Scabies is a very contagious skin condition caused by microscopic mites that requires immediate medical attention and prescription treatment.
If you think you might have scabies, a prompt diagnosis and treatment is highly recommended to prevent the risk of complications as well as spreading scabies to others.
The sooner you treat the condition, the sooner you can find relief. Here’s what to know.
What Is Scabies?
Scabies is a contagious condition caused by tiny parasitic mites called Sarcoptes scabiei. It impacts up to 300 million people worldwide each year, particularly in developing nations. The World Health Organization (WHO) has called it a neglected skin disease since it’s often not treated as quickly and effectively as necessary to control its spread.
That being said, the condition is highly treatable with prescription medication.
Understanding Sarcoptes scabiei and How They Spread
The scabies mites, which are part of the arachnid class, bury into the skin, often causing intense itching. They can then spread to others, typically through direct skin-to-skin contact that persists for at least 10 minutes. More rarely, scabies may spread indirectly through contaminated clothing, towels, or bedding.
In most cases, someone who’s infected will initially have about 10 to 15 mites on them. The exception is the more severe and highly contagious variant commonly called crusted or Norwegian scabies, in which someone might have millions of mites. Crusted scabies is more severe and very contagious.
The third variant of scabies, called nodular scabies, tends to be transmitted via the armpit and groin regions, which means they are often transmitted during sexual contact.
Since the female mites lay eggs on the skin, without treatment the number of mites can also increase over time.
Common Symptoms of Scabies
Common signs of scabies include:
- Intense itching, particularly at night
- Acne-like rashes, often between the fingers and toes, on the back of the wrists, or around the buttocks or breasts
- Skinny, gray-white or skin-colored lines called burrow marks where the mites have tunneled
- In babies, a rash all over the body, particularly on the face, head or neck, with sores on the palms of the hands and soles of the feet
- Sores from persistent scratching that may lead to secondary infections
Symptoms may take four to eight weeks to appear for first-time infections, though the mites can infect others immediately. Someone who’s had scabies before, meanwhile, may experience symptoms in as few as one to four days. According to WHO, recurring infestations are common.
Effective Ways to Kill Scabies Mites
The Centers for Disease Control and Prevention (CDC) advises against using over-the-counter (non-prescription) treatments in an attempt to treat scabies, since they have not been tested and approved to clear the condition. Instead, they recommend visiting a healthcare provider as soon as possible.
With that in mind, here’s what to know about medical and at-home treatments.
Medical Treatments for Scabies
Prescription medication (scabicides) is the fastest, most effective treatment for scabies. Proven treatments include:
- Topical permethrin cream (5%) is the first-line treatment In the U.S., United Kingdom, and Australia, in part thanks to its effectiveness and few side effects. It’s approved in the U.S. for people two months of age and older.
- Ivermectin (topical or oral) is not an FDA-approved scabies treatment. That being said, according to the Centers for Disease Control and Prevention (CDC), topical permethrin and oral ivermectin are both about equally effective at treating scabies.
- Topical benzyl benzoate is a common alternative, especially in areas where permethrin resistance may occur.
For crusted scabies, the CDC recommends using both oral (ivermectin tablets) and topical (permethrin cream and/or keratolytic cream) products, depending on what your dermatologist advises.
Home Remedies for Scabies
While some natural remedies like tea tree oil or cayenne pepper are often purported to treat scabies, the CDC advises against using over-the-counter or home remedies as a primary scabies treatment.
Since these natural treatments have not been tested, approved, or proven to effectively combat scabies, a prescription medication from your doctor is instead highly recommended.
Using Heat to Kill Scabies Mites
Even though at-home treatments are not recommended to remove the scabies from the skin, it’s important to use heat to kill any mites remaining in your home or on your belongings. Here’s what to know.
The Role of Hot Water and Vacuuming
Heat is a vital element for killing mites in your environment. Here's how:
- Heat water to at least 122°F for laundering all clothes, bedding and towels you may have come into contact with in the past three days.
- Run your dryer on its hottest setting to kill any remaining mites.
- Take any items that aren’t machine-washable to the dry cleaner.
- Vacuum your furniture and carpets thoroughly. This is especially important if someone in your home has the crusted variant of scabies.
Cleaning and Disinfecting with Household Cleaners, Rubbing Alcohol & Other Products
Though the World Health Organization promotes the use of antiseptics like hand sanitizer to limit the spread of infectious disease, there’s currently no evidence to suggest that such agents combat scabies.
In a 2015 study, researchers found no evidence that three different topical antiseptics, including two alcohol-based solutions and one iodine-based were effective in reducing the quantity or transmission of scabies.
Preventing Scabies Reinfections
Since the risk of recurring infections is high, it’s vital to take every precaution to avoid further spread. Here’s what to do.
Managing Bedding and Clothes
If you have any items that can’t be washed or dry cleaned, the CDC recommends:
- Sealing these items in plastic bags for at least three to seven days. Scabies mites typically can’t survive more than a few days without human contact.
- Storing items in a place safely out of the way from human contact, such as in your garage.
Additional Tips for Avoiding Mite Spread
To further protect against scabies re-transmission, the CDC advises:
- Treating everyone in your home with prescription treatment at the same time.
- Waiting at least 24 hours after your first prescription treatment application before returning to work, school, or any other public area.
- Notify anyone you’ve had skin-to-skin contact with in the past two months that they should check themselves for scabies.
Risks and Side Effects of Scabies Treatments
Side effects associated with scabies treatment are rare, but possible.
Allergic Reactions to Scabies Remedies
Even though permethrin cream is generally well-tolerated and has low toxicity, some patients may rarely experience:
- Burning or stinging
- Intense itching
- Skin irritation
- Breathing difficulties
If you experience any of the above, contact your medical provider as soon as possible.
Managing Side Effects of Medical Treatments
In order to minimize side effects and ensure a positive treatment outcome, keep these tips in mind:
- Apply a cool, wet washcloth to affected areas to soothe irritation.
- Use calamine lotion on impacted areas to minimize itching.
- Consider taking an antihistamine to curb any intense burning sensation.
- Contact your healthcare provider if symptoms persist beyond two to four weeks post-treatment, if you have any signs of further infection, or if you have a fever.
Working with a Piction Dermatologist
If you think you may have scabies or another skin condition, the expert dermatologists from Piction Health can help. Prompt assessment, diagnosis and treatment can help kill scabies as soon as possible as well as combat the risk of re-transmission.
