About scabies

Scabies is a skin rash caused by an infestation of tiny insects (mites) called Sarcoptes scabiei. The infestation happens when female scabies mites burrow under the surface layer of the skin and lay their eggs in the small tunnels that form as they burrow.

Scabies usually spreads through skin-to-skin contact.

Scabies is common in preschoolers and school-age children because they often come into close contact while playing. But it can also spread to adults, including elderly relatives. This is why there are often outbreaks in kindergartens, schools and nursing homes.

Symptoms of scabies

Scabies usually shows up as lumps and threadlike ‘tracks’ on the skin. On children with darker skin, the lumps and tracks might look brown, purple or grey. On children with lighter skin, the lumps and tracks might look red.

In children and teenagers, the tracks appear especially between the fingers and toes, on the insides of wrists, on the backs of elbows, in the armpits, around the belly button and groin, and on the buttocks.

In babies, the rash often appears on the palms of the hands and soles of the feet and might look like little blisters or pimples. Some babies might get a rash on their heads and necks. Or they might have thick, crusted areas on the affected skin.

Scabies is extremely itchy, especially at night, or after a hot bath or shower. When children scratch the itchy areas, they can sometimes get secondary infections. If this happens, there might be yellow crusting on the skin and it might be painful.

It can take up to a month after infection for the rash to appear, because it takes this long for the scabies eggs to mature.

Does your child need to see a doctor about scabies?

Yes. See your GP if you think your child might have scabies.

It’s particularly important to see your GP if:

• itching goes on for more than a week, or initially stops and then comes back
• bleeding, scabs or pus-filled sores appear in the same area as the itching.

You should also take your child to the GP if you’re not sure what’s causing your child’s rash.

Tests for scabies

Your GP will look at your child’s skin to diagnose scabies. Sometimes they might take skin scrapings to confirm the diagnosis, but they don’t usually need to do this.

Treatment for scabies

Scabies spreads very easily, so your child must stay at home until treatment is completed.

Your GP or pharmacist will recommend a lotion or cream (usually 5% permethrin cream), which will need to go on your child’s skin from the neck down.

For younger children, you’ll need to apply the cream. Older children and teenagers can apply the cream themselves. Here’s what to do:

1. Start with a lukewarm bath or shower. Dry the skin gently.
2. Apply the cream. Make sure the cream gets into all folds and creases on the body.
3. Cover the skin thoroughly, particularly the genital area.
4. Don’t wash the lotion or cream off for 8-12 hours. If your child washes their hands during the treatment period, the cream needs to go on their hands again.
5. Wash the body thoroughly 8-12 hours after applying the cream.

Your child will usually need this treatment twice, with a week between each treatment. Don’t use the treatment more than twice unless you’re told to.

The itch can take up to 6 weeks to go away. This is usually because of an allergic response, not ongoing scabies. Treat the itch with calamine lotion or an antihistamine. If the itch doesn’t go away with this treatment, your health professional might recommend a corticosteroid cream.

Your child might need antibiotics if they get a secondary infection because of scratching.

You should also wash all your child’s clothing, sheets, towels and soft toys, using the hottest setting possible. Dry the clothes and bedding on the hottest setting of your clothes dryer, if you have one. This will destroy the mites and their eggs.

If there are things you can’t wash, spray them with insecticide and leave them closed in a plastic bag for around a week. Scabies eggs can live on clothes and bedding for up to 2 days.

Vacuum all carpets and mattresses.

Preventing the spread of scabies

You can’t prevent an initial infection of scabies, but you can stop scabies from spreading through your family.

Prevent the spread of scabies by washing everyone’s sheets, towels, clothes and soft toys.

Treat all family members with the lotion or cream at the same time, even if only one child is affected.

It’s best to keep your child home from child care, kindergarten or school until they’ve finished 2 treatments. But ask the school or child care centre how long they’d prefer scabies-affected children to stay away, because this can vary from place to place.