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Scabies: Causes, Symptoms and Treatment

Scabies is a contagious skin condition caused by the mite Sarcoptes scabiei, which burrows into the skin and triggers intense itching and a characteristic rash.

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Things worth knowing about "Scabies"

Scabies is a contagious skin condition caused by the mite Sarcoptes scabiei, which burrows into the skin and triggers intense itching and a characteristic rash.

What is Scabies?

Scabies is a highly contagious skin infestation caused by the microscopic mite Sarcoptes scabiei. The mite burrows into the outer layer of the skin, where it lives and lays eggs. Scabies affects people of all ages and backgrounds worldwide and is not related to poor hygiene.

Causes and Transmission

Scabies is almost always spread through prolonged, direct skin-to-skin contact with an infected person. It can affect entire households, care facilities, or schools when left undetected.

Close physical contact (e.g., sleeping in the same bed, extended hand-holding)
Sharing clothing, bedding, or towels
Sexual contact

Symptoms

The hallmark symptom of scabies is intense itching, which typically worsens at night. The itching is caused by an allergic reaction of the immune system to the mite, its eggs, and waste products.

Severe, especially nocturnal itching
Small red bumps, blisters, or pimple-like sores
Thin, irregular burrow lines visible on the skin (grey or skin-colored), especially between fingers, on wrists, elbows, and in the genital area
Scratch marks and crusting from repeated scratching
In people with weakened immune systems: Crusted scabies (Norwegian scabies) with thick, scaly crusts and millions of mites

Diagnosis

Scabies is usually diagnosed by a dermatologist based on the clinical picture, symptoms, and patient history. Common diagnostic methods include:

Dermoscopy: Magnified examination of the skin to identify mite burrows and the mite itself
Microscopic examination: A skin scraping from a burrow is examined under a microscope to detect mites, eggs, or feces
History of itching among close contacts or household members

Treatment

Scabies is treatable, and full recovery is expected with appropriate therapy. Treatment involves the use of antiparasitic agents, either applied to the skin or taken orally.

Topical Treatment

Permethrin 5% cream: First-line treatment; applied over the entire body from the neck down and left on overnight
Benzyl benzoate: An alternative topical option
Crotamiton: Has both antiparasitic and anti-itch properties

Oral Treatment

Ivermectin: Used for severe cases, crusted scabies, or outbreak management in communal settings

Additional Measures

All close contacts and household members should be treated simultaneously
Wash all clothing, bedding, and towels at a minimum of 60 °C (140 °F)
Items that cannot be washed should be sealed in plastic bags for at least 72 hours

Prognosis

With correct treatment, scabies is fully curable. However, itching may persist for several weeks after successful treatment due to the ongoing allergic response of the immune system to dead mites and their by-products. Re-infestation is possible if contact with an untreated infected person occurs.

References

World Health Organization (WHO): Scabies Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/scabies
Sunderkotter C. et al.: S1 Guideline on Scabies. AWMF Registration No. 013-052, 2021. Available at: https://www.awmf.org
Hay R.J. et al.: Scabies in the developing world – its prevalence, complications, and management. Clinical Microbiology and Infection, 2012; 18(4): 313–323.

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