Scabies
Intensely itchy rash from microscopic burrowing mites. Worse at night. Spreads through prolonged skin contact.
What to look for
Side-by-side comparison
Normal skin
No intense itch
Scabies
Burrows between fingers, itch
Scabies is caused by the microscopic mite Sarcoptes scabiei, which burrows into the outermost layer of skin to lay eggs. The resulting immune reaction causes intense itching that is characteristically worse at night and can be severe enough to disrupt sleep.
The classic findings include small bumps or blisters in a linear pattern (representing the mite burrow), and the rash tends to favor specific locations: between the fingers, wrists, elbows, armpits, waistline, buttocks, and genital area. In infants, the palms, soles, face, and scalp may also be involved.
Scabies spreads through prolonged, direct skin-to-skin contact (15-20 minutes). Brief contact like handshakes rarely transmits it. It can also spread through shared bedding or clothing, though mites survive only 48-72 hours off the body. Scabies is not related to hygiene - it can affect anyone.
Treatment involves prescription topical permethrin 5% cream applied to the entire body from neck to toes (head included in infants), left on for 8-14 hours. Oral ivermectin is an alternative, especially for crusted scabies. All household contacts should be treated simultaneously, and all bedding and clothing washed in hot water. Itching may persist for 2-4 weeks after successful treatment due to ongoing immune response to dead mites.
Quick self-check
Does this look like scabies? Answer 2 questions.
Is the itching intensely worse at night?
Are there bumps between the fingers, on wrists, or waistline?
Risk factors
- Close personal contact with an infected person
- Crowded living conditions (dorms, nursing homes, shelters)
- Immunosuppression (risk of crusted/Norwegian scabies)
- Shared bedding or clothing with an infected person
When to see a dermatologist
- ⚠Intense itching worse at night, especially in typical locations
- ⚠Bumps between the fingers, on the wrists, or in the genital area
- ⚠Multiple household members itching simultaneously
- ⚠Itching not improving after 4 weeks despite treatment (possible re-infection)
Often confused with
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Full ABCDE check →Frequently asked questions
Can you see the mites?
The mites are microscopic (0.3mm) and almost impossible to see with the naked eye. Dermatologists may use dermoscopy to visualize mites or their burrows, or perform a skin scraping to confirm the diagnosis under a microscope.
Why am I still itchy after treatment?
Itching commonly persists for 2-4 weeks after successful treatment because the immune reaction to the dead mites continues. This does not mean treatment failed. However, if itching persists beyond 4 weeks or new bumps appear, retreatment or re-evaluation may be needed.