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Pubic Lice vs Scabies

An infestation of coarse body hair by crab lice, usually spread through close contact. Scabies is an intensely itchy rash caused by a tiny mite that burrows into the top layer of skin. It spreads through prolonged skin-to-skin contact, it has nothing to do with cleanliness, and it clears with prescription treatment when everyone in the household is treated at the same time.

Research updated 2026-10-23
Pubic LiceThe finger webs and wrist on fair light skin, with small red bumps, several thin gray burrow lines a few millimetres long, and scratch marks across the area.
Key differencesWhat is it?What it looks likeDiagramsWhen it startsTriggersDaily CareTreatmentOutlookComplicationsWhen to get helpQuestions

Key differences

The same eight facts on every condition comparison.

Usual age
Sexually active adults
Any age
Where
Pubic hair
Finger webs, wrists, waist, groin
Main sign
Lice and eggs on hairs
Tiny burrows and itchy bumps
Itch or pain
Itchy
Severe itch, worse at night
Contagious
Yes, close contact
Yes, skin contact
Long term
Clears with treatment
Clears with treatment
Scars
No
No
Who gets it
Sexually active adults
Households, care homes, close contacts

What is it?

Pubic Lice
Scabies
What is it?
  • What it is
    An infestation of coarse body hair by crab lice, usually spread through close contact.
  • It is caused by a mite.
    The human scabies mite lives in superficial skin and triggers an immune reaction.
  • Symptoms can be delayed.
    A first infestation can go unnoticed for weeks while it can still spread.
  • It is not about hygiene.
    Scabies can occur in any household or care setting.
  • Crusted scabies is different.
    It carries a very large mite burden and needs a specialist regimen.

What it looks like

Pubic Lice

A tan crab-shaped louse viewed from above with six legs and large claws.

Pubic Lice The insect's broad body and prominent grasping claws are shown in detail.

Scabies

Scabies: Classic.

Classic scabies Itchy bumps and burrows with few mites.

A thin, winding track is visible in the finger web.

Burrows between fingers A thin, winding track is visible in the finger web.

Scabies: Crusted.

Crusted scabies Thick gray crusts with huge numbers of mites.

Firm itchy lumps that can last for months.

Nodular scabies Firm itchy lumps that can last for months.

Skin tones
Pubic Lice, close-up of representative skin findings.
Pubic Lice, close-up of representative skin findings.
Pubic Lice, close-up of representative skin findings.
Pubic Lice, close-up of representative skin findings.
The finger webs and wrist on fair light skin, with small red bumps, several thin gray burrow lines a few millimetres long, and scratch marks across the area.
The finger webs and wrist on medium olive-tan skin, with small pink-brown raised bumps, faint burrow lines and several scratch marks.
The finger webs and wrist on brown skin, with small raised brown-gray bumps and several scratch marks. There is no redness in the rash.
The finger webs and wrist on deep dark brown skin, with small raised bumps only slightly darker than the surrounding skin, no visible burrows, and short linear scratch marks.
Diagram
Scabies mechanism diagram. A mite enters the outer layer: Close contact can pass mites between people. Eggs remain in the burrow: The female lays eggs within the outer skin. The immune response causes itch: Sensitivity to mites and their products drives symptoms.
In the skin

Pubic lice feed on blood at the skin surface and attach their eggs to hair shafts. The skin's reaction to feeding can cause itching and irritation.

Scabies mites burrow into the outermost skin and lay eggs there. The immune reaction to mites and their products causes an itchy rash; the itch does not mean the mites are burrowing deep into the body.

When it usually starts

010203040506070+

Pubic Lice. Usually follows close contact; unexplained infestation in a child needs professional assessment.

Scabies. Can affect people of any age after close contact with an affected person.

Causes and triggers

Causes

Lice feed on blood and attach eggs to hair shafts.

Scabies is caused by a tiny mite that burrows into the top layer of skin. The intense itch is the body's allergic reaction to the mites and their eggs.

Risk factors
Close intimate contact
Crowded living, Nursing homes and care settings, Young children, Weakened immunity
How it spreads
  • Long skin-to-skin contact — Well established
  • Sexual contact — Well established
  • Shared bedding and clothing — Possible
Trigger
● Pubic Lice
● Scabies
Contact with an infested person
Can contribute
Not listed

Daily Care

Pubic Lice
Scabies
Daily care

Habits that help

  • Use the recommended lice treatment exactly as directed
    Follow the product-specific repeat schedule rather than improvising extra doses.
  • Wash recently used underwear, clothing, towels and bedding
    Use suitable hot washing and drying or follow advice for items that cannot be washed.
  • Tell recent sexual partners so they can be assessed and treated
    Ask about testing for other sexually transmitted infections.
  • Avoid sexual contact until treatment and partner management are complete
    Follow local sexual-health guidance about when contact can resume.
  • Follow the pubic lice care plan
    Follow the labelled treatment, address recent contacts and wash clothing and bedding. Do not apply ordinary lice products to eyelashes.

Avoid

  • Avoid: Sharing towels, bedding or clothing
    Re-exposure can restart the infestation.
  • Avoid: Insecticide sprays, shaving alone or lice medicine near the eyes
    Eyelash infestation needs clinician-guided care; shaving does not reliably cure pubic lice.

Habits that help

  • Washing what needs washing
    Bedding and clothes from the last three days — hot wash or bagged.
  • Keeping nails short
    Limits the damage from scratching.
  • Moisturizing
    Use a fragrance-free moisturizer for dry, itchy skin; it does not kill mites.
  • Treating everyone at once
    Household and close contacts, same day, itch or not.
  • Reapply scabies treatment to washed hands when the treatment instructions require it
    Hands are affected — the cream goes back on.

Avoid

  • Avoid: Hot showers and overheating at night
    Both intensify the itch.
  • Avoid: Harsh soaps and dry skin
    Irritated skin itches more.
  • Avoid: Scratching
    Breaks the skin and lets bacteria in.
  • Avoid: Treating only the person with the rash
    Contacts have mites, no itch, and reinfest everyone.
  • Avoid: Treating contacts at different times
    The mite moves back and forth.
  • Avoid: Delay in diagnosis
    More mites, more contacts.
  • Avoid: Missing areas when applying the cream
    Mites survive between fingers and toes, under nails.
  • Avoid: Not leaving it on long enough
    Permethrin needs 8 to 14 hours, usually overnight.
  • Avoid: Skipping the second application
    The first dose misses eggs that hatch later.

Treatment differences

Evidence labels come from each condition’s own treatment list.

Treatment
● Pubic Lice
● Scabies
Filter by type
All types
Scabies type

Select one or more.

Over-the-counter

Permethrin or pyrethrin lice treatment

Listed

Use an appropriate labelled formulation and address recent contacts; do not apply to eyes.

Illustration: Generic oral tablet bottle and tablets.

Non-drowsy antihistamines

Limited evidence

Worth trying in the daytime, though scabies itch is only partly driven by histamine, so the effect is usually modest. They will not shorten the infestation or replace treatment. If the itch is stopping you sleeping, a sedating antihistamine at night is the more useful version of this.

A plain white ointment tube lying on its side, labeled Hydrocortisone with a blue swoosh.

Hydrocortisone 1%

Limited evidence

Mild steroid cream helps the itch, but only after scabies has been diagnosed and treated. Used before that on an undiagnosed itchy rash it flattens the rash enough to make scabies much harder to recognize while the mites carry on spreading — sometimes called scabies incognito. If you have been using it, say so at your appointment.

Five colloidal oatmeal eczema products lined up on white: tubes, a jar and a pump lotion

Colloidal Oatmeal

Limited evidence

A cool oatmeal soak settles the itch for a while during the weeks it takes the allergic reaction to fade. Keep the water cool rather than hot, because heat and hot showers reliably make scabies itch worse. It is comfort only, and it does nothing to the mites.

Five dark glass tea tree essential oil bottles with glass droppers and one green box on white

Tea Tree Oil

Limited evidence

The home remedy asked about most often. It does kill mites in a dish, and small studies have looked at it, but there is no evidence it clears an infestation on a person. Applied neat to skin that is already scratched and inflamed it commonly stings and can cause a reaction of its own. Bleach and vinegar do not work either.

Prescription topicals
None listed
Permethrin — Header Image

Permethrin

Strong evidence

Permethrin 5% cream. The usual first treatment. It goes on the whole body from the neck down — every fold, between the fingers and toes, under the nails, around the navel and the genitals — and is left on for 8 to 14 hours, usually overnight. Put it back on your hands after any hand washing. It is repeated a week later to catch eggs that hatch after the first dose, and everyone in the household is treated on the same day whether they itch or not.

Illustration: Generic lotion bottle and lotion.

Benzyl benzoate lotion

Moderate evidence

An older treatment, used where permethrin is unavailable or has not worked. It is applied the same way, over the whole body, and usually repeated. It stings on broken or scratched skin and can irritate, which is why it is rarely the first choice where permethrin can be had.

Illustration: Generic ointment jar and translucent ointment.

Sulfur ointment

Limited evidence

Precipitated sulfur in petrolatum, applied for three nights in a row. It is the option most often chosen for very young babies and is one your doctor may consider if you are pregnant or breastfeeding — ask them, since that decision is theirs to make with you. It smells strongly, stains clothing and bedding, and is greasy, which is the main reason people struggle to finish the course.

Representative medication packaging labelled Triamcinolone, lying sideways on a white background.

Triamcinolone Acetonide

Limited evidence

A steroid cream used after the mites have been killed, to settle the itch and the firm lumps left behind. It does nothing to the mites, and used on an undiagnosed itchy rash it blurs the picture while the infestation carries on spreading. So it is a second step, never a first one.

Representative selection of topical treatment forms, not exact product packaging.

Crotamiton

Limited evidence

Marketed as both a scabies treatment and an anti-itch cream. It clears the mites in fewer people than permethrin does, so it is not a good first choice on its own. It is sometimes used for the itch after treatment, where it is mild and safe but not particularly effective.

Mupirocin — Header Image

Mupirocin

Limited evidence

An antibiotic ointment for scratched areas that have become infected — golden-yellow crust, oozing, soreness rather than itch. It has no effect on the mites at all. If the infection covers more than a small patch, or the skin around it is spreading red and swollen, antibiotic tablets are needed instead.

Prescription pills
None listed
Illustration: Generic oral tablet bottle and tablets.

Oral Ivermectin

Strong evidence

Oral ivermectin. Tablets taken as two doses about a week apart, weighted by body weight. They are the practical answer when a whole household or a care home has to be treated at once, when cream cannot be applied properly, or when cream has already failed. For crusted scabies they are given together with cream, often repeatedly. Ask the prescribing doctor whether they suit you, since they are not used in very small children and are avoided in pregnancy.

Antibiotics for infected skin

Antibiotics for infected skin

Listed

A short course of antibiotic tablets when scratched skin has become properly infected — spreading redness, swelling, pain or fever. They treat the bacteria only, so the scabies treatment still has to be done alongside them. This is a common reason a scabies visit ends with two prescriptions rather than one.

Sedating antihistamine at night

Sedating antihistamine at night

Listed

An older antihistamine taken at bedtime, for the weeks when the itch is keeping you awake. Most of the benefit is that it makes you drowsy rather than that it blocks the itch, which in scabies is only partly driven by histamine. It is useful, it is short-term, and it can leave you groggy the next morning.

Outlook

Long term

Correct treatment and management of close contacts can clear the infestation. Itching may take longer to settle; persistent live lice suggest reinfestation or the need to review treatment.

Itching can continue for several weeks after successful treatment, so itch alone does not prove that mites remain. New burrows or continuing new spots need reassessment; treating close contacts together helps prevent reinfestation.

Complications

Possible complications

Other sexually transmitted infections can coexist and testing may be appropriate.

  • Skin infection from scratching
  • Lumps that linger after treatment
  • Weeks of broken sleep
More details

Skin infection from scratching
Scratching breaks the skin and lets bacteria in, so scabies commonly turns into impetigo or, less often, cellulitis. The signs are pain rather than itch, golden-yellow crust, oozing, or spreading redness and swelling with fever. It needs antibiotics alongside the scabies treatment. In parts of the world where scabies is very common, these skin infections are also a route to kidney and heart problems later, which is one reason outbreaks are taken seriously.

Lumps that linger after treatment
Firm, itchy, red-brown lumps can stay on the genitals, groin and armpits for weeks to months after the mites are dead. They are a stubborn allergic reaction, not live infestation, and re-treating with scabies cream does nothing for them. A steroid cream from your doctor, and sometimes an injection into the lumps, is what settles them.

Weeks of broken sleep
The itch is at its worst at night, and by the time most people are diagnosed they have had several weeks of it. Broken sleep is the part that wears people down, and it usually carries on for another two to four weeks after treatment while the allergic reaction settles. It is worth treating in its own right — a sedating antihistamine at night, a cool bedroom and moisturizer before bed all help.

When to get help

When to get help

Seek care for eyelash involvement, pregnancy, treatment failure or infestation in a child.

Arrange treatment for suspected scabies and close contacts. Crusted widespread rash or infection needs prompt assessment.

Common questions

Pubic Lice:What is Pubic Lice?

An infestation of coarse body hair by crab lice, usually spread through close contact.

Pubic Lice:What can I do day to day?

Follow the labelled treatment, address recent contacts and wash clothing and bedding. Do not apply ordinary lice products to eyelashes.

Pubic Lice:When should I get medical advice?

Seek care for eyelash involvement, pregnancy, treatment failure or infestation in a child.

Scabies:Why do I still itch weeks after treatment?

Because the itch is an allergic reaction to the mites, not the mites themselves, and it takes two to four weeks to settle after they are gone. Moisturizer, antihistamines at night, and a steroid cream if your doctor prescribes one. Re-treating now irritates the skin. An itch worsening after four weeks does need review.

Scabies:How did I get it if I keep myself clean?

Cleanliness has nothing to do with it. The mite spreads through prolonged skin-to-skin contact - sharing a bed, holding a child, caring for a relative, sexual contact - and cannot be washed off once burrowed. Outbreaks happen in immaculate homes and hospitals.

Scabies:Does everyone in the house really need treating?

Yes, on the same day, itch or not. Contacts can carry mites for four to six weeks before itching, so treating only the person with the rash almost guarantees it comes back. This is the most common reason scabies drags on.

Scabies:How long am I contagious?

You were contagious before you had symptoms, which is why it spreads so quietly. After a correctly applied treatment, most people are no longer contagious after about 24 hours. Many workplaces and schools use that as the point of return; follow local advice.

Scabies:Do I need to clean the whole house?

Not for ordinary scabies. Wash bedding, towels and clothing from the last three days on a hot wash and dry them hot, or bag them for about three days. The mite does not survive long off skin. Crusted scabies needs much more thorough cleaning.

Scabies:Can I get it from my pet, or give it to them?

Not the human form. Animals have their own mite varieties, which can cause a brief itchy rash on people but cannot reproduce on human skin and clear once the animal is treated by a vet.

Sources

Sources and further reading

  1. Pubic lice
  2. DermNet
Dermapedia on YouTube