Scabies is a highly contagious parasitic skin infestation caused by the microscopic human itch mite, Sarcoptes scabiei var. hominis.
The fertilized female mite burrows into the outer layer of the skin to lay eggs, triggering a delayed hypersensitivity (allergic) reaction.
This produces intense itching, rash, and skin irritation. Although scabies is an infestation—not an infection—secondary bacterial infections from scratching are common.
Scabies affects all socioeconomic groups and is not related to hygiene. Untreated infestations can persist for months or even years.
Causes & Transmission
Primary Cause:
- Infestation with Sarcoptes scabiei
Modes of Transmission:
- Prolonged skin-to-skin contact
- Sexual contact
- Household spread
High-Risk Environments:
- Care homes, dormitories, prisons, student housing, refugee settings
- Fomite spread (bedding, clothes) is uncommon in classical scabies, more likely in crusted scabies
Mite Survival:
- Off-host survival is ~2–3 days
Risk Factors:
- Close communal living
- Children, students, infants, elderly
- Care-home residents
- Sexual partners
- Immunosuppression
- Delayed or incorrect treatment, treatment resistance
- Poor nutrition or homelessness
Recent years have seen increased institutional outbreaks in the UK.
Types / Clinical Forms
Common Forms:
- Classical (common) scabies – itchy papules and burrows (~5–15 mites)
- Crusted (Norwegian) scabies – hyper-infestation with thick crusts (thousands–millions of mites), extremely contagious; often affects immunocompromised, elderly, or neurologically impaired
- Nodular scabies – persistent nodules, often in genitals or axillae
Less Common / Special Forms:
- Bullous scabies – blister-like lesions
- Infantile scabies – scalp, face, palms involved
- Scabies incognito – altered presentation due to steroid misuse
Signs & Symptoms
Core Features (from allergic reaction to mites, eggs, and feces):
- Intense itching, worse at night or with heat
- Burrows – thin, wavy, silver-colored lines with a black dot at one end
- Pimple-like rash, tiny red spots, nodules, vesicles
- Crusty sores and excoriations from scratching
- Secondary eczema
Typical Distribution:
- Finger webs, wrists, waistline, buttocks, groin, genitals, breasts, axillae
- Infants and elderly: scalp, face, palms, soles
Timing of Symptom Onset:
- First infestation: 2–6 weeks
- Reinfection: 1–4 days
Complications if Untreated or Mistreated:
- Skin: impetigo, cellulitis, abscesses, chronic eczema, lichenification, persistent nodules
- Systemic: sepsis, post-streptococcal glomerulonephritis, rheumatic heart disease
- Severe dermatologic: crusted scabies, chronic pruritus
- Additional: sleep disturbance, anxiety, psychological distress, rare delusional infestation
- Extreme neglected cases: deep infection (osteomyelitis)
Prevention: DOs & DON’Ts
- Maintain proper hygiene
- Avoid exposure to dirty areas
- Take precautions for those working in sand or soil
- Treat scabies at the earliest to prevent deep secondary infections
- Treat all contacts simultaneously
Environmental Control:
- Hot-wash bedding and clothes ≥60 °C
- Bag non-washables for 72 hours
- Vacuum mattresses, sofas, and other furniture
- Avoid close contact until treatment is complete
- Trim nails to prevent scratching injury
- Mites die ~72 hours off the host
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