We’re all used to an occasional itch, whether it’s a mild tingle or an intense discomfort. But if you notice that an itch isn’t going away or appears alongside other symptoms, it’s important to talk with a doctor. A proper diagnosis can tell you if it’s an allergic reaction or if you’re dealing with a contagious condition that requires treatment to heal.

In the case of scabies, which affects hundreds of millions of people each year, it’s technically both. Keep reading to learn what scabies and its key symptoms are, how they compare to similar conditions and what you can expect from treatment.

What is scabies?

Scabies is a highly contagious condition caused when mites (Sarcoptes scabiei, sometimes called “itch mites”) burrow under the skin. It can affect people from all backgrounds and living conditions around the world, but it’s most commonly diagnosed in hot, tropical environments and densely populated areas.

In immunocompromised people, scabies can become what is known as crusted scabies, also called Norwegian scabies. This has slightly different symptoms and requires immediate treatment.

Scabies is treatable, and treatment is important for preventing it from spreading. Someone’s first case of scabies typically has an incubation period of 2-8 weeks before symptoms appear, while repeat cases show symptoms in 1-4 days. But no matter how long it takes for symptoms to appear, the mites are active the whole time and won’t go away without treatment.

How you get scabies

Scabies generally spread during extended direct contact, such as sex. However, it’s possible for mites to spread indirectly through shared clothes, bedding or towels, especially with cases of crusted scabies. Because of this, scabies can spread easily through households and other places where people are in close contact with each other, like nursing homes, daycares and schools.

Itching, body rash and other scabies symptoms

Scabies symptoms are mainly the result of your body having an allergic reaction to foreign matter in your skin. These symptoms can include:

• Itching which is often severe and tends to get worse at night
• A body rash with acne-like bumps, blisters or scales

Scabies symptoms can affect any part of the body but are most common around areas that tend to be sheltered, such as the armpits, inner elbows, waist, belly button, groin, buttocks, nipples, and between fingers and toes.

In addition to the allergic symptoms, the tunneling of the mites may also cause raised squiggles or lines to form on the surface of the skin.

How to spot crusted (Norwegian) scabies symptoms

Though they’re similar, the symptoms of crusted scabies differ from regular scabies symptoms in a couple of ways. First, someone affected by crusted scabies might experience mild or no itchiness. This is because crusted scabies occurs in people with weakened immune systems – the body may not be strong enough to create an allergic reaction.

Second, crusted scabies cause thick, grayish crusts that contain many mites instead of a bumpy rash. This is where crusted scabies gets its name, and it’s why it’s far more contagious than regular scabies.

How to tell the difference between scabies and other skin rashes

There are a number of conditions with symptoms that are similar to those of scabies. However, there are some key differences:

• Hand, foot and mouth disease (HFMD) – A skin rash is one of the main symptoms of HFMD. However, unlike scabies, the rash typically doesn’t itch. It also commonly appears alongside mouth sores and flu-like symptoms.
• Chickenpox – Chickenpox is another condition characterized by a rash, but a chickenpox rash always turns into blisters that scab over. It usually starts on the chest, back and face before spreading over the entire body. Chickenpox also tends to cause fever, fatigue and headaches a day or two before the rash forms.
• Ringworm – Like scabies, ringworm can cause a red, itchy, scaly rash along with raised lines on the skin. But unlike scabies, the raised lines caused by ringworm tend to border the rash, which typically takes a circular shape.

How doctors identify scabies

Doctors can often identify scabies through your symptoms and talking with you about other things you’ve noticed, such as whether people close to you are also experiencing symptoms. If your doctor needs more information to make a diagnosis, they might take a small skin sample from an affected area to test for mites.

Prescription medicines for scabies treatments

Scabies won’t go away on its own. A diagnosis and treatment are necessary to recover and avoid spreading it to others.

Scabies is usually treated with a prescription cream that’s applied to the body from the neck down (though kids with scabies should also have it applied to their neck and head). Since scabies is highly contagious, all household members and sexual partners of someone with scabies should start treatment at the same time. For more serious cases of scabies and cases of crusted scabies, a doctor may prescribe oral ivermectin if other medicines aren’t effective.

The treatment your doctor prescribes will depend on your specific case and symptoms. In most cases, itchiness may remain for 2-4 weeks after completing treatment – you can use allergy medicine to help manage it. Talk to your doctor if new symptoms appear or the itchiness lasts longer than four weeks.

How to prevent scabies from spreading to others

Human itch mites can’t survive longer than three days off of a human body. In addition to avoiding close contact with people until you can be treated, you can help prevent scabies from spreading after you start treatment by:

• Washing all clothes, bedding and towels that were used by your household in the three days before treatment began with hot water and a hot dryer cycle. Seal items in airtight plastic bags for at least three days if you’re unable to wash them.
• Thoroughly vacuuming any rooms that you or anyone else with scabies used.

If you suspect scabies, see a doctor

An itch that doesn’t go away, appears alongside a rash or other symptoms, or that people close to you are also experiencing is always worth asking a doctor about. These kinds of symptoms have many possible causes, and a diagnosis is your key to getting the right treatment.

An in-person or virtual visit with a primary care doctor can get you treatment recommendations and a referral to a dermatologist, if needed. The experts at the Virtuwell online clinic are experienced in diagnosing and treating many different skin conditions, including scabies.