Scabies
Scabies is an infestation of the skin by a microscopic mite that burrows into the surface layer.
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Medicines commonly prescribed for Scabies
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CREAM, 5 g permethrin / 100 gActive substance: permethrinManufacturer: Galenicum Derma S.L.U.Prescription requiredDosage form: CREAM, 5 g permethrin / 100 gActive substance: permethrinManufacturer: Unipharma S.A.Prescription required
Scabies is an infestation of the skin by a microscopic mite that burrows into the surface layer. It causes intense itching, particularly at night, and spreads through prolonged skin-to-skin contact. It has nothing to do with hygiene. It treats well, but two things decide the outcome: applying the product exactly as directed, and treating everyone in the household on the same day whether or not they have symptoms.
Symptoms
- intense itching, worse at night and in the warmth of the bed — the most characteristic feature;
- small red papules, often with crusts from scratching;
- fine, greyish, wavy burrows a few millimetres long, with a small elevation at one end;
- typical sites: between the fingers, the inner wrists, elbows, armpits, waistline, navel, buttocks, male genitals and, in women, the areolae;
- in adults it spares the face and head;
- in infants and young children it does affect the palms, soles, scalp and face, with blisters and pustules;
- itching begins 2–6 weeks after infestation the first time, and within 1–3 days if you have had it before;
- often several people in the same household are itching.
Special forms
- nodular scabies: persistent reddish nodules on the genitals, groin and armpits that keep itching for weeks after successful treatment. They are an immune reaction, not live mites;
- crusted scabies: a highly contagious form with thick crusts and thousands of mites, in people with severely reduced immunity, frail older people or those with disabilities. Itching may be minimal, which is why it goes unnoticed and causes outbreaks in care homes.
How it spreads
- prolonged direct skin-to-skin contact of at least 10–15 minutes: living together, sharing a bed, sexual contact, caring for a dependent person;
- a handshake or a brief hug is rarely enough;
- shared clothing, towels and bedding, particularly in the crusted form;
- away from skin the mite survives 2–3 days;
- care homes, nurseries and multi-occupancy households are the usual settings.
When to see a doctor
- you have intense night-time itching and a rash in the typical sites;
- several people in the household are itching;
- yellow crusts, pus, extensive redness or fever have appeared — added bacterial infection;
- itching continues more than four weeks after treatment;
- it is an infant, or you are pregnant or breastfeeding: the product is chosen specifically;
- your immunity is reduced;
- there are thick, extensive crusts;
- there has been a case in your care home or workplace.
Treatment
- 5% permethrin cream — the treatment of choice in most cases, including in children from two months, in pregnancy and while breastfeeding;
- oral ivermectin for extensive disease, outbreaks, the crusted form or where topical treatment is impractical;
- benzyl benzoate and precipitated sulphur as alternatives;
- repeat the treatment after seven days — essential, because the products do not kill all the eggs;
- treat all household members and close contacts at the same time even without symptoms: otherwise the infestation passes back and forth between people;
- antihistamines and a mild topical steroid for residual itching;
- antibiotics if there is bacterial infection.
How to apply the cream
- onto clean, cool, dry skin; if you shower first, wait until the skin is cool;
- cover the whole body from the neck down, missing nothing: between the fingers, under the nails — cut them first — the navel, genitals, buttocks, soles and behind the ears;
- in infants and older people, also the face and scalp, avoiding eyes and mouth;
- leave on for 8–12 hours, usually overnight;
- if you wash your hands during that time, reapply to the hands;
- shower off once the time is up;
- an adult needs about 30 g: a single application can use a whole tube.
Clothing and the home
- wash all clothing, towels and bedding used in the previous three days at 60 °C and tumble dry hot;
- anything that cannot be washed goes into sealed bags for seven days;
- vacuum mattresses and upholstery;
- there is no need to fumigate the home.
Itching after treatment
This is the greatest source of confusion. Itching can persist for two to four weeks after successful treatment, because it is an allergic reaction to the remains of the mite, not a sign that mites are still alive. Do not repeat the treatment on your own initiative: use moisturisers, antihistamines and a mild steroid. Seek advice if new burrows or new lesions appear, as those do indicate treatment failure.
Common questions
Is it due to poor hygiene? No. Anyone can get it.
Do animals pass it on? Animal mites can cause transient itching but do not reproduce on human skin or cause scabies.
Is it a sexually transmitted infection? It is also transmitted sexually, through the prolonged contact, but not only that way.
Can I go to work or school? You can return 24 hours after completing the first treatment.
Why treat people with no symptoms? Because itching takes weeks to appear: a person can be infested and passing it on without noticing anything.
Online consultation
In an online consultation the doctor reviews photographs and the distribution of the rash, helps distinguish scabies from eczema and insect bites, chooses the treatment according to age and pregnancy, explains in detail how to apply it, and organises simultaneous treatment for the whole household.
This material is for information only and does not replace a medical consultation.
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Reviewed on Jul 5, 2026
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