JAMA PATIENT PAGE

Scabies
Scabies is a contagious skin infestation caused by tiny mites.
The microscopic, 8-legged human itch mite digs into the skin to feed
Scabies
and lay eggs; however, it cannot survive outside human skin for more
Scabies is a contagious skin infection caused by the human itch mite.
than 2 to 3 days. Scabies is transmitted by direct person-to-person Infection starts with severe itching that worsens at night.
contact or through objects that carry the mites, such as clothing and
Common sites Armpits
bedding. Scabies can affect anyone but is most common in chil- of infection
dren and crowded populations, such as jails, refugee camps, and
nursing homes. Because scabies is a human parasite, household pets Beneath jewelry
and watches Groin
are typically not affected. Most people with scabies have fewer than
100 mites. However, the itching and rash can be everywhere.
On palms and
Norwegian scabies, or crusted scabies, is a severe infesta- between fingers
tion of hundreds to thousands of mites that appears as a thick, yel-
low-gray crust on the skin. It occurs in elderly people or those with
On feet and
disabilities who cannot scratch or feel the itch. It also occurs in those between toes
with weakened immune systems.

Signs and Symptoms The mite burrows into the outermost layer of Treat all household members
skin (stratum corneum) to feed and lay eggs. and close contacts.
• Intense, itchy rash that worsens at night
• The rash usually consists of tiny, raised bumps arranged in a line
where the mites burrow under the skin to lay eggs. The rash can
Rash Burrow Prescription cream
also resemble pimples, eczema, and insect bites. Mite (permethrin, 5%)
• Scabies commonly live between the fingers and toes, under jew-
elry or watches on the wrist, and in armpits, skin folds, and geni- Stratum
talia. corneum
EPIDERMIS
• Infants with scabies may appear irritable, not wanting to eat or
sleep, and commonly have the rash on their palms or the soles of Wash all clothing, bedding,
DERMIS
their feet. Infants can also have the rash on their face, scalp, and and towels in high heat.

neck, which is rare in adults.

• Itching and the rash may remain for up to 4 weeks after treat-
• Symptoms can take 2 to 6 weeks to appear after infestation. People
ment despite killing all the mites.
can be contagious even when they do not have symptoms.
• Because scabies is highly contagious, children must be kept out of
Diagnosis and Treatment school until they complete treatment.

• A doctor examines the skin and rash to make a diagnosis and may
take a scraping of skin to look for microscopic evidence of mites.
• Treatment requires killing the mites living on the body with a pre-
scribed cream or oral pills. No over-the-counter treatment is avail-
able for scabies.
• The most commonly prescribed cream is permethrin, 5%, which
is applied from neck to toes, left on for 8 to 14 hours, washed off,
and reapplied 1 week later.
• Crusted scabies requires multiple treatments of oral and topical
medications as directed by a doctor.
• Household pets do not need to be treated.
• Itching can be relieved with lotions, antihistamines, and cortico-
steroids, but these do not kill the mites.
Avoid Reexposure
All people living in the same household, sexual partners, and oth-
ers who have had close skin-to-skin contact with the affected per-
son need to be treated. Heat kills mites and their eggs, so it is im-
portant to wash all bedding, clothes, and towels in hot water and
dry them in high heat each time treatment is administered.
FOR MORE INFORMATION
• Centers for Disease Control and Prevention
www.cdc.gov/parasites/scabies/index.html
• American Academy of Dermatology
www.aad.org/public/diseases/contagious-skin-diseases/scabies

Authors: Michelle Tarbox, MD; Kendra Walker, BS; Michael Tan, BS
Conflict of Interest Disclosures: All authors have completed and submitted the
ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Sources: Baumrin E, et al. JAMA. 2015;313(3):298-299.
Eshagh K, et al. JAMA Pediatr. 2014;168(4):379-380.
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