of topical treatment, the doctor may consider prescribing an oral medication.
It is essential to treat all household members and partners simultaneously, regardless of whether they have symptoms or not. This is because they may be infected but have not yet started experiencing itching. Treating everyone at the same time helps prevent reinfection.
Other measures that are important to eliminate mites from the home include washing clothes, bed linens, and towels at 60°C. Alternatively, they can be stored in plastic bags without contact with the skin for at least 7 days at room temperature. Freezing is not necessary as Scabies mites cannot survive outside the human body at room temperature. Furniture such as sofas should be covered with plastic or avoided for 7 days. The same applies to mobile phone cases or other objects that have been in frequent contact - set them aside for 7 days to ensure any Scabies mites on them disappear.
