DermNet NZ

Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


What is scabies?

Scabies is an itchy rash caused by a little mite that burrows in the skin surface. The human scabies mite's scientific name is Sarcoptes scabiei var. hominis.

Scabies Scabies Scabies
Sarcoptes scabiei

How does one get scabies?

Scabies is nearly always acquired by skin-to-skin contact with someone else with scabies. The contact may be quite brief such as holding hands. Frequently it is acquired from children, and sometimes it is sexually transmitted. Occasionally scabies is acquired via bedding or furnishings, as the mite can survive for a few days off its human host.

Scabies is not due to poor hygiene. Nor is it due to animal mites, which do not infest humans. However animal mites can be responsible for bites on exposed sites, usually the forearms.

Typically, an affected host is infested by about 10 -12 adult mites. After mating, the male dies. The female scabies mite burrows into the outside layers of the skin where she lays up to 3 eggs each day for her lifetime of one to two months. The development from egg to adult scabies mite requires 10 to 14 days.

What are the symptoms and signs of scabies?

The itching appears a few days after infestation with scabies. It may occur within a few hours if the mite is caught a second time. The itch is characteristically more severe at night and affects the trunk and limbs. It does not usually affect the scalp.

Scabies burrows appear as tiny grey irregular tracks between the fingers and on the wrists. They may also be found in armpits, buttocks, on the penis, insteps and backs of the heels. Microscopic examination of the contents of a burrow may reveal mites, eggs or mite faeces (scybala).

Generalised rash
Scabies rash appears as tiny red intensely itchy bumps on the limbs and trunk. It can easily be confused with dermatitis or hives (and may be accompanied by these). The rash of scabies is due to an allergy to the mites and their products and may take several weeks to develop after initial infestation.

Itchy lumps or nodules in the armpits and groins or along the shaft of the penis are very suggestive of scabies. Nodules may persist for several weeks or longer after successful eradication of living mite.

Blisters and pustules on the palms and soles are characteristic of scabies in infants.

Secondary infection
Impetigo commonly complicates scabies and results in crusting patches and scratched pustules. Cellulitis may also occur, resulting in localised painful swelling and redness, associated with fever.

Scabies only rarely affects the face and scalp, and this most often occurs in young babies and bed-bound elderly patients.

Burrows (arrows point to mites)
Affected webspace
Pustules on hand
Baby with scabies rash
Scabetic nodules

More images of scabies

What is crusted scabies?

Crusted scabies (also called ‘Norwegian scabies’) is a very contagious variant of scabies in which there are thousands or even millions of mites, but very little itch. The patient presents with a generalised scaly rash. It is frequently misdiagnosed as psoriasis. Unlike the usual form of scabies, crusted scabies may affect the scalp.

Crusted scabies is most likely to affect individuals with a poor immune system, neurological diseases, the elderly or those with mental incompetence. It is the usual cause of severe outbreaks of scabies in an institution such as a hospital, rest home or prison.

People in contact with someone with crusted scabies may become very itchy, with tiny red spots and blisters on exposed areas; these people are not always infested themselves but must be treated with insecticides just in case they are carrying the mite.

Scabies Scabies Scabies
Scabies Scabies Scabies
Crusted scabies

Who gets scabies?

Scabies can affect children, young adults and the elderly in every community. Think of it if you or your child has developed a widespread itchy rash, especially if there's been close contact with another itchy person. However, not everyone who itches has scabies; dermatitis also itches but is not contagious and is much more common in New Zealand.

How is scabies diagnosed?

If you or your doctor consider scabies a possible explanation for an itchy rash, the diagnosis can be confirmed by microscopic examination of the contents of a burrow. However, even experienced dermatologists only recover a mite or an egg in about 50% of cases of scabies.

Occasionally, a skin biopsy is necessary to diagnose or confirm scabies, and typical histological features may be seen on histopathology.

Dermatoscopy makes it easy to identify a mite at the end of a burrow by its characteristic jet-plane or hang-glider appearance.

Scabies dermoscopy Scabies dermoscopy Scabies dermoscopy
Dermoscopy of scabies burrows
Red arrow points to mite

What is the treatment for scabies?

Scabicides are chemical insecticides used to treat scabies. Those available in New Zealand include:

Gamma benzene hexachloride cream is no longer recommended because of resistance and potential toxicity. Sulphur and crotamiton were popular in the past but are relatively weak scabicides.

The scabicide has to be applied before bed to the whole body from the scalp to soles.

Scabicide should be repeated a week to 10 days after the first application to catch mites that have newly hatched. It should not be repeated for several weeks after that without medical advice. Overuse of insecticides will irritate the skin and may cause cause contact dermatitis.

Each treatment with scabicide should be followed the next morning by hot-wash laundering or dry cleaning of sheets and pillow cases and any clothes worn against the skin over the last week. Non-washable items should be sealed in a plastic bag and stored above 20 C for one week. Alternatively they can be frozen below -20 C for 12 hours. Rooms should be thoroughly cleaned with normal household products. Fumigation or specialised cleaning is not required. Carpeted floors and upholstered furniture should be vacuumed and all areas cleaned with normal household products. The vacuum bag should then be discarded and furniture covered by plastic or a sheet during treatment and for 7 days afterwards.

Scabies itch usually improves within a few days of scabicide treatment but it may take 4–6 weeks for the itch and rash of scabies to clear completely because of dead mites at the skin surface. These will be slowly cast off.

To reduce the risk of the scabies treatment failing:

Persistent rash after scabies treatment

A rash may persist after scabies treatment. Reasons for this include:

Oral ivermectin is an effective alternative to topical treatment and is now considered treatment of choice for crusted scabies and in patients unable to apply scabicides properly.

Related information

On DermNet NZ:

Other websites:

Books about skin diseases:

See the DermNet NZ bookstore

Author: Dr Amanda Oakley, Hamilton, New Zealand.

DermNet NZ does not provide an online consultation service.
If you have any concerns with your skin or its treatment, see a dermatologist for advice.