Patient Basics: Scabies

Scabies is a very itchy rash caused by tiny mites that burrow into the top layer of the skin and lay eggs there. It spreads mostly through close skin-to-skin contact, so it often passes between people who live together, sexual partners and people in nursing homes or child care. Prescription cream or pills cure it. Everyone in the household needs treatment at the same time, even people who don’t itch yet.

Key points

• The main sign is intense itching that is worse at night, often with small bumps and thin lines on the skin.
• The first time you get scabies, itching can take 2 to 6 weeks to start. You can still spread it during that time.
• Permethrin cream and ivermectin pills are the most common treatments.
• Wash bedding, towels and clothes, or seal them in a bag for at least 3 days.
• Itching can last 2 to 4 weeks after the mites are gone. That doesn’t mean the treatment failed.

What causes scabies

Scabies comes from a mite called Sarcoptes scabiei. It’s too small to see without magnification. The female mite digs a short tunnel (burrow) in the skin, lays eggs and lives for about a month. The itching and rash come from the body’s allergic reaction to the mites, their eggs and their waste.

The mites can’t jump or fly. They spread through skin-to-skin contact that lasts a while, such as sharing a bed, holding a child or having sex. A quick handshake or hug rarely passes them on. Less often, they spread through shared bedding, towels or clothes. Off the human body, they usually die within 2 to 3 days. Scabies has nothing to do with being unclean. Anyone can get it.

Dogs and cats get a different mite. It may cause a brief rash on people but can’t live on human skin.

Crusted scabies

In people with a weak immune system, older adults in care homes and some people with disabilities, scabies can form thick, gray, crusted patches that hold huge numbers of mites. This form, once called Norwegian scabies, may itch less but spreads very easily. It needs stronger treatment and close follow-up.

Scabies symptoms

• Strong itching, worst at night
• Small red bumps that look like pimples, and sometimes tiny blisters
• Burrows, which look like short, thin, wavy gray or skin-colored lines
• Sores from scratching, which can become infected
• Sometimes firm, itchy lumps in the armpits or groin that last for weeks

The rash often shows up between the fingers, on the wrists and elbows, in the armpits, around the waist and belt line, on the buttocks, around the nipples and on the genitals. In babies and young children, it can also appear on the palms, soles, face and scalp, and the child may be fussy and feed poorly.

If you’ve had scabies before, symptoms can start within a few days of being exposed again.

How it’s diagnosed

Doctors usually diagnose scabies by looking at the rash and asking whether people around you are itchy. They may look closely with a handheld magnifier (dermatoscope), which can show the mite at the end of a burrow. A doctor can also gently scrape the skin and look at it under a microscope for mites or eggs. Not finding a mite doesn’t rule out scabies.

Scabies treatment

Medicines that kill the mites

• Permethrin cream is the usual first choice for adults, during pregnancy and for babies 2 months and older. Apply it to clean, cool, dry skin over the whole body from the neck down, including between fingers and toes, under the nails, the soles of the feet, the genitals and the buttocks. For babies and older adults, it’s also put on the scalp and face, avoiding the eyes and mouth. Leave it on overnight, about 8 to 14 hours, then wash it off. Most people repeat it a week later.
• Ivermectin pills are taken in two doses about a week apart. They’re handy for large groups, for people who can’t use cream on their whole body, and for crusted scabies. They’re not usually given to young children or during pregnancy.
• Other options include spinosad lotion and sulfur ointment, which is sometimes used for babies younger than 2 months.

Treat everyone in the household, sexual partners and other close contacts on the same day, even if they have no symptoms. Otherwise, the mites can pass back and forth.

Easing the itch

• Antihistamine pills, such as cetirizine during the day or a drowsy one at night, can help with sleep.
• Cool compresses and fragrance-free moisturizers soothe the skin.
• Your doctor may suggest a steroid cream once the mites have been treated.
• Skin infections from scratching may need antibiotics.

Cleaning your home

• On the day you start treatment, wash clothes, towels and bedding used in the past 3 days in hot water and dry them on a hot setting.
• Seal items you can’t wash, such as stuffed toys or shoes, in a plastic bag for at least 3 days. Use a week for crusted scabies.
• Vacuum carpets and upholstered furniture.
• You don’t need to use pesticide sprays or fumigate, and pets don’t need treatment.

Recovery

Children and adults can usually go back to school, child care or work the day after the first treatment. The itch often lasts 2 to 4 weeks, because the skin is still reacting to dead mites. If you see new burrows or new rash after that, or the itch gets worse, see your doctor. You may need another round of treatment, or someone close to you may not have been treated.

Lowering your risk

• Avoid close skin contact with someone who has scabies until they’ve finished treatment.
• Don’t share bedding, towels or clothes with someone who has it.
• Make sure every household member and close contact is treated at the same time.
• In nursing homes and other group settings, report itchy rashes early so an outbreak can be controlled.

When to see a doctor

• An itchy rash that is worse at night, especially if others at home are itching too
• Itching or rash that is worse, or new burrows, 2 to 4 weeks after treatment
• Signs of skin infection, such as spreading redness, warmth, pus, honey-colored crusts or fever
• Thick, crusted patches of skin
• A rash in a baby, someone who is pregnant or someone with a weak immune system

Common questions about scabies

Why is scabies called the seven-year itch?

Before modern treatment, scabies could linger for years, so people nicknamed it the seven-year itch. Today cream or pills cure it, though the itch can last a few weeks after the mites die. The same phrase is used for restlessness in a long marriage, which has nothing to do with the rash.

Can you see scabies mites on your skin?

Barely. A female mite is about a third of a millimeter long, so at most it looks like a tiny white dot at the end of a burrow. The mites live inside the skin, so you won’t see them crawling or biting. Bugs you can see moving on your skin or hair are more likely lice.

Can scabies cause itching with no rash?

Early on, yes. Itching, especially at night, can start before the bumps are easy to see, and burrows can be faint. Many other things also cause itching without a rash, such as dry skin, some medicines, and liver, kidney or thyroid problems. If others at home itch too, scabies is more likely.

Questions to ask your doctor

• Is this scabies, or could it be another rash?
• Who else needs to be treated?
• Can you show me how to put the cream on correctly?
• When can my child or I go back to school or work?
• How long should I expect the itching to last?

Learn more

• About scabies (Centers for Disease Control and Prevention)
• Scabies (DermNet)

This guide is general information and doesn’t replace advice from your own doctor. Last updated October 2026.