Scabies is a skin infestation by tiny mites that burrow into the skin, causing an intensely itchy rash that is often worse at night. It spreads mainly through prolonged skin-to-skin contact, so it moves easily within households, schools, hostels, prisons, hospitals and care homes. Treatment works well, but everyone in close contact must be treated at the same time, even without symptoms.
Signs and symptoms
- Intense itching, especially at night
- A rash of small raised spots, often between fingers, on wrists, elbows, armpits, waist, buttocks, genitals and around nipples
- Burrows: thin, wavy, greyish lines on the skin
- In babies and young children: rash may appear on the head, face, palms and soles
- Scratching can lead to infected sores
If someone has never had scabies, symptoms may take 4 to 6 weeks to appear, but they can spread it during this time. With a repeat infestation, itching starts within days.
Treatment
- Permethrin 5% cream is commonly used first-line. Apply to the whole body from the neck down (including the scalp, face and ears in babies, older adults and people with weak immunity, avoiding eyes and mouth), on cool, dry skin.
- Pay attention to between fingers and toes, under nails, the genitals and soles of the feet.
- Leave on for 8 to 12 hours (usually overnight), then wash off.
- Reapply to hands if washed during the treatment time.
- Repeat after 7 days.
- Oral ivermectin is used in some situations, including crusted scabies and mass treatment, as prescribed.
- Itching can continue for 2 to 4 weeks after successful treatment. This does not mean treatment failed; antihistamines or soothing creams can help.
Treat contacts and the environment
- Treat everyone in the household and sexual partners on the same day.
- Wash clothes, towels and bedding used in the last 3 days at a high temperature (50°C or above) and dry on a hot cycle.
- Items that can’t be washed can be sealed in a plastic bag for at least 3 days.
- Fumigating the house is not necessary.
Crusted (Norwegian) scabies
A severe form with thick crusts that contain huge numbers of mites. It occurs in older adults, people with weak immunity or disability, and can cause outbreaks. It may not itch much. It needs combined treatment (topical plus oral), strict contact precautions and specialist advice.
Outbreak control in wards and care homes
- Inform infection prevention and control as soon as scabies is suspected
- Contact precautions: gloves and aprons for hands-on care
- Treat all residents, patients and staff with close contact at the same time
- Coordinate laundry so linens are washed after treatment
- Check new admissions for itchy rashes
- Staff with symptoms should be treated and follow occupational health advice
Frequently asked questions
How long is scabies contagious?
Until the first treatment has been applied properly. People can usually return to work or school 24 hours after the first application.
Can you get scabies from pets?
Animal mites can cause temporary itching in humans, but they don’t cause ongoing human scabies.
Why am I still itching after treatment?
Post-scabies itch can last up to 4 weeks. New burrows or new spots after this time may mean treatment needs repeating.
Related reading: Contact and transmission-based precautions · Chickenpox nursing care · WHO 5 moments for hand hygiene
Checked against NHS guidance on scabies. Updated 5 November 2026.
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