Severe itching (pruritus), especially at night, is the earliest and most common symptom of scabies. A pimple-like (papular) itchy (pruritic) “scabies rash” is also common. Itching and rash may affect much of the body or be limited to common sites such as: Between the fingers.
The main symptoms of scabies are intense itching and a rash in areas of the body where the mites have burrowed. The itching is often worse at night, when your skin is warmer. It may take 4 to 6 weeks before the itching starts because this is how long it takes for the body to react to mite droppings.
Typically, someone with scabies has about 10 to 15 mites. But someone with crusted scabies may have millions of mites. Yet itching may not occur or may be mild.
Unfortunately, in practice, scabies is largely diagnosed based only on the clinical picture, which may lead to a misdiagnosis. A broad differential diagnosis of scabies can include atopic dermatitis (AD), allergic contact dermatitis, nummular eczema, arthropod bites, dermatitis herpetiformis, etc. (1, 7).
To make sure that a patient has scabies, a dermatologist may remove some skin. This is painless. Your dermatologist will put the skin on a glass slide and look at the slide under a microscope. If your dermatologist sees scabies mites or their eggs, it is certain that you have scabies.
The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies. Scabies occurs worldwide and affects people of all races and social classes.
How long does it take before a person with scabies has symptoms? In people that have never been infested with scabies before, symptoms (like itching and redness of the skin) usually appear 2 to 6 weeks after coming in contact with someone who has scabies and becoming infested.
The most common symptoms are: Blisters or bumps — Pink, raised bumps with a clear top filled with fluid are likely to appear on areas of the body where scabies have infested. Itching — A sensation of a foreign object crawling on the skin will create constant and sometimes severe itching, especially at night.
Two tests are used – the burrow ink test and handheld dermatoscopy. The burrow ink test is a simple, rapid, noninvasive test that can be used to screen a large number of patients. Handheld dermatoscopy is an accurate test, but requires special equipment and trained practitioners.
Location in children: The most common scabies bite locations in infants and children are the face, neck, palms of the hands, and soles of the feet.
The scabies rash takes the form of small, red bumps that may look like pimples, bug bites, hives or knots under the skin. You might be able to see the burrow tracks created by the mites, which appear as raised lines of tiny blisters or bumps. Some people develop scaly patches that resemble eczema.
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. The rash and itching are the body's allergic reaction to mites in the skin.
Scabies is highly contagious and is spread by close contact. If untreated, it can last indefinitely. Scabies is not caused by poor hygiene.
Scabies usually is spread by prolonged skin-to-skin contact with a person who has scabies; persons who have had such contact should be evaluated by a physician and treated if necessary. Scabies mites do not survive more than 2-3 days away from human skin. Spraying or fumigating office or living areas is unnecessary.
If you don't usually get rashes, but you develop an itchy rash after being in a crowded living space, it might be scabies. If you've had rashes that come and go in the same areas over years, it's more likely eczema rather than scabies.
Small, raised, crooked lines on your skin (caused by the scabies mites burrowing under the surface of your skin).
Itch can deteriorate over the night (nocturnal crescendo). This, however, is not specifically applicable to scabies, as other common skin diseases also display a nighty worsening of itch, that is, atopic dermatitis and psoriasis (19–22).
Key points about scabies
Scabies mites are very contagious. They often spread from person to person while they are sleeping in the same bed, or during other close contact. Scabies should be treated quickly to keep the mites from spreading.
Scabies is spread by prolonged skin-to-skin contact with a person who has scabies. Scabies sometimes also can be spread by contact with items such as clothing, bedding, or towels that have been used by a person with scabies, but such spread is very uncommon unless the infested person has crusted scabies.
Wash all clothes, bedding, and towels that you used in the 4 to 5 days before you started treatment. Use hot water, and use the hot cycle in the dryer. Another option is to dry-clean these items. Or seal them in a plastic bag for 3 days.
Scabies will not go away without treatment 1. First have a warm bath or shower. 2. Then cover the whole body with cream/lotion, from the chin down to the soles of the feet, in between the fingers, under the nails and on the private parts.
After treatment (8 hours for cream, 24 hours for lotion) you can bath or shower as normal. You can return to work or school. You will not give scabies to anyone.