Definition

• A very itchy rash caused by the scabies mite
• A mite is a tiny, invisible bug that burrows under the skin

Health Information

Symptoms

• Widespread little red, bumpy rash that mainly involves the skin folds.
• Intense itching is the main symptom. If it doesn’t itch, it’s not scabies.
• Appearance. The small red bumps are often in short straight or wavy lines. These are the burrows/tunnels of the mite. The bump or water blister is where the mite entered the skin.
• Location. Classic scabies is found in skin creases such as finger webs. Hands and wrists are the most common sites. Armpits, groin, scrotum, buttocks, navel, waist, and ankles can be involved.
• The face and neck are usually spared. In infants, the rash can involve the face and scalp.
• The rash usually looks the same on both sides of the body.

Cause

• Scabies mite
• Scabies comes from skin-to-skin contact with someone who has scabies.
• After contact, a person will come down with scabies rash in 4 to 6 weeks.
• Itching is the first symptom.
• Can occur in anyone and does not mean poor hygiene.
• Scabies mites do not carry any disease.

Prevention of Spread to Others

• Scabies is very contagious and prevention is difficult.
• It’s best to treat everyone who has had close contact.

Care Advice

1. Overview:
   • Scabies are easy to treat. Itching is the problem.
   • The itching normally lasts for 2 weeks after the scabies mites are killed.
   • Treatment with the anti-scabies cream does not help the itch.
   • The itching is an allergic reaction. The body reacts to the dead mites and eggs in the skin. It continues until all the skin containing the dead mites is shed. This usually takes 2 weeks.
   • Continuing to have the itch does not mean that the treatment didn’t work. It also doesn’t mean that it needs to be repeated.
   • Here is some care advice that should help.
2. Treating Close Contacts:
   • Scabies is easily spread to others. The symptoms don’t start for an average of 30 days.
   • Therefore, everyone living in the house should be treated before they develop a rash.
   • Close contacts only need to be treated once with the scabies cream.
3. Anti-Scabies Medicine (Prescription):
   • Scabies is treated with a prescription cream. (Currently, the most common product is Elimite).
   • If applied correctly, it’s almost 100% effective at curing scabies.
   • Apply the cream from the chin to the toes. Cover every square inch of the body. Don’t forget the navel, between the toes, under the fingernails and all the creases.
   • Areas that don’t seem infected still need to be covered with the cream.
   • Caution: Infants less than 1 year old also need the cream applied to the head. Put it on the scalp, forehead, temples, ears and neck. Avoid putting it around the eyes and mouth.
   • Bedtime is usually the best time to apply it.
   • Eight to 12 hours later give your child a bath with warm water. This will remove the cream.
   • One treatment is usually effective. For severe rashes, repeat the treatment 1 week later.
   • Approved for as young as 2 months old.
4. Steroid Cream for Itching:
   • For relief of itching, apply 1% hydrocortisone cream. No prescription is needed.
   • Do this 3 times per day to the most itchy spots.
5. Allergy Medicine for Itching:
   • For severe itching, an oral allergy medicine should help.
   • Age Over 1 Year: Give Benadryl 4 times per day. No prescription is needed.
   • Age Over 2 Years: Another option is to give cetirizine (Zyrtec) each morning and Benadryl at bedtime. No prescription is needed.
6. Cool Baths for Itching:
   • For flare-ups of itching, give your child a cool or lukewarm bath. Bathe for 10 minutes.
   • Can add baking soda 2 ounces (60 ml) per tub.
   • Avoid all soaps. Reason: Soaps make the itching worse.
7. Cut Nails for Itching:
   • Discourage scratching.
   • Cut the fingernails short. Reason: Prevents a skin infection from bacteria.
8. Cleaning the House:
   • Live scabies mites are in clothing your child has worn in the last 3 days.
   • Machine wash all your child’s sheets, pillowcases, underwear, pajamas, and other recently worn clothing. Use hot water. High dryer temps also kill mites.
   • Put items that can’t be washed (such as blankets) into plastic bags. You need to keep them in the bags for 4 days to kill the mites. Scabies cannot live off the human skin for more than 3 days.
9. What to Expect:
   • One treatment with a prescription anti-scabies cream usually helps. This usually kills all the scabies mites and eggs. Make sure you leave it on for 8–12 hours
   • The rash will heal up and go away in 2 weeks. There shouldn’t be any new rash after treatment.
   • The itching may last up to 4 weeks. Reason: It’s an allergic reaction to the dead scabies.
10. Return to School:
    • Your child can return 24 hours after one treatment with the anti-scabies cream.

Call Your Doctor If

• Rash looks infected (draining pus, scabs become larger)
• Itching becomes worse or lasts over 4 weeks
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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