Scabies: Information for Patients

A treatable infestation that requires correct diagnosis, careful application of treatment, and simultaneous management of close contacts.

Summary in 60 seconds

• Scabies is a skin infestation caused by the human mite Sarcoptes scabiei var. hominis .
• It is mainly transmitted through direct and sustained skin-to-skin contact.
• It is not a consequence of poor hygiene and can affect anyone.
• It usually causes intense itching, especially at night, small lesions and, sometimes, fine furrows in the skin.
• In a first infestation, symptoms may take several weeks to appear, although the person can already transmit it.
• Topical 5% permethrin remains a common initial option; alternatives such as oral ivermectin exist for selected situations.
• Household members, sexual partners, and other close contacts often need simultaneous treatment, even if they do not yet have symptoms.
• Recently used clothes, towels, and bedding should be washed in heat or temporarily isolated in a sealed bag.
• The itching may persist for several weeks after the mites are removed.

What is scabies?

Scabies, also known as human mange, is a parasitic infestation caused by a microscopic mite. The female burrows into the outermost layer of the skin and creates small tunnels where she lays her eggs. Most of the lesions and itching are not due to the mechanical movement of the mite, but rather to the immune response to the parasite, its eggs, and its debris. (WHO 2023 , Sunderkötter 2021 )

It is a common disease worldwide. The World Health Organization estimates that at least 200 million people have it at any given time. It can affect people of any age and socioeconomic status, although transmission is facilitated by close living arrangements, frequent physical contact, or difficulty accessing rapid diagnosis and treatment. WHO 2023 .

Classic scabies usually involves few mites—often around 10 to 15—although the itching and rash can be extensive. This explains why it is sometimes difficult to find the parasite even with a properly performed test. WHO 2023 , CDC 2024 .

It is not a sign of dirt, neglect, or poor hygiene. That link is a myth and can cause embarrassment, delay seeking medical attention, and prevent those in contact with the animal from receiving treatment. It is also not hereditary. The mites responsible for mange in animals are different and generally do not maintain a typical, long-lasting human infestation. BAD 2023 .

Why does it appear?

Scabies occurs after contact with an infected person. The usual mode of transmission is direct, prolonged, or repeated skin-to-skin contact , such as can happen when sleeping in the same bed, living together, caring for a dependent person, having sexual contact, or engaging in activities involving close physical contact. A handshake or a brief hug is not usually sufficient to transmit classic scabies. CDC 2024 , Morris 2025 .

Transmission via clothing, towels, or bedding is possible, but less frequent in classic scabies. It becomes much more important in crusted scabies , because in this form there can be thousands or millions of mites and a large amount of contaminated scales. WHO 2023 , CDC 2024 .

When a person is first infested, symptoms usually take about three to six weeks to appear—some guidelines use a four-to-eight-week range. During this time, they can be contagious without knowing it. If someone has had scabies before, their immune system recognizes the mite sooner, and symptoms may appear one to four days after a new exposure. CDC 2024 .

Crusted scabies

Crusted scabies, formerly known as Norwegian scabies, is a rare, highly contagious, and potentially serious form of scabies. It is more likely to occur in people with immunosuppression, advanced age, malnutrition, neurological disorders, cognitive impairment, or limitations that prevent them from feeling itching and scratching. It may present with thick, crusted plaques, but with little or no itching. It requires priority medical evaluation and specialized treatment. (WHO 2023 , Morris 2025 )

What does it look like and what symptoms does it cause?

The most characteristic symptom is intense itching that usually worsens at night . The rash may consist of small bumps, tiny blisters, scratch marks, crusts, or nodules. Burrows are fine, slightly raised, wavy lines that are whitish, grayish, or similar in color to the skin. Although they are very indicative, they are not always visible to the naked eye. CDC 2024 , BAD 2023 .

In adolescents and adults, common locations include:

• spaces between the fingers;
• wrists, elbows and armpits;
• waist, lower abdomen and buttocks;
• groin, genitals and area around the nipples;
• ankles and feet;
• edges and areas located under the nails.

In infants and young children, lesions may also be seen on the head, neck, palms, and soles. These areas can also be affected in older adults, immunocompromised individuals, or those with crusted scabies. CDC 2024 , Thompson 2021 .

Repeated scratching can break down the skin barrier and promote bacterial infections. Attention should be paid to the appearance of increasing pain, heat, pus, yellowish crusts, foul odor, spreading redness, or fever. WHO 2023 , CDC 2024 .

Not all nighttime itching is scabies: the appearance can be confused with eczema, contact dermatitis, insect bites, urticaria, folliculitis, prurigo, or drug reactions. The presence of nighttime itching, lesions in typical locations, and similar symptoms in household members increases suspicion, but does not replace clinical evaluation. Uzun 2024 , Al-Dabbagh 2023 .

What can you do today?

1. Request an assessment

• If you suspect scabies, consult a dermatologist. Improper application of a scabicide can irritate the skin, obscure lesions, and make diagnosis more difficult.

2. Temporarily reduce close contact

• Until the treatment has started correctly:
  • avoid sleeping in the same bed with other people;
  • It limits direct and sustained skin-to-skin contact;
  • Do not share clothes, towels, or garments that have been in direct contact with the skin;
  • discreetly informs cohabitants, sexual partners, and other recent close contacts.
• This is not about finding someone to blame. The goal is to break the chain of transmission before new cases appear. CDC 2024 , BAD 2023 .

3. Coordinate the handling of contacts

• Household members, bed partners, sexual partners, and other close physical contacts often require same-day treatment, even if they do not yet have itching or lesions. Treating only the symptomatic individual is a common cause of reinfestation within the home. Morris 2025 , CDC 2024 .

4. Follow the instructions given by the medical professional exactly.

• Topical permethrin 5% remains one of the most commonly used initial treatments for classic scabies. It should be applied to all indicated areas, not just visible lesions. It is important to cover skin folds, between the toes, the genital area, the feet, and the skin under or around the nails. If hands are washed during the application period, it is usually necessary to reapply the product to the hands. Many guidelines call for a second application about a week later. (CDC 2023 , Morris 2025 )
• The exact extent of application varies depending on the product, age, and clinical situation. Some protocols indicate treatment from the neck down in adults, while infants, the elderly, immunocompromised individuals, or patients with scalp lesions may require application to the head and neck, avoiding the eyes and mouth. Product instructions and those of the prescribing professional should take precedence. CDC 2023 , BAD 2023 .
• Oral ivermectin is an alternative for selected situations, such as difficulty in achieving complete topical application, certain outbreaks, or crusted scabies. It should not be used without medical supervision. Pregnancy, breastfeeding, infant weight, potential interactions, and associated illnesses influence the choice of treatment. CDC 2023 , Uzun 2024 .
• Current evidence: A 2025 British guideline includes permethrin and ivermectin among the main treatment options for adults. However, a large clinical trial published in 2026 found better results with 5% permethrin than with oral ivermectin in classic scabies. This supports maintaining permethrin as a common first-line treatment, without denying that ivermectin retains important indications when topical treatment is not appropriate. Morris 2025 , Boralevi 2026 .

5. Handle clothing and bedding without extreme measures

• Coinciding with the start of treatment:
  • Wash recently used clothes, towels, and bedding;
  • Use a hot cycle and high-temperature drying when the fabric allows;
  • Store items that cannot be washed in a sealed bag for at least three days; some guides advise keeping them isolated for up to a week;
  • Use clean clothes and bedding after treatment.
• The mites that cause classic scabies typically survive only two to three days off human skin. Disposing of mattresses, sofas, or clothing is not usually necessary. More intensive environmental cleaning is reserved primarily for crusted scabies and institutional outbreaks. CDC 2024 , WHO 2023 .

6. Protects the skin while reducing itching

• They may be useful:
  • warm or cool showers;
  • a simple, fragrance-free moisturizer;
  • Keep nails short and clean to reduce scratching damage;
  • loose clothing;
  • Topical corticosteroids or antihistamines should only be used when they have been indicated to control inflammation or sleep.
• These measures alleviate symptoms, but do not replace scabicide . BAD 2023 , Morris 2025 .

What NOT to do?

• Do not apply the treatment only to visible lesions. The mite may be present in areas that are not yet itchy.
• Don’t treat only the most symptomatic person. Asymptomatic contacts can maintain transmission.
• Do not reapply the scabicide daily on your own (without medical supervision). Excessive use can cause irritant dermatitis or worsen eczema.
• Do not use bleach, chlorine, kerosene, gasoline, household insecticides, fumigants, or veterinary products on the skin.
• Do not rely on essential oils or home remedies as substitutes for medical treatment. Their effectiveness is uncertain, and some can cause irritation or allergies.
• Don’t fumigate the entire house or automatically discard the mattress. In classic scabies, this is usually unnecessary.
• Do not interpret persistent itching as automatic proof that mites are still present.
• Do not take ivermectin without individual medical evaluation , especially during pregnancy or in young children.

When should I consult?

Consult a dermatology specialist as a priority if any of these situations appear:

• thick plaques, extensive scales or crusts , especially on the hands, feet, scalp or nails;
• little itching despite crusty lesions , especially in an elderly, dependent or immunosuppressed person;
• pus, yellowish scabs, pain, local heat, bad odor or progressive redness ;
• fever or general malaise associated with skin lesions;
• affecting an infant;
• pregnancy or breastfeeding;
• immunosuppression, neurological disease, cognitive impairment, or significant frailty;
• outbreak in a residence, health center, daycare, institution or shared housing;
• injuries near the eyes or inside the mouth;
• intense reaction after applying the treatment;
• appearance of new furrows or pimples after completing the pattern;
• itching with no tendency to improve after two to four weeks;
• symptoms that continue for six to eight weeks or raise doubts about the diagnosis.

The combination of fever, significant pain, rapidly progressing redness, drowsiness, confusion, or general deterioration requires immediate medical attention, as it may indicate a significant bacterial infection. WHO 2023 , CDC 2024 , Morris 2025 .

What does a dermatologist usually do?

The dermatologist begins by reviewing when the itching started, whether it worsens at night, which areas are affected, whether any household members have symptoms, and what treatments have been used. The examination should include the spaces between the fingers, wrists, armpits, waist, genitals, feet, and nails. In infants, the elderly, or complex cases, the head and neck are also carefully examined. Dermatoscopy allows magnified observation of the end of the burrow and, sometimes, identification of a dark triangular structure corresponding to the anterior part of the mite. It is a quick and non-invasive technique, although its accuracy depends on experience and finding a suitable lesion. (Engelman 2020 , Uzun 2024 )

The specialist can obtain a surface sample from a burrow by scraping or using adhesive tape and examine it under a microscope. Finding the mite, its eggs, or its debris confirms the diagnosis. However, a negative test does not completely rule out scabies, because in the classic form there may be very few mites. CDC 2024 , Engelman 2020 .

A biopsy is not usually necessary. It may be considered when the presentation is atypical, another disease is suspected, or routine tests do not clarify the diagnosis. Histological examination may show parts of the mite, eggs, or fecal material within the stratum corneum, but their absence does not rule out infestation. Al-Dabbagh 2023 , Morris 2025 .

In addition to confirming the cause, the dermatologist assesses for bacterial infection, treatment-induced dermatitis, secondary eczema, crusted scabies, or a source of reinfestation in the environment. They then adjust the scabicide, itch control, and contact management.

Frequently Asked Questions

Is scabies caused by poor hygiene?

• No. It can affect anyone. Routine hygiene does not necessarily prevent infection when there is close contact with an infested person, and repeated bathing does not eliminate mites. BAD 2023 .

Is it considered a sexually transmitted infection?

• It can be transmitted during sexual contact through prolonged skin-to-skin proximity, but it is not exclusively acquired in this way. It is also transmitted among cohabitants, caregivers, children, and people who share a bed. Having scabies does not prove infidelity nor does it allow one to establish with certainty when or from whom it was acquired. When exposure was likely sexual, the healthcare professional may offer testing for other infections depending on the context. Morris 2025 , BAD 2023 .

How long does it take to appear after infection?

• In the first infestation, itching can take approximately three to six weeks, and some sources use a range of up to eight weeks. If the person has had scabies before, symptoms can begin in one to four days. Transmission can still occur during the asymptomatic period. CDC 2024 .

Do all family members need to be treated?

• Household members and other close contacts deemed exposed by the healthcare professional should be treated simultaneously, even if they do not have itching. Not everyone who knows the patient needs treatment: the risk depends on physical contact, sharing a bed or clothing, and the presence of crusted scabies. CDC 2024 , Morris 2025 .

Why do I still have itching after the treatment?

• The immune system can continue to react to mite remnants even after the mite has died. This post-scabies itching usually improves gradually over two to four weeks, although it lasts longer in some people. Isolated instances of persistent itching do not confirm that treatment has failed. New burrows, new spots, or a complete lack of improvement are more concerning. CDC 2024 , Morris 2025 .

How long can dust mites live on clothes, beds, or mattresses?

• In classic scabies, the parasite typically survives for two to three days off human skin. Therefore, it is recommended to wash or isolate recently used items, rather than indiscriminately disinfecting all belongings. In crusted scabies, the environmental burden and the risk of transmission are greater, so additional measures may be necessary. WHO 2023 , CDC 2024 .

Can dogs or cats transmit it?

• Common human scabies is caused by a variety of mite adapted to humans. Mites from some animals may cause temporary irritation upon contact with a person, but they do not usually reproduce or maintain a typical human infestation. If a pet has hair loss, scabs, or severe itching, it should be evaluated by a veterinarian. BAD 2023 .

Bibliography and sources

• World Health Organization. Scabies [Internet] . Geneva: World Health Organization; 2023 May 31 [cited 2026 Jul 12] .
• Centers for Disease Control and Prevention. About scabies [Internet] . Atlanta (GA): CDC; 2024 Sep 9 [cited 2026 Jul 12] .
• Centers for Disease Control and Prevention. Symptoms of scabies [Internet] . Atlanta (GA): CDC; 2024 Jan 12 [cited 2026 Jul 12] .
• Centers for Disease Control and Prevention. How scabies spreads [Internet] . Atlanta (GA): CDC; 2024 Feb 23 [cited 2026 Jul 12] .
• Centers for Disease Control and Prevention. Clinical care of scabies [Internet] . Atlanta (GA): CDC; 2023 Dec 18 [cited 2026 Jul 12] .
• Centers for Disease Control and Prevention. Treatment of scabies [Internet] . Atlanta (GA): CDC; 2024 Jan 12 [cited 2026 Jul 12] .
• British Association of Dermatologists. Scabies: patient information sheetlet [Internet] . London: British Association of Dermatologists; 2023 Oct [cited 2026 Jul 12] .
• Morris G, Haddow L, Sashidharan PN, Savary-Trathen A, Soni S, Bigland C, et al. British Association for Sexual Health and HIV National Guideline on the Management of Scabies in adults 2025 . Int J STD AIDS. 2025;36(7):516-532. doi:10.1177/09564624251321264.
• Uzun S, Durdu M, Yürekli A, Mülayim MK, Akyol M, Velipaşaoğlu S, et al. Clinical practice guidelines for the diagnosis and treatment of scabies . Int J Dermatol. 2024;63(12):1642-1656. doi:10.1111/ijd.17327.
• Engelman D, Yoshizumi J, Hay RJ, Osti M, Micali G, Norton S, et al. The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies . Br J Dermatol. 2020;183(5):808-820. doi:10.1111/bjd.18943.
• Sunderkötter C, Wohlrab J, Hamm H. Scabies: epidemiology, diagnosis, and treatment . Dtsch Arztebl Int. 2021;118(41):695-704. doi:10.3238/arztebl.m2021.0296.
• Mbuagbaw L, Sadeghirad B, Morgan RL, Mertz D, Motaghi S, Ghadimi M, et al. Failure of scabies treatment: a systematic review and meta-analysis . Br J Dermatol. 2024;190(2):163-173. doi:10.1093/bjd/ljad308.
• Morgado-Carrasco D, Piquero-Casals J, Podlipnik S. Treatment of scabies . Aten Primaria. 2022;54(3):102231. doi:10.1016/j.aprim.2021.102231.
• Thompson R, Westbury S, Slape D. Paediatrics: how to manage scabies . Drugs Context. 2021;10:2020-12-3. doi:10.7573/dec.2020-12-3.
• Al-Dabbagh J, Younis R, Ismail N. The currently available diagnostic tools and treatments of scabies and scabies variants: an updated narrative review . Medicine (Baltimore). 2023;102(21):e33805. doi:10.1097/MD.0000000000033805.
• Boralevi F, Simon G, Bernigaud C, et al. Oral ivermectin versus 5% permethrin cream to treat children and adults with classic scabies: multicenter, assessor blinded, cluster randomized clinical trial . BMJ. 2026;392:e086277. doi:10.1136/bmj-2025-086277.