Scabies
Introduction
Scabies (skay-beez) is a highly contagious skin infection caused by a small mite. It is not dangerous, but can be very itchy. It is important to treat scabies as it can spread quickly to family members and loved ones.
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Child with itchy red rash from scabies covering sole of foot
Who gets it?
Scabies can affect anyone, but is particularly common among primary school aged children and elderly people. It may affect multiple members of a family who live together, such as siblings. Boys and girls are affected equally.
What causes it?
Scabies is a very itchy rash caused by a small mite, a tiny bug somewhat similar to head lice, that burrows in to the top layer of skin. It is very contagious and spreads particularly quickly in situations where there are many people living in close contact with one another, such as in crowded family homes. It spreads between people through skin, or items that have been in contact with skin, such as:
Directly through skin-to-skin contact (most common)
Indirectly through shared items, such as towels, clothes or bed linen (less common)
Symptoms of scabies may not be noticeable for many weeks after infection has occurred, so it is important to maintain good hygiene at all times.
What does it look and feel like?
Looks like…
Scabies mites themselves are too small to see, but can cause a rash.
The rash is usually made up of small, pink, slightly raised spots that may cluster together. It can also cause small squiggly line a few millimeters long with some scaling on the skin. These are most commonly found in between the fingers, wrists, armpits, belly button, elbows and feet, as well as the nappy area in small children, but can be found anywhere on the skin.
It can sometimes occur on the scalp in infants.
The skin bumps or lesions caused by scabies are generally very small and may be hard to see. Sometimes the only symptom is itch, without an obvious rash.
Sometimes, the area affected by scabies can also become infected by bacteria (usually during scratching). This can cause a different rash that is pink, may weep clear fluid and become crusty.
Feels like…
The rash caused by scabies can be very itchy, sometimes itchy enough to distract from sleep at night.
It may also feel itchier after taking a warm shower.
Although scabies mites burrow into skin, this is not painful.
What tests might be needed?
Most of the time, your GP or dermatologist will be able to diagnose scabies by having a close look through a magnifying glass. Sometimes, a sample of the skin (a biopsy) may be needed to confirm the diagnosis.
What treatments are available?
What can I do?
Hand Hygiene: Good hygiene is extremely important to prevent spread to other people or other areas of skin. Teach your child to avoid scratching and ensure regular hand washing at home.
Disinfecting household items: You should also wash all clothes, bed linen, towels, soft toys and other cloth household items using hot water (60 degrees or more) in order to destroy the mites and their eggs. Any items that cannot be washed (such as winter shoes, leather jackets, etc) can be tied up in a plastic bag and left in sunshine daily for 10 days prior to use.
Treat all close contacts: When you are advised to treat your child, make sure all the members of your household and other regular close contacts (grandparents that babysit, childcare attendees, etc) are also treated at the same time. This is important even if these close contacts are not itchy or do not appear to have scabies at the time, to prevent re-infection of your child, once your child has been treated. Close contacts may have a long delay from getting infected to developing symptoms. It is also possible for some people not to develop any symptoms and still be infected.
Inform authorities: It is also important to keep your child from school or childcare until after they have completed a full course of treatment as scabies is highly contagious. If children attend childcare or school then the authorities must be notified so other children and close contacts can be monitored and treated.
Medical therapies
There are many effective treatments available for scabies, which might be given by your doctor. These include:
Creams: Scabies is most commonly treated with skin creams to get rid of the scabies mite. The rash and itch may take up to six weeks after treatment to completely resolve. Second application of treatment should be applied one week after the initial treatment to kill any newly hatched mites. Both treatments are essential to complete one course of treatment.
Tablets: In some cases, tablets can be used to help to treat scabies that is not improving with creams. These are less commonly used, but may be an option if your child has failed treatment with creams or if your child has sensitive skin and reacts to creams.
What happens after treatment?
Scabies is very treatable, and your child's symptoms should improve within days of treatment. However, it is possible for your child to get re-infected with scabies, so good hygiene is still important even after the infection has passed. If symptoms (particularly the itch) continue after treatment, it is important to follow up with your doctor in case the infection has not been completely treated.
What support is available?
Your GP or dermatologist will be able to support you and your child in the management of scabies, and answer any questions that you may have about this condition.
Authors/Reviewers:
Author: Dr Imogen Kate Thompson
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
