Scabies: Symptoms, Causes, Diagnosis and Treatment

Scabies is a contagious mite infestation that causes intense itching and a spreading rash, especially at night, and needs targeted treatment for the person and close contacts.

Scabies is an infestation of the outer layer of skin by tiny mites. The mites burrow into the skin and trigger an immune reaction, which causes itching and small bumps or a rash. Scabies can affect people of any age and is not a sign of poor hygiene.

It commonly spreads during prolonged, close skin-to-skin contact. Sharing a bed, clothing or towels can also contribute. Because itching may begin after the infestation has been present for a while, a person can pass scabies on before recognising the cause.

Most people with scabies notice intense itching, often worse at night when warmth and quiet make it more noticeable. A pimple-like rash may appear on the hands, wrists, between the fingers, elbows, waist, buttocks, genitals or other skin folds. Fine, short lines may mark the burrows, although they can be difficult to see.

Scratching can create broken skin, crusts and soreness. In infants, young children and older adults, the rash may involve the scalp, face, palms or soles. Explore more about [Itching Worse At Night](/symptoms/itching-worse-at-night/), [Itchy Skin](/symptoms/itchy-skin/) and [Skin Rash](/symptoms/skin-rash/).

Scabies is caused by infestation with the human itch mite. A fertilised female mite can burrow into the outer skin and lay eggs. The body’s response to the mites, eggs and waste produces the itch and rash; the symptoms are not caused by an allergy to dirt.

Transmission usually requires close or sustained contact, such as living in the same household or sharing a bed. Brief contact is less likely to spread ordinary scabies, but crusted scabies can contain many mites and may spread more readily.

Itching and rash may take time to appear after a first infestation. Once symptoms start, new itchy spots can continue to develop while mites remain untreated. Scratching may damage the skin and allow bacteria to enter.

After effective treatment, the immune reaction can continue for a while, so itching does not always stop immediately. New burrows or a steadily expanding rash can indicate continuing infestation and should be assessed.

Risk rises with prolonged close contact in a household, care setting, shared accommodation or intimate relationship. Outbreaks can occur wherever people live closely together. A previous episode does not provide dependable protection from catching scabies again.

A clinician usually considers the distribution of the rash, the pattern of itching, contact history and whether other household members are affected. They may inspect the skin closely and, when needed, examine a sample from a burrow under magnification. A diagnosis can sometimes be made from the clinical pattern without finding a mite.

Tell the clinician when the itch began, which areas are affected, whether anyone close to you is itchy, and what products or medicines you have already used. A [GP Consultation](/treatments/consultations-and-assessment/gp-consultation/) can help arrange assessment and treatment.

Treatment uses a prescribed or recommended anti-scabies medicine applied to the skin or taken by mouth, depending on the person’s age, pregnancy status, health and the type of infestation. Follow the instructions for where to apply it, how long to leave it on and when to repeat it. Treating only the most itchy spots may leave mites elsewhere.

Close household and intimate contacts may need assessment and treatment at the same time, even if they have no symptoms. Wash recently used clothing, towels and bedding as directed, and place items that cannot be washed aside according to clinical advice. Read more about [Scabies Treatment](/treatments/medical-dermatology/scabies-treatment/).

Keep fingernails short and use gentle skin care while the itch settles. Scratching lessens the chance of open sores, but persistent itch can be difficult to control; a clinician can suggest suitable relief. Avoid sharing towels, clothing or bedding until the treatment plan is complete.

Repeated scratching can cause bleeding, crusting and bacterial skin infection. Seek prompt medical care if painful warmth, spreading redness, pus, fever or rapidly worsening soreness develops. Thick crusted areas need medical assessment because they can represent a more extensive form of scabies and spread easily.

Avoid close skin contact while awaiting assessment, and notify people who may have had prolonged contact with you. Follow the full treatment instructions and coordinate contact treatment when advised. Cleaning recently used fabrics and avoiding shared personal items can reduce further exposure.

Arrange a dermatology review when the diagnosis is uncertain, symptoms continue after correctly following treatment, the rash is widespread or crusted, or a baby, older adult or person with reduced immunity is affected. Bring a list of treatments used and note which contacts have symptoms.