Scabies

Scabies is a very itchy skin condition caused by a tiny mite that burrows into the top layer of skin. It's common worldwide and is spread by close skin-to-skin contact. Scabies is NOT a sign of poor hygiene — it can affect anyone, and outbreaks occur in homes, schools, hostels, old-age homes, and hospitals.

Symptoms

• Intense itching, especially at night — the hallmark symptom
• Small red bumps, often with tiny thread-like burrow marks
• Common areas: between the fingers, wrists, elbows, armpits, waist, genitals, between buttocks, soles of feet (especially in babies)
• In babies and young children, the head, neck, palms, and soles are often affected
• Secondary skin infection (bacteria) from scratching is common

Symptoms start 2-6 weeks after first infestation, or within 1-4 days if you've had scabies before.

How it spreads

• Prolonged skin-to-skin contact — cuddling, sharing a bed, sexual contact
• Sharing clothes, bedding, towels (less commonly than direct contact)
• Crowded environments make outbreaks easier

Diagnosis

Usually clinical — a doctor recognises the typical itchy rash with burrows. A skin scraping examined under a microscope can confirm if needed.

Treatment

Treatment is straightforward and highly effective:

• Topical scabicide cream or lotion — applied from the neck downwards (or including the scalp for young children), left on for the recommended time, then washed off. Most need one application, repeated after 7-14 days.
• Oral medicine — in some cases, particularly crusted scabies or outbreaks
• Treat all household members and close contacts at the same time, even if they don't have symptoms — otherwise reinfection is likely
• Wash all clothes, bedding, and towels used in the past week in hot water, or seal in a plastic bag for a week (mites die without a human host)
• Itching often continues for 2-4 weeks after successful treatment — this is NOT treatment failure; it's the immune system's delayed response. Antihistamines and soothing creams help.

When to see a doctor

• Suspected scabies, to confirm diagnosis and get treatment
• Signs of bacterial skin infection (yellow crusts, spreading redness, fever)
• Treatment hasn't worked after 4 weeks
• Crusted scabies — a severe form with thick scaly skin; highly contagious and needs special care