Condition

Scabies

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.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed September 8, 2026
16:9 hero for Scabies. Never cropped: the tone strip and the corner logo depend on the full frame.

Start here

Scabies catches people out twice. The itch is an allergic reaction to the mite, not the mite itself, so the first time you get it there can be four to six weeks between catching it and itching — you were contagious before you had any idea. Second, the itch does not stop when the mites die: they are killed within a day, but the reaction takes two to four weeks to settle, and re-treating during that window only irritates the skin. And this has nothing to do with hygiene — it spreads through prolonged skin-to-skin contact, mostly households, couples, small children and care settings.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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How commonCommon worldwide - hundreds of millions of cases at any one time, with outbreaks in households, schools, care homes and shelters
Who gets itAnyone. Most common in children, in people living in crowded conditions, and in long-term care settings
Curable or managedCurable. Prescription treatment clears it, provided close contacts are treated at the same time
Prescription neededYes. There is no reliable over-the-counter cure
Time to improveMites are killed within about a day. The itch takes 2 to 4 weeks to settle afterward

What It Is

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Scabies is an infestation of the skin by a mite, Sarcoptes scabiei. The female tunnels into the outermost layer and lays eggs as she goes. She is about a third of a millimeter long, at the edge of what the eye can see. An ordinary case has few mites - often only ten to fifteen on the whole body.

The burrowing is not what itches. The itch is an allergic reaction to the mites, their eggs and their waste, so it takes time to develop: four to six weeks on a first infestation. If you have had scabies before, the reaction is primed and the itch can start within a day or two.

The distribution is characteristic - finger webs, the sides of the fingers, wrists, elbows, armpits, the waistline and belt area, buttocks, the genitals in men, and under the breasts in women. In adults it usually spares the head and neck. In infants, older adults and people with weakened immunity it can involve the scalp, face, palms and soles too.

What you see is a mixture: small red or brown bumps, scratch marks, and sometimes fine wavy lines a few millimeters long called burrows, which are the tunnels themselves. Burrows are the one truly specific sign, though scratching usually rubs them away first. Firm itchy nodules can persist on the genitals, groin and armpits for weeks after treatment.

Crusted scabies, previously called Norwegian scabies, is much less common and far more serious. It occurs in people with a weakened immune system, some older adults, and anyone who cannot feel or respond to the itch. Instead of a handful of mites there are thousands, the skin becomes thick and crusted, and the itch may be mild or absent. It is extremely contagious and needs specialist treatment.

Symptoms

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Itchy spots in the finger webs

Burrows and Bumps

Tiny wavy tracks and small itchy bumps between the fingers, on the wrists, around the waist, on the buttocks and around the genitals. The itch is worst at night and out of proportion to what is visible. Everyone in the household is usually treated at once.
Palms, soles and face

In Babies and Young Children

Bumps and blisters on the palms, soles, scalp and face, sites that are usually spared in adults. Babies are often unsettled and sleep badly. The pattern is easy to mistake for eczema.
Thick scaly skin, little itch

Crusted

Thick, crusted, scaly patches carrying huge numbers of mites, seen in people whose immune system is weakened or who cannot scratch. It may barely itch at all. It is extremely contagious and needs urgent treatment.

How It Looks by Skin Tone

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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.
LightMediumBrownDeep

On deeper skin tones the bumps are often brown, gray or violet rather than red, so the classic red itchy rash is little help. The distribution and the itch stay reliable - intensely itchy bumps in the finger webs, wrists, waistline, armpits and genitals, worse at night, in someone whose household is also itching.

Burrows are harder to see with less color contrast, so they are less dependable. Dermoscopy - the skin examined with a magnifier - or a scraping under the microscope is more useful, and it is reasonable to ask for one. Delayed diagnosis is the real risk. Scabies on deeper skin tones is more often treated as eczema first, which means steroid cream. Steroids dull the itch and can flatten the rash enough to make it hard to recognize afterward, sometimes called scabies incognito, while the mites keep spreading. Afterward, flat dark marks where the rash and scratching were can last many months, particularly on the hands, wrists and waist. That is post-inflammatory hyperpigmentation, not remaining infestation, and needs no further scabies treatment. Scratching hard enough to break the skin raises the risk of those marks and of raised thickened scars, so treat the itch actively while the skin recovers.

Where It Shows Up

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Front view of a whole body with red marks between and along both hands and fingers, on both wrists, on both elbows and in both armpits.
Finger webs, wrists and armpits
Scabies picks the warm, thin-skinned places, and the webs between the fingers are the first place to look. The sides of the fingers, the wrists, the elbows and the armpits follow. The itch is worst at night and it is usually far worse than the rash looks.
Front view of a whole body with red marks around the waistline and belt area, under both breasts, across the lower abdomen and over the genital area.
Waistline, belt area and the genitals
The waistline and belt area, the buttocks, the genitals in men and the skin under the breasts in women are the other classic sites. In adults it usually leaves the head and neck alone.
Front view of a whole body with red marks on the head and face, on both palms and on both soles. The rest of the body is clear.
Babies and older adults: the head, palms and soles too
In babies, in older adults and in people with weakened immunity it can also involve the scalp, the face, the palms and the soles — the areas that are spared in a healthy adult. That is why a rash on a baby's palms and soles is taken seriously.

What Happens in the Skin

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This is what is going wrong under the skin, in the order it happens. Click a step to see it.

How Scabies happens
Skin basics
BARRIEREPIDERMISDERMIS0NORMAL SKIN1THE MITE IS PASSED ON2IT BURROWS AND LAYS EGGS3THE ALLERGIC REACTION THAT CAUSES THE ITCH4SCRATCHING AND THE DAMAGE IT DOES

An intact barrier with nothing living in it.

It takes prolonged skin-to-skin contact, so it spreads within households and between partners rather than in passing. Bedding and clothing matter much less than people expect.

The female tunnels into the outer layer and lays eggs along the burrow, leaving the fine thread-like lines seen between the fingers, at the wrists and around the waist.

The itch is a reaction to the mites, their eggs and their droppings, not to the burrowing. It can take four to six weeks to start after a first infestation, which is why a partner with no symptoms still needs treating.

Relentless night-time scratching breaks the skin and invites infection. The itch also carries on for two to four weeks after successful treatment, because the reaction outlasts the mites.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

The cause is a single organism: the human scabies mite, Sarcoptes scabiei var. hominis. A fertilized female burrows into the outer layer of skin within about half an hour and tunnels along it, laying two or three eggs a day for several weeks. The eggs hatch, the young mites reach the surface, mature and mate, and the cycle repeats - roughly two weeks start to finish.

Transmission needs prolonged, direct skin-to-skin contact, usually ten to fifteen minutes or more. Sharing a bed, holding hands, caring for a child or an older relative, sexual contact. A handshake or a brief hug does not. That is why scabies moves through households, couples, nurseries and long-term care rather than casual public contact.

Objects matter less than people assume. The mite survives off human skin for only about two to three days, so wash bedding, towels and clothing from the last few days - but decontaminating the house is unnecessary. Crusted scabies is different: mite numbers are enormous, and bedding, furniture and even brief contact all spread it.

Two points cause repeated confusion. Animals do not give people scabies - they carry their own varieties of the mite, which can cause a short-lived itchy rash on human skin but cannot complete their life cycle there, and it clears once the animal is treated. And scabies has no relationship to hygiene: washing does not remove burrowed mites.

Risk Factors

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Scabies is about close contact and crowding, not cleanliness.

Close contact
Living with someone who has it
The strongest risk factor by far. Household transmission is high, which is why everyone is treated together.
Close contact
Sexual contact
Prolonged skin-to-skin contact of any kind transmits it, and in adults it is recognized as a sexually transmitted infestation.
Close contact
Caring for an older or dependent relative
Exactly the contact the mite needs.
Where you live and stay
Crowded living conditions
Shared bedrooms, shelters, dormitories, prisons and refugee settings all raise transmission.
Where you live and stay
Long-term care facilities and hospitals
Hands-on care and delayed recognition make outbreaks common; one crusted case can seed a ward.
Where you live and stay
Recent travel or stay
In a high-prevalence area - scabies is far more common in some parts of the world.
Age
Young children
Common in children, who pass it on through normal play, carrying and sleeping arrangements.
Age
Older age and reduced mobility
Less able to scratch or report itching, so diagnosis is delayed; both are associated with crusted scabies.
Other health conditions
A weakened immune system
Illness, immunosuppressing medicines, HIV and some cancers raise the risk of crusted scabies, which behaves differently.
Other health conditions
Previous scabies
No protection. It only means the itch starts much faster next time.

Course

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The scabies timeline explains most of the confusion about treatment. The itch starts weeks after the mites arrive and carries on weeks after they are killed.

SilentWeeks 0 to 6 after contact
Contagious, with no itch yet

The mites are established and you are contagious, but the allergic reaction has not started. On a repeat infestation this phase lasts one to four days.

Itching startsWeeks 4 to 6
The itch is worse at night

Intense itch begins, worse at night and after a hot shower, with bumps, scratch marks and sometimes burrows. Untreated, it escalates, the rash spreads, and scratched skin can get infected. Household members usually start itching now too.

Finger websWristsWaistlineArmpitsGenitals
TreatmentDay 1
The mites die within about 24 hours

A correctly applied treatment kills the mites within about 24 hours. Most people are no longer contagious after that, though the itch continues.

Post-scabetic itchWeeks 1 to 4 after treatment
Still itching is expected

The itch persists while the allergic reaction settles. This is not treatment failure, and re-treating now only irritates the skin. An itch worsening after four weeks, or new burrows, suggests treatment failure or reinfestation from an untreated contact, and needs review, not another round of cream.

Nodules and marksWeeks 4 to 12
The last traces take months

Firm itchy lumps can last weeks to months, and flat dark marks remain where the rash was. Neither means live mites.

GenitalsGroinArmpits

What Makes It Better & Worse

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Scabies is four problems — close contact that passes the mite, the mite burrowing and multiplying, the allergic reaction that itches, and scratching damage. Almost every case that will not clear fails on step one, not on medication.

What is driving yours?

FATBARRIEREPIDERMISDERMIS

It takes prolonged skin-to-skin contact, so it spreads within households and between partners rather than in passing. Bedding and clothing matter much less than people expect.

The female tunnels into the outer layer and lays eggs along the burrow, leaving the fine thread-like lines seen between the fingers, at the wrists and around the waist.

The itch is a reaction to the mites, their eggs and their droppings, not to the burrowing. It can take four to six weeks to start after a first infestation, which is why a partner with no symptoms still needs treating.

Relentless night-time scratching breaks the skin and invites infection. The itch also carries on for two to four weeks after successful treatment, because the reaction outlasts the mites.

What helps

  • Treating everyone at once Household and close contacts, same day, itch or not.
  • Washing what needs washing Bedding and clothes from the last three days — hot wash or bagged.

What makes it worse

  • Treating only the person with the rash Contacts have mites, no itch, and reinfest everyone.
  • Treating contacts at different times The mite moves back and forth.
  • Delay in diagnosis More mites, more contacts.

What helps

  • Permethrin 5 percent cream First treatment, overnight, repeated a week later.
  • Applying it properly and everywhere Every area, and back on the hands.
  • The second application a week later Catches the later-hatching eggs.
  • Oral ivermectin when appropriate Two doses about a week apart.

What makes it worse

  • Missing areas when applying the cream Mites survive between fingers and toes, under nails.
  • Washing hands after applying Hands are affected — the cream goes back on.
  • Not leaving it on long enough Permethrin needs 8 to 14 hours, usually overnight.
  • Skipping the second application The first dose misses eggs that hatch later.

What helps

  • Expecting four weeks of itch An easing itch means it worked.
  • A steroid cream, after treatment Settles leftover itch and nodules, not before a diagnosis.
  • Antihistamines and a bland moisturizer Ease the itch and help sleep.

What makes it worse

  • Steroid creams on an undiagnosed rash They blur it while mites spread.
  • Hot showers and overheating at night Both intensify the itch.
  • Harsh soaps and dry skin Irritated skin itches more.

What helps

  • Keeping nails short Limits the damage from scratching.

What makes it worse

  • Scratching Breaks the skin and lets bacteria in.

How These Treatments Work

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Treatments for Scabies do not all work in the same place. Tap one to see where it acts.

Pick a treatment
Skin basics
BARRIEREPIDERMISDERMISKILLS THE MITESKILLS THEM FROM INSIDESTOPS REINFECTIONCLEARS THE SURFACETHE ITCH LASTS WEEKS

Neck down, everywhere, left on overnight, and repeated a week later.

For widespread cases, or when a cream is hard to apply properly.

Everyone on the same day, including the people with no itch yet.

A hot wash, or sealed in a bag for a few days.

The itch is the reaction, and it outlives the mites by two to four weeks.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

Over-the-Counter Products

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Everything here you can buy without seeing anyone.

A bland ceramide moisturizer
A bland ceramide moisturizer
Moderate evidence
Scabies leaves the skin dry, scratched and irritated, and dry skin itches more. A thick fragrance-free moisturizer twice a day, and again before bed, makes the four weeks after treatment considerably easier. It does not kill mites and it is not a substitute for treatment — it is what stops the itch feeding itself.
Five colloidal oatmeal eczema products lined up on white: tubes, a jar and a pump lotion16:9 hero for Colloidal Oatmeal. Never cropped: the tone strip and the corner logo depend on the full frame.
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.
Non-drowsy antihistamines
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 swoosh16:9 hero for Hydrocortisone. Never cropped: the tone strip and the corner logo depend on the full frame.
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 dark glass tea tree essential oil bottles with glass droppers and one green box on white16:9 hero for Tea Tree Oil. Never cropped: the tone strip and the corner logo depend on the full frame.
Weak 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.

Prescriptions

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These need a prescription.

16:9 hero for Permethrin. Never cropped: the tone strip and the corner logo depend on the full frame.
Permethrin 5% cream
Strong evidence
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.
A white cream tube lying on its side on a white background, with a plain white label reading Benzyl Benzoate and a blue swoosh beneath it.
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.
Four sulfur acne products: Kate Somerville EradiKate, De La Cruz 10% sulfur ointment, The Ordinary and Thayers
Sulfur ointment
Moderate 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.
16:9 hero for Triamcinolone Acetonide. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Triamcinolone Acetonide works in the skin
Moderate 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.
16:9 hero for Mupirocin. Never cropped: the tone strip and the corner logo depend on the full frame.Diagram: how Mupirocin works in the skin
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.
A white cream tube lying on its side on a white background, with a plain white label reading Crotamiton and a blue swoosh beneath it.
Crotamiton
Weak 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.
An amber prescription bottle lying on its side on a white background with a plain white label reading Ivermectin, and six small round white tablets spilled out in front of it.
Oral ivermectin
Strong evidence
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.
An amber prescription bottle lying on its side on a white background with a plain white label reading Antibiotics, and six small round white tablets spilled out in front of it.
Antibiotics for infected skin
Moderate evidence
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.
An amber prescription bottle lying on its side on a white background with a plain white label reading Antihistamines, and six small round white tablets spilled out in front of it.
Sedating antihistamine at night
Limited evidence
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.

Procedures

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These are done in the office, usually over several visits.

No procedures listed yet.

When to See a Dermatologist

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Scabies needs a doctor - effective treatment is prescription-only, and an intensely itchy rash that is worse at night, especially with other people at home itching, is reason enough to book this week. Come ready to name names, because everyone in the household needs treating. Go back if the itch is worsening rather than easing four weeks after treatment, if new burrows or bumps appear, or if the skin becomes painful, oozing, crusted with yellow or golden crust, or develops spreading redness, swelling or fever. Get help urgently for thick, crusted, scaling skin, particularly in someone with a weakened immune system, an older adult, or in a care setting, because that suggests crusted scabies, which is highly contagious and needs specialist treatment rather than a single cream.

— Dr. Schwarz, Board Certified Dermatologist

Complications

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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.

Lookalikes

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Eczema

This is the mix-up that lets scabies run on for months. Both are intensely itchy, both produce bumps and scratched skin, and both get treated with steroid cream — which quietens scabies just enough to make it hard to recognize while the mites keep spreading. Eczema favors the inner elbows, behind the knees and the neck, has a long history behind it, and does not make the rest of the household itch. Scabies goes for the finger webs, wrists, waistline and genitals, and it arrives out of nowhere.

Contact Dermatitis

A reaction to something touching the skin can be very itchy and can turn up on the wrists and around the waist, which is exactly where scabies goes. The giveaway is the shape: contact dermatitis follows the outline of whatever touched the skin, so it sits in a band under a watch strap or a belt buckle with a sharp edge to it. Scabies scatters across several separate areas at once, is worst at night, and other people at home start itching too.

Folliculitis

Both give crops of small itchy bumps in the armpits, around the waistband and on the buttocks. Folliculitis bumps each sit on a hair, many of them have a small pus head, and they usually appear after shaving, sweating or a hot tub. Scabies bumps are not tied to hairs, have no pus head, reach the finger webs and wrists where there is little hair, and itch far more at night than during the day.

Myths

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  • "Scabies means you are dirty." It does not It spreads through prolonged skin-to-skin contact, nothing else. Washing more does not prevent it or remove burrowed mites. Outbreaks happen in spotless homes and hospitals.
  • "You can catch it from a handshake or a bus seat." Ordinary scabies needs prolonged direct contact, usually ten to fifteen minutes. Brief contact rarely transmits it. Crusted scabies is the exception - numbers are so high that briefer contact and contaminated bedding spread it.
  • "My dog gave it to me." Animals carry their own varieties of the mite. They can cause a short-lived itchy rash but cannot reproduce on human skin, so it clears once the animal is treated. Human scabies comes from people.
  • "If I still itch, the treatment did not work." Itching for two to four weeks after treatment is the normal course - the itch is an allergic reaction that takes time to settle. Re-treating now irritates the skin. Worsening itch or new burrows after four weeks needs review.
  • "Only the person with the rash needs treating." The most costly myth. Contacts carry mites for weeks before they itch, so treating only the visible case guarantees it comes back. Everyone in the household is treated on the same day.
  • "You have to deep clean and fumigate the whole house." Not for ordinary scabies. The mite survives only about two to three days off human skin, so washing bedding, towels and clothing from the last few days is enough. Crusted scabies does need thorough cleaning.
  • "There is an over-the-counter cure." Not a reliable one. Effective treatment is prescription-only in most places. Tea tree oil, bleach and vinegar do not clear it - they irritate inflamed skin.

Questions Patients Ask

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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.

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.

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.

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.

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.

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.

References

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