Scabies

Scabies is a common skin infestation of tiny mites called Sarcoptes scabiei. The mites burrow into the top layer of human skin to lay their eggs, causing small itchy bumps and blisters.

A child with scabies may have a bumpy red rash. Sometimes, raised wavy lines appear where the mites have burrowed, especially on the inner part of the wrist or between the fingers or toes.

How Do People Get Scabies?

Scabies is contagious and usually spreads through skin-to-skin contact with someone who is already infected. It spreads most easily in crowded conditions and those with a lot of close contact — among families, in childcare centers, college dorms, or nursing homes. So if someone in your child’s class or childcare group has scabies, it’s wise to have your child treated for the infection even before symptoms develop.

Mites can live for about 2 to 3 days in clothing, bedding, or dust, making it possible to catch scabies from people who share the same infected bed, linens, or towels.

It may take up to 4 to 6 weeks after infection for symptoms to appear in someone who’s never had scabies. In people who have had scabies before, symptoms may start in just a few days.

Signs and Symptoms

The most common symptom of scabies is severe itching, which can be worse at night or after a hot bath.

A scabies infection begins as small itchy bumps, blisters, or pus-filled bumps that break when scratched. Itchy skin may become thick, scaly, scabbed, and crisscrossed with scratch marks. The itching is due to a hypersensitivity reaction to the mite and/or its feces and eggs.

The areas of the body most commonly affected by scabies are the hands and feet (especially the webs of skin between the fingers and toes), the inner part of the wrists, and the folds under the arms. It may also affect other areas of the body, particularly the elbows and around the breasts, genitals, navel, and buttocks.

Infants and young children can have the rash on the scalp, palms, and soles of feet. Rashes in infants and young children can look redder or have larger blisters.

Scratching the itchy areas of skin can allow bacteria to get into the injured skin. Impetigo, a bacterial skin infection, may affect skin that’s already infected with scabies.

Treatment

Scabies infections need to be treated by a doctor. Call the doctor or dermatologist any time your child has a skin itch or rash that will not go away, especially if the itch is worse at night and occurs around the wrists or in the webbed part of the fingers.

If scabies is suspected, the doctor may scrape a small part of the affected skin and examine the scrapings under a microscope for signs of scabies mites.

Doctors treat scabies by prescribing a medicated cream or lotion to kill the mites. The cream needs to be applied to skin all over the body, not just the area with the rash, and usually must stay on the skin for 8 to 12 hours before it can be washed off.

In infants and young children, remember to also put the cream on the head, face, and scalp — even on the ears. If you forget these areas, you may not get rid of all the mites. Also trim your child’s fingernails and scrape off any dirt that’s on the fingertips, and put medicine on the fingertips as well. After applying the cream, don’t wash your own hands — scabies mites love the area between the fingers! You may want to apply the medication before your child goes to bed, then wash it off in the morning.

Most often, the treatment needs to be repeated in 1-2 weeks, especially if you see live mites on the skin 2 weeks after treatment.

Sometimes the doctor may choose an oral medication instead of topical lotion to treat scabies in older children.

Since scabies is highly contagious and can cause re-infestations, other members of your household also should be treated, even if they have no symptoms. Because scabies can be sexually transmitted, sexually active teens with scabies should be examined for other sexually transmitted diseases (STDs) too. Any sexual partners also should be treated for scabies.

The doctor might prescribe antibiotics if your child also develops a bacterial skin infection (such as impetigo) and an antihistamine to help relieve the itching.

Once a child begins treatment for scabies, it usually takes about 1 to 2 days for the itching to stop. In some cases, though, itching can last for a few weeks. If your child has itching that’s severe, the doctor may prescribe a steroid cream for the skin, like hydrocortisone. Steroid cream should only be used if recommended by your doctor because it can make certain infections worse.

If the treatment is effective, there should be no new rashes or burrows after 24 to 48 hours.

Prevention

Direct physical contact — like holding hands — is the most common way to transmit scabies. But because the mites can live for several days in clothing, bedding, or dust, scabies can spread when people share infected bed, linens, or towels.

If someone in your family is being treated for scabies, all other members of the household should be treated, too. Wash clothing, sheets, and towels in hot water and dry on a hot setting. Put stuffed animals and any other items you cannot wash in a sealed plastic bag for at least 3 days. Vacuum each room in the house, then throw away the vacuum cleaner bag.

Most kids can return to school the day after the treatment is complete.