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WHAT IS IT?
Scabies is a skin disease caused by a tiny mite, a distant cousin of the spider. These mites live only on humans and get under your skin anywhere on your body, but most often in the folds of the skin.
Scabies is not serious, but the itching it brings can be severe. The discomfort is worse at night when you’re resting and more likely to notice the itching, which can make it hard to sleep. If you scratch and break the skin, you may get other skin diseases that are harder to get rid of than scabies.

Each year, at least 300 million people worldwide get scabies. In the United States, no government health agency keeps track of scabies cases, so no one really knows how many Americans are affected. But all people can catch scabies at any time, no matter how clean they are, where they live, or their race or age. School-age children are most prone to getting scabies, since they often wrestle or roughhouse and come into close contact with one another. Once a child brings scabies home, everyone in the household who has close contact with him or her is at risk, especially a child under two, whose immune system isn’t mature yet.

Skin-to-skin contact spreads scabies mites more often than anything else does. You can catch scabies from clothing, bedsheets, or furniture, but it’s not likely. The mites can’t live away from a host for more than 2 or 3 hours in cool weather, and for no more than 24 hours in warm weather with high humidity. The mite that causes a more severe form of the disease, crusted or Norwegian scabies, can survive for up to three days away from a human.

The good news is that most cases of scabies are fairly easy to cure. A prescription lotion kills the pests overnight.
WHAT IS HAPPENING?
The mite that causes scabies is almost invisible to the naked eye. Unless you have a strong magnifying glass, you most likely won’t see the whitish, flat, round eight-legged insects. The tunnels they make just under your skin aren’t easy to see, either, but they may appear as short, thin gray lines.

The pregnant female is attracted to the warm body of a new host-especially to the web spaces between your fingers, the insides of your elbows and wrists, the armpits, the buttocks, and the genital area. With her jaws and sawlike forelegs, she burrows into the first patch of skin she lands on. She lays two to four eggs a day as she tunnels along. The eggs hatch within a few days and become larvae (baby mites) that live on and just under the skin. They grow into adult mites within a week or two. Males and females mate, and the new mothers head back into the skin and make more tunnels.

The mites’ feces and other waste products, as well as their bites, cause intense itching two to six weeks after the first mite burrows into your skin. In a few more weeks, you get a red, bumpy rash. Because scratching can cause sores or other infections, your doctor may not notice scabies, the source of the itching. Sometimes doctors will prescribe a scabies lotion even if they’re not sure what the skin problem is, just in case you do have scabies.
WHAT CAUSES IT?
People used to blame crowded conditions for scabies outbreaks. Scabies was common in places where many people lived together in close spaces, or during wars, when thousands of soldiers shared barracks, tents, and trenches. Even today, prisoners and soldiers are still more likely than others to catch scabies. But touching another person anytime, anywhere-even just shaking hands-is all it takes to catch the disease. You can do a few things to reduce your risk, though.

THINGS YOU CAN’T CHANGE

Being a child
Children are most at risk for scabies. Kids can pass the mites to each other through normal play, and you can’t do much about it.

Being a caregiver
People who take care of children often catch scabies from them, chiefly kids who are elementary school age or younger.

Random contact
You can catch scabies from touching someone or, very rarely, from clothing or blankets or even a toilet seat. Scabies is not a sexually transmitted disease (STD), but it can be passed when people have sex or if they sleep in the same bed.

THINGS YOU CAN CHANGE

Multiple sex partners
Having sex with many people or with people who have many partners raises your chances of getting scabies. You can catch scabies even if you use a condom or practice other safe sex habits.

Crowded living conditions
The more people you live with, the higher your risk of catching scabies. Elderly people in rest homes often catch scabies, and so do the people who work with them. In a household, if one person has scabies, often other family members will, too.
WHAT YOU CAN DO FOR YOURSELF
You can take steps to avoid scabies by staying away from crowded living conditions and by having sex or sleeping with only one person. If you have scabies, be sure that everyone in your household is treated along with you (see What Your Doctor Can Do for You).

Watch for symptoms
Scabies gets worse with time. Sometimes, you aren’t aware of any other symptoms, such as bumps or rashes, until you’ve been itching for a week or two. Scratching at night is your first clue. If you notice another sign, such as itching between the fingers, you most likely have scabies. Watch for other family members who are itching. Get to your doctor fast, and you’ll avoid a bad case.

Don’t scratch
Scratching breaks the skin easily, allowing bacteria on your fingernails to enter and cause another skin disease. Impetigo-sores that ooze and crust over-is one such infection, and it may cause scarring.

Use the medicine thoroughly
You’ll get rid of scabies by covering your body from the top of your neck down to your feet with one of many lotions your doctor can prescribe. These lotions contain insecticides that kill the mites.

Before you go to bed, pour the lotion into your palm and coat every area of your skin, including the bottoms of your feet and between your fingers, under the fingernails, around the belt line, and on the genitals. Leave on overnight or for 8 to 12 hours during the day, then rinse off the lotion.

Most people need to apply the lotion only once to get rid of scabies. But adults and children older than six have a better chance of avoiding another bout of scabies (reinfestation) if they repeat the treatment after 10 days to kill any newly hatched mites. Don’t repeat the treatment for infants or younger children.

Clean all clothes and linen
Wear freshly washed clothes after the lotion treatment. Wash all clothes, sheets, and towels that you used before the treatment in hot water. Dry them in a dryer set on high. Vacuum all furniture, floors, and carpets well. Don’t use sprays with permethrin or other insecticides in your home. They do little good, since scabies mites cannot live for long on objects.

Treat everyone at once
Because you may not know right away if you or someone else has scabies, treat everyone in your family at the same time to help prevent a new outbreak a few weeks later.

Make sure your sex partner is treated
Tell your sexual partner or partners that you have scabies. Don’t have sex with any partner again until he or she is treated.

Relieve the itch
In some cases, scabies will still cause itching for two to four weeks after you’ve used the lotion, even if you’ve killed all the mites. To stop this itch, try an over-the-counter oral antihistamine, such as Benadryl. Avoid creams or lotions with antihistamines or anesthetics; these may bother your skin, which is more sensitive after the treatment. Sarna, an anti-itch lotion sold in drugstores, contains menthol and camphor and may be soothing. Or try an oatmeal bath. Toss a handful of oatmeal (sold in drugstores; not the kind you cook) into warm (not hot) bathwater and soak for 20 to 30 minutes.
WHAT YOUR DOCTOR CAN DO FOR YOU
If you have scabies, your doctor will most likely prescribe a medicated lotion that contains an insecticide. If you’re still itching many weeks after using the lotion, your doctor may prescribe stronger skin medicines to stop the itch or to heal sores or infections caused by scratching.

Lotions
Most prescription lotions used to treat scabies contain either 5 percent permethrin or 1 percent lindane. Permethrin is not as potent as lindane, but it also isn’t as risky. Lindane is strong enough to cause serious side effects such as convulsions in young children, pregnant or nursing women, and people who are already prone to seizures or who have nervous system disorders. The FDA has not banned lindane, but doctors no longer prescribe it for children.

If you are an adult with scabies, tell your doctor if you prefer to use a lotion without lindane. Products with lindane have many names, so be sure to ask your doctor or pharmacist what you’re getting. Don’t use any lotions with lindane more than once every 10 days, or at all if you have had seizures.

Other Medicines
Ivermectin (Stromectol): Studies suggest that ivermectin, already approved by the FDA for treating river blindness (a disease caused by worm infestation) and strongyloidiasis (a type of diarrhea), is an effective oral treatment for scabies, especially crusted scabies. The FDA has not yet approved ivermectin as a scabies treatment, but some doctors are prescribing it for this use. Side effects include short-term hypotension (low blood pressure), stomach pain, and vomiting.

Prescribed oral antihistamines: Antihistamines can be taken with other scabies medicines to help relieve itching.

STD Tests
If you got scabies by touching another person during sex, your doctor may suggest that you get tested for a sexually transmitted disease, such as herpes or genital warts. Do this above all if you don’t know the sex history of your partner.