Scabies
Tiny mites that burrow into the skin, causing an intense itch that’s worst at night. Caught from close skin contact, not from being unclean. Very treatable, as long as everyone close to you is treated at the same time.
Signs. Itch, worse at night, with small bumps and short wavy lines (burrows) between the fingers, on the wrists, elbows, armpits, waist, buttocks, genitals and breasts. Babies can get it on the palms, soles, face and scalp. The first time, the itch can take up to 6 weeks to start; next time, within days. On brown and black skin, bumps may look darker or purple rather than red, and firm itchy lumps (nodules) are common.
Diagnosis is usually from the pattern and the story (others at home itchy too). A doctor may look with a magnifier or take a skin scraping. In Australia, scabies affects a large share of children in some remote communities, and the scratched skin lets in strep bacteria linked to school sores, kidney disease and rheumatic heart disease.
The scabies ladder
Treat everyone at once, do it twice, and expect the itch to outstay the mites.
- Step 1 · PharmacyPermethrin 5% cream for you and everyone closeApply to cool, dry skin over the whole body, including scalp, face and ears (avoiding eyes and mouth), between fingers and toes, under nails and the genitals. Leave on at least 12 hours (overnight), then wash off. Repeat in 7 days.
- Works
- About 7 in 10 clear at 2 weeks in trials. Treating everyone at once stops you catching it straight back
- Cost
- About $15–30 a tube; adults often need 1–2 tubes for both treatments
- How long
- Two treatments, 7 days apart
- Watch for
- Reapply to hands after washing them. Check with a doctor first for babies, in pregnancy and for older people.
One itchy person treated alone is how scabies goes on world tours.
- Step 2 · Self-careHot wash and bagWash clothes, towels and bedding used in the last 3 days at 50°C or hotter, or tumble-dry hot. Seal what can’t be washed in a plastic bag for at least 3 days (some guides say a week).
- Works
- Supports treatment; mites don’t survive long off the body
- Cost
- Free
- How long
- On day 1 of treatment
- Watch for
- No need to fumigate the house or treat pets.
A hot wash, not a house fire.
- Step 3 · PrescriptionIvermectin tabletsAn alternative when the cream hasn’t worked or is hard to use, for example in care homes or with widespread eczema.
- Works
- About as good as permethrin by 2 weeks (about 7 in 10 clear with either)
- Cost
- Prescription; costs vary
- How long
- Two doses, usually 1–2 weeks apart
- Watch for
- Not for young children under 15 kg or in pregnancy. Take with food.
A pill instead of a whole-body paint job. Still needs the laundry.
- Step 4 · PharmacySettle the leftover itchMoisturiser, a sedating antihistamine at night, or a short course of steroid cream once the mites are treated.
- Works
- Small trials only; the itch usually fades over 2–4 weeks
- Cost
- About $10–20
- How long
- Up to 4 weeks
- Watch for
- New burrows or itch that’s worse, or still there after 4 weeks: see your GP.
Still itchy on day 10 doesn’t mean it failed. Still itchy on day 40 might.
- Step 5 · SpecialistCrusted scabies careThick, crusted, scaly skin with huge numbers of mites, usually in people with weakened immunity or who are frail. Needs repeated tablets and creams under medical care.
- Works
- Needs a combination of treatments; single treatments often fail
- Cost
- Usually through a hospital or specialist
- How long
- Weeks
- Watch for
- Very contagious. Staff and visitors need treatment too.
Not the time for pharmacy DIY.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Tea tree oilNot enough evidence that it cures scabies in people, and it can cause skin allergies.
- Pest control or fumigating the houseMites don’t live long off people. Hot-wash the bedding instead.
- Treating the dog or catHuman scabies doesn’t live on pets. (Animal mange is a different mite.)
- Repeating permethrin every few daysTwo treatments a week apart is the plan. More often just irritates the skin and keeps the itch going.
What you can do
- Treat everyone in the house and close or sexual contacts from the past month on the same day, even with no itch.
- Keep children home from school or childcare until 24 hours after starting treatment.
- Cut nails short and keep scratched skin clean to prevent infection.
- In aged care or childcare, tell the manager so others can be checked.
See your GP if
- You think you or your child has scabies (to confirm it and get the right dose)
- You’re pregnant, breastfeeding, or treating a baby
- Itch is still there 4 weeks after the second treatment, or new burrows appear
- Skin looks thick and crusted, or sores are weeping or crusted (possible infection)
See a doctor the same day for fever, spreading red, hot or painful skin, or weeping sores, or for puffy eyes, cola-coloured urine or much less urine in the weeks after infected sores.
Common questions
How did I get scabies? I’m clean!
Hygiene has nothing to do with it. It spreads mainly through long or close skin contact, often within a household, and less often through shared bedding or clothes.
Why am I still itchy after treatment?
The itch is an allergy to the mites, which takes 2 to 4 weeks to fade after they’re dead. See your GP if it lasts more than 4 weeks.
Do my family need treatment if they’re not itchy?
Yes. They can carry mites for weeks before itching starts. Everyone treated on the same day stops ping-pong reinfection.
Is scabies a sexually transmitted infection?
It can spread during sex because of skin contact, so recent sexual partners need treatment too. A sexual health check may be worth considering.
Helpful resources
- NSW Health: ScabiesAustralian guide to treatment, contacts and laundry. Free.
- Primary Care Dermatology Society: Scabies leafletStep-by-step guide to applying the cream properly, with amounts by age. Free, UK.
Evidence and more information
- NSW Health: Scabies
- Primary Care Dermatology Society: Scabies
- Cochrane: Ivermectin and permethrin for scabies (2018)
- MJA (2020): Skin infections in Australian Aboriginal children
maladywise.com/scabies/