What Is Scabies? This Skin Infestation Causes an Itchy, Contagious Rash

The idea of someone having scabies can conjure up some seriously negative connotations: Even the word itself sounds scary. And while the infestation can cause an itchy and unsightly rash, it’s important to know that scabies is something that can happen to pretty much anyone—and that it’s completely curable.  

So what exactly is scabies? Simply put, it’s an infestation of the outer layer of human skin caused by the Sarcoptes scabiei mite. “The mite is microscopic, so not visible to the naked eye,” Edidiong Kaminska, MD, dermatologist at Northwestern Medicine in Chicago, tells Health. “It has eight legs and can burrow and lay eggs in the skin.” Here’s everything you need to know about this mite, and the problems it can cause.

How you get scabies

Scabies does not discriminate: Anyone can get it—but there are some people who are at higher risk. Children, residents of long-term care facilities, sexually active people, and those with a weakened immune system are more likely to develop an infestation, according to CDC.

People can “catch” scabies from others who have the condition. “Scabies is contagious and is transmitted by close personal contact,” Anna Bender, MD, a dermatologist at NewYork-Presbyterian and Weill Cornell Medicine in New York, tells Health. It’s usually spread through sex or other prolonged skin-to-skin touching, but it can also be caught by sharing bedding, clothing, or towels with a person that has scabies.

It’s much less common to get scabies from brief, casual contact, like shaking hands or hugging, according to the CDC.

Symptoms of scabies

Most people don’t realize immediately that they’ve been exposed to scabies. But once symptoms develop, they’re hard to miss. Scabies is usually very itchy, and symptoms tend to be worse at night.

“After first exposure to scabies, it can take two to six weeks to develop the symptoms of intense itching and rash,” says Dr. Bender. “Often the rash looks like little red bumps along with scratch marks, but a dermatologist can identify small white lines called ‘burrows’ in the skin.” Borrows are small tunnels created by the mite crawling under the skin, she explains, and they’re more commonly seen in certain areas, such as between the fingers.

There’s a more serious type of scabies, as well, called Norwegian scabies or crusted scabies. This type of scabies is more common in people with weakened immune systems. It causes crusty lesions, according to the CDC.

Scabies treatments

If you’ve been diagnosed with scabies, your treatment will include a few steps. You’ll likely be prescribed medication, such as permethrin cream. “This is a cream that that kills the scabies mite and its eggs,” says Dr. Kaminska. “It is generally considered safe for adults, pregnant women, and children ages 2 months and older.”

Malathion lotion, which also kills scabies mites, can be used as an alternative to permethrin. Lindane lotion and crotamiton cream or lotion may also provide relief, but usually aren’t prescribed unless other treatments haven’t been effective.

Lotion or ointment made with sulfer can also be prescribed to treat scabies, but these may require more frequent application than other medications. And people with suppressed immune systems who’ve developed crusted scabies—or those who don’t respond to creams and lotions—may be prescribed the oral medication ivermectin (brand name Stromectol).

Medications aren’t the only way to relieve the itch, however. Patients should also try to keep  their skin cool. “Heat can make the itch much worse,” says Dr. Kaminska. “Applying cool water or bathing in cool water can decrease itch sensation in the skin.”

Anti-itch creams and lotions—like over-the-counter hydrocortisone or Calamine lotion—can also help with scabies itch. Over-the-counter antihistamines can also provide some relief.

What to do after a scabies diagnosis

If you or someone you live with is diagnosed with scabies, you’ll need to take steps to rid the mites from your home. “All washable clothing, towels and bed linens which have been in contact with the infested persons should also be machine-laundered in hot water and machine dried on high heat for 20 minutes to destroy the mites,” says Dr. Bender.

Items that can’t be washed should be dry-cleaned or sealed in a plastic bag for at least a week, says Dr. Kaminska, and the entire home should be vacuumed. “The vacuum bag should be discarded,” she says. “If a vacuum canister is used, it should be emptied and cleaned with hot soapy water.”

How to protect yourself

The only way to protect yourself from getting scabies is to avoid close contact with others who might have scabies, and with their clothing, bedding, and towels. But if you suspect that you have been exposed to the mites, see a doctor as soon as possible.

“Scabies does not resolve on its own,” says Dr. Kaminska. “If untreated, symptoms will persist and the rash and infestation may get worse. There is also an increased risk of bacterial infection.”

A doctor can confirm that a rash is due to scabies by scraping a small sample of skin and looking at it under a microscope, says Dr. Bender. “If a mite or an egg of the mite is seen under the microscope, or if the rash looks like it possibly could be scabies, then that person and all of their close contacts should receive treatment,” she says.

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