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Scabies is a skin infestation caused by a tiny insect, called a mite (Sarcoptes scabiei). The mite burrows under the surface of the skin where it lays its eggs. The eggs hatch into larvae which move about the skin before maturing into adult mites, which lay eggs to start the whole cycle again. The presence of the mites on the skin and their waste products in the skin sets up an allergic reaction that produces intense itching.

Areas of the body usually affected include the fingers, hands, wrists, elbows, armpits, breasts, buttocks and, in males, the genitals.

Scabies is common and can affect people of any age. In the UK, it is estimated that about 1 in 1,000 people develops scabies each month. Scabies is more common in towns, in women and children and in the winter, probably due to close contact.
The mite is highly contagious, transferred by contact between people. It is spread easily when people are in close contact with each other such as in schools or residential homes, or between sexual partners. Transfer may also occur through contact with contaminated clothing or bed linen.
Itching occurs about 4 to 6 weeks after infestation. However, if the person has been infested before she/he will be already sensitised to the mite, so itching may develop within a matter of hours.

Itchy hands are usually the first symptoms, followed by intense itching in other parts of the body. A red, raised rash is also usually present. Sometimes the burrows of the mites can be seen as fine, wavy, scaly lines just below the skin surface, especially in the webs of the fingers.

In people with an inadequate immune system, many thousands of mites may be present and the skin develops a crust-like appearance. This condition is called hyperkeratotic or Norwegian scabies.

Secondary bacterial skin infections may occur as a result of breaking the skin through scratching.
Scabies is treated with insecticide lotions or creams containing permethrin or malathion. Water-based or aqueous liquids are preferable to alcoholic lotions as the alcohol may irritate broken skin and it may cause respiratory problems in young children.

The lotion or cream is applied over the whole body, especially between the fingers and toes and beneath the nails, and including the scalp, neck, face and ears. If the hands are washed, another application must be applied.

Preparations containing permethrin are usually left on for 8 to 12 hours before being washed off. Those containing malathion are usually left on for 24 hours, before being washed off. The applications are repeated after 7 days to kill any mites that may have hatched since the first application.

An older, less effective treatment called benzyl benzoate application may also be used, but it is an irritant and should not be used in children.

Intense itching may persist for several weeks after the mites have been successfully destroyed as the dead mites and their waste products remain until the skin is shed. In such circumstances creams containing crotamiton, or topical steroids such as hydrocortisone, may be applied, or oral antihistamines taken, to relieve itching and reduce inflammation.
When to consult your pharmacist
All preparations for the treatment of scabies and the relief of intense itching are available from your community pharmacist without a prescription.

Do not be embarrassed to talk to your pharmacist about scabies. It is important that you describe the symptoms fully, say what areas of the body are affected and whether children or anybody who is pregnant or breast feeding is affected. Your pharmacist will select an appropriate product for you and your family. If your pharmacist considers that your scabies is particularly difficult to treat, or that you have a skin infection, you will be advised to see your doctor.
When to consult your doctor
It is very unusual for scabies treatments not to work. Itchiness can persist for some weeks after treatment. If the itchiness has not settled after two or three weeks and over the counter remedies have not worked you should see your doctor.

If your skin is infected your doctor will probably prescribe a course of antibiotics.

Crusted scabies may be particularly difficult to treat and your doctor may decide to refer you to a specialist.
Living with scabies
If you or any members of your family or household have scabies you should try to avoid close personal contact with other people to reduce the risk of spreading the mite. Similarly, if you know anyone with scabies or anyone with an undiagnosed itchy rash, avoiding close contact will reduce your chances of catching scabies.

If one member of a household has scabies, all members of that household should be treated even though they may not be showing any signs of infestation. Failing to follow this precaution can result in the mite returning after treatment has stopped. One of the treatments described above must be used. Simply scrubbing at the skin or taking hot baths will not kill the mite. Follow the treatment instructions, including second applications, to ensure that the mite is killed.

Clothing, towels and bed linen should not be shared, but should be washed at 50°C. Items of clothing that cannot be washed at this temperature should be dry cleaned or kept in a plastic bag for about 5 days, by which time the mites should have died.
Useful Tips
  • Do not have a hot bath before applying treatments for scabies
  • Try not to wash your hands during treatment, but if you do, remember to re-apply the treatment
  • Treat all members of your household, even if they do not seem to have any symptoms
  • Wash all your bedding, clothes and towels after treatment

Reviewed on 6 June 2011