Scabies - symptoms, cause and treatment
Dr. Anja Loose-Roland
Updated on 02. November 2023
Scabies, medically known as scabies, is also on the rise again in Germany. The skin disease is caused by mites and was thought to be extinct. In recent years, cases of scabies have been increasing again. The disease is not dangerous, but causes a high degree of suffering due to the intense itching.
Scabies Brief overview:
- Causes: Transmission of scabies mite through close skin contact with infected persons
- Symptoms: Intense itching; rash, blisters or pustules, often in the interdigital spaces, wrists, crooks of the elbow, buttocks and genital area.
- Prevention: Avoiding close skin contact with infected persons
- Treatment: Prescription of prescription scabies medication
What is the cause of scabies?
Scabies is triggered by mites that settle on people's skin. The female scabies mites dig tunnels in the skin to lay eggs there. The ducts are a maximum of three centimetres long, sinuous and reddish brown. Mites belong to the arachnids, but are not visible to the naked eye. The animals leave their excretions in the ducts, which irritate the immune system.
What are the symptoms of scabies?
In the initial stage of scabies, mite ducts are the only signs of disease. Because there are no other symptoms, scabies is not noticed. Only after two to five weeks does an immune system reaction to the mites' excretions occur. This causes severe [itching](), redness and burning. If the disease occurs repeatedly, the body reacts to the mite infestation within a few days.
What does scabies look like?
The skin appearance of scabies is characterised by small, reddened poplars that are often filled with fluid. If the poplars are scratched open, inflammation often occurs, with severe redness and bleeding. As a result, crusts form later. In children, scabies can cause blisters to form on the skin. Scabies is often mistaken for normal [eczema]() in the early stages. However, the appearance of scabies can also be atypical and differ from the classic symptoms.
How can I recognise scabies?
The mites prefer warmth and are particularly active then. Unusually strong itching, especially when it is warm, is a clear indication of scabies. Affected persons unfortunately suffer from the symptoms especially in warm beds. At the same time, the parasites prefer to infest warm body regions with thin skin, such as:
- between fingers or toes
- in the crooks of the arms and wrists
- in the armpits
- in the genital and oral area
- in the navel region, belt line and groin area
- In the ankle area and on the inner edges of the feet.
In adults, scabies does not occur in the head and neck area. In contrast, in infants and young children, these areas can also be infested by mites.
What are the different forms of scabies?
Scabies is classified into different forms depending on its severity:
- "Normal scabies": The appearance shows the typical symptoms
- "Maintained scabies": With a strong immune system or extreme hygiene, scabies does not show such clear symptoms. This makes it difficult to diagnose.
- "Bark scabies": Scabies crustosa often occurs in people with weak immune systems. The mites infest these people very severely. Often, scales or heavy crusts form on the affected areas.
How does transmission occur in scabies?
Scabies mites are transmitted through prolonged skin contact. A brief touch or a handshake is usually not enough. The most common ways of transmission are:
- prolonged hugging
- Sleeping in the same bed
- Cuddling
- Sexual intercourse
- Personal hygiene by infected persons
- Playing
Is scabies caused by poor hygiene?
Scabies is an infectious disease. Infection is independent of personal hygiene. All groups of people of all ages are affected, with a focus on children, older people or people with immune deficiencies.
Can I catch it from my pet?
In pets, such as dogs and cats, other scabies mites occur. These can be passed on to humans. However, they only survive there for a few days.
What is the treatment for scabies?
Scabies is treated by killing the mites. Anti-mite preparations in the form of creams or tablets are used for this purpose. With the right active ingredient and the right dosage, the disease can be treated very well.
What is scabies treated with?
Preparations against mites can be used as creams or tablets. The active ingredient is an insecticide that is approved for use on humans. Special attention must be paid to the correct dosage. Independent treatment with over-the-counter remedies against scabies can lead to undesirable side effects. The medicines offered are based on different active substances:
- Crotamiton: This active ingredient in over-the-counter medicines is not recommended because the effect is not sufficiently proven.
- Benzyl benzoate: Medicines with this active ingredient are over-the-counter and work well against scabies. However, the creams burn very unpleasantly when applied and there are no comprehensive scientific studies available yet.
- Permethrin: This prescription medication is effective against scabies and is usually preferred.
- Ivermectin: This active ingredient is contained in prescription tablets against scabies. The active ingredient is mainly used for bark scabies. If the mites are resistant to permethrin, ivermectin can also be administered.
How are children treated for scabies?
Treatment of children against scabies should always be done in consultation with a doctor. Babies can be treated with permethrin from the age of 3 months. Benzyl benzoate may also be used from the second year of life. The correct dosage must be discussed individually with the doctor.
How long does it take to heal from scabies?
Within a week, the parasites can be killed and the patient is no longer contagious. However, it still takes up to two weeks for the symptoms to completely subside. Some patients may develop post-scarring eczema. This is an allergic reaction to the residue of the mites in the body and can last up to six weeks.
How can I support healing?
Due to the strong itching, scabies can lead to open sores. In the worst cases, this can lead to erysipelas or even blood poisoning. Remedies such as oral antihistamines or cortisone ointments relieve the itching. Adults should trim their fingernails. Tight-fitting gloves are recommended for babies so that they do not scratch themselves.
Can scabies be treated with home remedies?
Home remedies cannot remove the annoying scabies mites. They are recommended to relieve the itching and to speed up the healing of the affected areas. Especially with post-scabies eczema, it takes weeks until the affected persons are free of symptoms. The following home remedies can be used to support scabies:
- [Witch hazel](): Witch hazel reduces itching and inhibits inflammation. This allows the affected areas of skin to heal more quickly. Witch hazel can be applied as a poultice to the inflamed area or used as an additive to a hot bath. Witch hazel ointment is applied to the affected area.
- Hot water: High temperatures kill the larvae and nymphs. Unfortunately, the mites do not die from this. In cases of severe infestation such as bark scabies, baths can help.
- Tea tree oil: Tea tree oil is said to be able to kill the mites. However, the effect has not yet been sufficiently scientifically proven. Due to its anti-inflammatory properties, the oil supports healing and prevents infections. The oil should only be used diluted with a neutral oil such as almond or coconut oil.
- Sauna: If you have your own sauna, the high temperatures can kill the scabies mites. Due to the risk of infection, public saunas must not be visited by affected persons.
Do I have to go to the doctor with scabies?
If scabies is suspected, a doctor should be consulted, as scabies is difficult to treat oneself. Many effective remedies against scabies are available on prescription. If scabies is not treated, the disease becomes chronic. In the first few months, the number of mites increases sharply and papules and redness spread all over the body. In the final stage, the number of mites is greatly reduced again. Due to the constant infestation and itching, eczema and inflammation appear all over the body.
How can infection with scabies be avoided?
It is difficult to avoid infection with the mites. The reason is the long incubation period of scabies with two to five weeks. During this period, transmission of scabies can already take place. Affected patients should inform their environment and avoid contact with other people during treatment.
What hygiene measures should I take if I have scabies?
Especially within families, the disease can spread quickly. Therefore, family members are often also treated preventively against scabies. Scabies mites survive on surfaces and textiles at room temperature for up to 48 hours. In the cooler bedroom, the survival time even increases. Although infection is rare, important hygiene measures should be taken into account:
- Towels should only be used by one person
- Change bed linen daily if possible
- Wash bed linen and towels at least at 60 °C.
- Wash clothes that should not be washed at 60 °C with a hygiene detergent
- Store non-washable textiles in a sealed plastic bag for seven days or do not use them during this time.
- Carpets, upholstered furniture, mattresses and children's seats should be vacuumed daily if possible.
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