The first time a person is exposed to mites, it may take weeks for the itchy rash to develop; on subsequent exposure(s) to mites, the itchy rash will likely develop within days.
- The areas between the fingers (finger webs)
- Inner wrists, inner elbows, and armpits
- Breasts of females and genitalia of males
- Navel (umbilicus)
- Lower abdomen
- Backs of knees
Scabies is intensely itchy, especially at night.
Scratching the itchy lesions can create breaks in the skin, and these breaks can become infected with bacteria.
A severe form of scabies, called Norwegian scabies or crusted scabies, is seen in:
- Elderly people
- Individuals with weakened immune systems (such as organ transplant recipients or people with HIV/AIDS)
- Malnourished people
- People who are physically and/or mentally impaired or disabled
People who are exposed to scabies may not develop itchy lesions for up to 6 weeks after becoming infested, as the immune system takes some time to recognize the mites and develop an allergic response to them. However, individuals who have had scabies before may develop the rash within several days of re-exposure.
Scabies requires prescription medication in order to stop the infestation. Once you are under a doctor's care, there are steps you can take to prevent scabies from coming back:
- Mites cannot survive off the human body for more than 48–72 hours. Therefore, wash all clothing, bedding, and towels used by the infested person in approximately the previous 72 hours in hot water and dry these items in a hot dryer.
- Vacuum all carpets, rugs, and upholstered furniture, and discard the vacuum bags.
- Anything that cannot be laundered should be sealed in plastic bags for 5 days.
In most cases of scabies, your doctor may recommend a topical cream or lotion, such as:
- Permethrin cream – After application, wash the cream off after 8–14 hours. Use the permethrin cream again in one week.
- Crotamiton lotion or cream – Apply once daily for 5 consecutive days.
- Sulfur ointment – Apply nightly for 3 consecutive nights. This is often the best choice for babies and for pregnant and nursing women because it is very safe to use.
- Lindane lotion or cream – Wash the cream or lotion off after 8 hours. Lindane may be toxic to some people. Therefore, young children and infants, pregnant or breast-feeding women, and people with diseases affecting the nerves (neurological diseases) should not use lindane.
- Apply to the entire body.
- Smear the product beneath the fingernails and toenails.
- Apply to body folds, including inside the navel, in the buttock crease, and between the fingers and toes.
- Ivermectin pills – Take once and then repeat 1–2 weeks later; not for use in pregnant or lactating women or in children under the age of 5
- Antihistamine pills
- Antibiotic pills, if any scratched areas appear to be infected with bacteria
Your doctor should remind you to launder towels, bed linens, and clothes used in the previous 72 hours and to vacuum carpets, rugs, and upholstered furniture.
Household members, sexual partners, and anyone else with prolonged skin-to-skin contact with an infested person should also seek treatment from their doctor. Because the initial development (incubation time) for scabies infestations can be from 6–8 weeks, people may be infected with scabies, but because they do not yet feel itchy, they are unaware that they have an infestation. If untreated, these close contacts could pass the mites back to you. Ideally, everyone should be treated at the same time in order to prevent re-infestation.