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The newbie’s guide to scabies

Doctor examining girl's hand

This intensely itchy skin infestation is caused by microscopic mites. Here’s how to prevent their spread — and find relief.  

Hallie Levine

By Hallie Levine

Does the thought of microscopic mites burrowing into your skin give you the heebie-jeebies? Yep, us too. But it’s the unfortunate reality in a common condition called scabies.

For starters, scabies is an uber-itchy, uber-contagious skin infestation. It’s caused by the aptly named itch mite. When the mites burrow into your skin, it can cause intense itching and a pimple-like rash, according to the Centers for Disease Control and Prevention (CDC).

There are about 1 million cases of scabies per year in the U.S. And it’s an equal-opportunity offender. It doesn’t care about your age, gender, race, economic status or personal hygiene. Basically, anyone is fair game.

“I even caught it once from a patient I saw in a nursing home,” says Beth Goldstein, MD. She’s a professor of dermatology at the University of North Carolina.

Worried about scabies? Here’s what to know about this itchy, irritating infestation. (Something you shouldn’t worry about? Affording your prescriptions. Download the Optum Perks mobile app today to save up to 80% at the pharmacy.)

How scabies spreads

These pesky mites most often pass from one person to another through close skin-to-skin contact. “You likely won’t get it from being in the same room as someone who has it unless you hug them,” points out Dr. Goldstein.

Sexual partners and household members are at particular risk. Or people who live in close quarters, such as those in nursing homes or college dormitories.

Sometimes scabies spreads indirectly too, says Dr. Goldstein. You can get it by sharing the same clothing, towels or bedding as someone who’s infested. Although, again, you’re not as likely to get it if there’s no skin-to-skin contact.

The good news: Scabies mites can survive for only 48 to 72 hours once they’re off someone’s skin. But they can live for longer in colder conditions — sometimes for as long as 1 to 3 weeks. So take extra precautions in the winter, says Dr. Goldstein.

The signs and symptoms of scabies

The telltale symptom is the maddening itch. “Patients say that they itch all over, and it’s worse at night,” says Dr. Goldstein. It also causes reddish bumps on your skin. But since the mites themselves are so tiny, you won’t be able to see them.

“The classic sign is what looks like bug bites in the typical areas,” Dr. Goldstein says. “But it itches like nothing you’ve ever experienced before.” You may also notice threadlike gray or white lines on your skin that look like pencil marks. Those are from the burrowing mites.

Here are the most common areas where you may see these signs, says Dr. Goldstein:

  • The webbing between your fingers
  • The skin folds around your wrists, elbows and knees
  • Your armpits
  • Around the nipples
  • Your waist
  • The penis in men
  • Your lower butt and upper thighs
  • The sides and bottoms of your feet

People with weakened immune systems are more likely to develop crusted scabies. It’s a more severe form of scabies, says the CDC. And it’s very contagious.

With crusted scabies, you may notice large, crusty red patches or bumps on the skin. Strangely enough, you may not have any itching at all. Especially if your immune system is unable to sound the alarm or fight back against these mites.

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How scabies is diagnosed

If any of the above sounds familiar, see your doctor right away, advises Dr. Goldstein. That way, you can get relief sooner and avoid further spread.

Scabies can usually be diagnosed easily from symptoms alone, says Dr. Goldstein. Your doctor can also confirm it by scraping the top layers of skin at the site of the itching and examining it for mites or eggs under a microscope.

What scabies treatment involves

What’s the gold standard for scabies treatment? A prescription topical cream medication known as permethrin (Elimite®), says Dr. Goldstein.

You apply it to your entire body, from the neck to the toes. After 8 to 14 hours, you wash it off in a shower or bath. “It’s very safe and can be used on everyone, including very young children,” Dr. Goldstein says. She adds that in babies and young kids, it should also be placed on the head and scalp. Those are common areas for scabies to invade in that age group. Then the treatment is usually repeated in 1 to 2 weeks.

If you have crusted scabies, you’ll likely be treated with both permethrin and an antiparasitic pill called ivermectin. (It’s the same ingredient found in heartworm-prevention medications for dogs.) This is usually a one-time treatment, although sometimes your doctor may recommend repeating it after a week.

These treatments get to work fast. Usually, you can return to work or school within 12 hours, says Dr. Goldstein. (Once you wash off the cream, of course.)

But that doesn’t mean the symptoms will be gone in a flash. Be prepared for the itching to last for a few more days — or even weeks, warns Dr. Goldstein.

What else can you do to find relief?

The continued itching is annoying. But it’s likely that your immune system is still in overdrive trying to fight off the mites.

Ask your doctor about safe ways to squash the itch. One option for relief: antihistamines. Examples include loratadine (Claritin®) or cetirizine (Zyrtec®). If you’re miserable, your doctor may also prescribe topical or oral steroids, says Dr. Goldstein.

Another key to finding relief: preventing reinfestation. You’ll need to wash any clothing, bedding, towels and even stuffed animals you touched in the 3 days leading up to treatment. Talk to your doctor about whether anyone you live with should get treatment even if they don’t have symptoms.

If you or someone you love has scabies, don’t worry. It’s a treatable condition that can happen to anyone, anywhere.

The Optum Perks app can also help you save money on your prescriptions anytime, anywhere. Download it now.


Additional sources
Background on scabies:
Centers for Disease Control and Prevention
Treatment considerations for children: American Academy of Pediatrics