Scabies is a human parasitic disease caused by mites (Sarcoptes scabiei) that is transmitted from person to person through skin contact, including sexual contact, as well as via bedding and clothing. Animals have their own scabies mites, which rarely infect humans. Outside the human body, scabies mites will die within 48–72 hours.
Children and older adults are more susceptible to infection. The female scabies mite burrows into human skin, forming tunnels between the fingers, on the wrists, in the armpits, in the groin folds and in the genital area. Since children have softer skin, the scabies mite can also infest the palms of the hands and soles of the feet.
All family members of the infected person, even if they are asymptomatic, and other people in close contact, such as sexual partners, must be treated at the same time.
You should inform the daycare centre if your child has scabies. You may return to daycare, school or work the day after your first treatment. The exception is cases of crusted scabies, as diagnosed by a physician, in which physical contact with others should be avoided until all treatments have been completed. Crusted scabies, or generalised scabies, can occur in older adults and people with impaired immune systems.
Symptoms
The main symptom of the disease is very intense itching due to the body’s reaction to the secretions from the mites. Individuals infected with scabies for the first time will not start to show symptoms until three to four weeks after infection. Individuals who are reinfected become sensitised, and the itching begins within a matter of days.
Itchiness occurs throughout the whole body, from the neck down. In children, the palms, wrists, soles of the feet, armpits and lower back are particularly itchy. This itching is most intense in the evenings and at night. It is very rare for children over the age of five to develop scabies on their faces.
The skin will show pimples, small blisters, scratch marks and scabies tunnels. In adults, itching and scratch marks are concentrated between the fingers, in the armpits, the groin folds, and the middle of the torso. Scabies can be passed on in the early stages, even if the infected person is still asymptomatic.
Self-treatment for scabies
- For self-treatment of scabies, you can use medicated creams that are available at pharmacies without a prescription. There are two different medicated creams available in pharmacies as self-care products (see below).
- Treat asymptomatic family members and others in close contact at the same time. Treat both symptomatic and infected persons and asymptomatic close contacts following the same instructions.
- If the only suspected case of scabies in your family is a child under two, please contact your doctor before you start treatment. Your doctor will confirm whether it is a scabies infection.
- Repeat the treatment after 7–10 days.
Applying the medicated cream
- Make sure that the skin is clean and dry.
- Apply the cream thoroughly all over the body, including the palms and soles of the feet. Although the package insert says to apply from the chin down, it is also advisable to treat the scalp and ears. Take particular care to apply the cream between the fingers and toes, at the elbows and under the armpits. Remember to also apply the treatment to the inside of the navel and the external genitalia (but do not apply the cream to mucous membranes). For children under the age of two, apply the cream to their face as well. The faces of adults and older children do not need to be treated if there are no symptoms or visible skin changes. Do not apply the cream near the eyes, mouth and nostrils.
- Cut fingernails and apply the medicine underneath them as well.
- Protect children’s hands with cotton gloves to avoid eye contact with any irritants. Adults should also wear gloves to avoid accidentally washing off the cream.
- Do not wash your hands after applying the solution! If this happens, reapply the cream immediately.
- Wash off the cream with soap and water after the specified period (see above).
- Put on clean clothes.
Aftercare
Itching may persist for more than a month after treatment, but this is not a sign of failed treatment. You can use hydrocortisone cream to relieve itching if necessary. It is available at pharmacies without a prescription.
When to see a doctor?
- If the scabies infection is severe, widespread, inflamed or if self-treatment does not help, your doctor may prescribe tablets, as well as other topical medications.
- If the only suspected case of scabies in your family is a child under two, please contact your doctor before you start treatment. Your doctor will confirm whether it is a scabies infection.
- If a baby under two months of age has been infected or exposed to scabies in a family outbreak.
- If the itching persists for more than a month after treatment.
These instructions were prepared by: Epidemiological Operations Unit.