Scabies: symptoms, how it spreads and how it is treated

In short

• Scabies is caused by a tiny mite that burrows into the top layer of skin. The main sign is itching that is worse at night, plus a rash that can look like pimples.
• It spreads mostly by prolonged skin-to-skin contact, including sexual contact. Sharing towels or bedding is a less common route. You do not catch it from pets.
• Symptoms can take 4 to 8 weeks to show up on a first infestation, and you can pass the mite on during that time.
• Treatment is a medicated cream or lotion, or a tablet, from a clinician or pharmacist. Household members and close contacts are treated at the same moment, even without an itch.
• The itch can last for several weeks after the mites are gone. See a clinician if it is still there 2 to 4 weeks later, or if the skin looks infected.

What scabies is

Scabies is an infestation of the skin by the human itch mite, Sarcoptes scabiei. The mite is too small to see. The female tunnels into the upper layer of the skin, where she lays eggs, and the itch is an allergic reaction to the mites and their droppings.

It is common worldwide, and anyone can get it. It travels fastest where people spend time in close contact, such as nursing homes, childcare settings, shelters and prisons. A healthy person usually carries only a small number of mites, which is one reason the diagnosis can be missed.

Symptoms and what the rash looks like

• Intense itching, often worst at night.
• A raised rash or spots. They look red on light skin; on brown or Black skin they can be harder to see but are easy to feel.
• Thin lines with a tiny dot at one end. These burrows are made by the mite.
• Typical places: between the fingers, the skin folds of the wrists, elbows, knees and armpits, the waist, the buttocks and the groin. In most adults the head and neck are spared.
• Babies, young children and older people may also have a rash on the head, face, neck, palms and soles of the feet.

Many other skin problems itch and cause a rash, so you cannot reliably diagnose scabies by looking at it yourself. A person with a weakened immune system can develop crusted scabies, a rare and very contagious form with a flaky, crusted rash, often on the elbows, knees, hands and feet. It needs prompt medical care.

How it spreads and who is at risk

The usual route is direct, prolonged skin contact with someone who has scabies, which is why partners and families so often catch it together. Clothing, towels and bedding used by an infested person can pass it on, but that is the less common way. Away from human skin, the mites generally do not survive more than two to three days.

Scabies has nothing to do with being unclean, and it is not caught from pets. Pets can have a different mite infection, but it is not the same as human scabies. The people at higher risk are those who live or work in crowded or close-contact settings.

Because the first symptoms can appear 4 to 8 weeks after the mites arrive, the person you caught it from may have had no idea they were infested.

What to do at home on treatment day

1. Get it confirmed.Treatments for scabies need a clinician's or pharmacist's advice. No over-the-counter product has been tested and approved for it in the US, so do not guess with a general anti-itch cream.
2. Treat everyone together.Household members and anyone who shared a bed or had skin contact should be treated at the same time, symptoms or not. Tell sexual partners from the last two months.
3. Apply as directed.The product goes on clean skin from the neck down to the toes, and on the head and neck as well for infants and young children. Leave it on for the time on the label, then wash it off.
4. Wash the fabrics.Wash bedding, towels and clothing worn against the skin in the three days before treatment in hot water, then dry them on a hot cycle. Dry cleaning works too.
5. Bag the rest.Items that cannot be washed can be sealed in a plastic bag for at least 72 hours.
6. Limit contact.Avoid skin-to-skin contact with others until treatment is finished. Most people can go back to work, school or childcare the day after treatment.

When to see a doctor

• You have night itching with a rash, or someone in your home does, and you have not been examined.
• The itch continues 2 to 4 weeks after treatment, or new burrows or pimple-like spots appear.
• The skin looks infected, or you have eczema or another skin condition.
• A child under 2 or a pregnant or breastfeeding person needs treatment.
• You have a crusted, flaky rash on the elbows, knees, hands or feet, or a weakened immune system.

Start with your primary care provider or a dermatologist. Scratching can bring in bacteria and lead to infections such as impetigo, and scabies can make eczema or psoriasis worse.

Red flags, call 911 now: swelling of the lips, mouth, tongue or throat; fast or difficult breathing; fainting; or fever with painful, hot red skin that is spreading quickly and a feeling of being very unwell.

How doctors confirm scabies

A clinician may recognize scabies from the story and the look of the skin, but will usually try to confirm it. That can mean scraping the skin or lifting a mite out of the end of a burrow with a needle tip and examining it under a microscope for the mite, its eggs or its droppings.

A negative scraping does not rule scabies out, because there may be very few mites. The decision to treat can rest on the exam and your history.

Treatment in general terms

Scabies is treated with prescription medicines that kill the mite, applied to the skin as a cream or lotion, or in some cases taken as a pill. In the US, only permethrin or sulfur ointment are used in infants. Treatment is repeated if the clinician advises it, because retreatment may be needed when itching continues or new burrows appear two to four weeks later.

The itch is an allergic reaction, so it often fades slowly over several weeks even after the mites are dead. A clinician can advise on easing the itch while it settles. Do not apply the scabies medicine again on your own just because you itch.

Children, pregnancy and care homes

Infants and young children need a clinician to choose the product, and the treatment usually covers the head and neck too. Pregnant or breastfeeding people should tell the pharmacist or doctor before treatment so a suitable product is chosen.

In nursing homes and childcare, one missed case can lead to an outbreak, especially with crusted scabies, so staff and contacts are often treated together.

Questions and answers

Sources

1. CDC — About Scabies
2. NHS — Scabies
3. MedlinePlus — Scabies
4. American Academy of Dermatology — Scabies: Overview

Sources checked on 28 October 2026.