Scabies

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 22 Apr 2025

Last updated: 28 Mar 2023

Scabies is highly contagious via direct skin-to-skin contact. It is most common in overcrowded living conditions and in developing countries.

Caused by Sarcoptes scabiei, a 0.3- to 0.5-mm mite that can burrow and deposit eggs in the human stratum corneum.

Microscopic visualization of mites, their eggs, or feces in skin scrapings is helpful but not essential to initiation of treatment.

Most popular treatment options include topical permethrin and oral ivermectin.

Primarily considered a nuisance in the developed world. Children in the developing world can contract secondary streptococcal infection in their skin lesions, with potential complications of rheumatic heart disease or poststreptococcal glomerulonephritis.

Definition

Scabies is caused by infestation with the ectoparasite Sarcoptes scabiei, a mite that burrows through the human stratum corneum. Spread is primarily via direct contact with an individual with scabies. Clinical clues to diagnosis include intense pruritus and linear erythematous burrows, particularly on the extremities, or erythematous papules and nodules elsewhere such as in the axilla or genital area. Rarely, it can present on the neck and scalp. Diagnosis is based on history and clinical appearance.[1]

History and exam

Key diagnostic factors

infants, children, and older adults
history of overcrowding
history of itching in family members or close contacts over the same period
generalized and intense pruritus, typically worse at night
burrows
papules, vesicles, excoriations
positive ink burrow test

Full details

Other diagnostic factors

papules on face, neck, palms, and soles in children
immunosuppression
bullae
thick, crusted lesions occurring on elbows, knees, hands, and feet with dystrophic nails
nodules

Full details

Risk factors

overcrowded living conditions/poverty
living in close quarters with others who are infected
age under 15 or over 65 years
sexual contact with new or multiple partners
immunosuppression
poor hygiene
contact with an infected animal
contact with contaminated clothing, towels, and bedding
winter season

Full details

Diagnostic tests

1st tests to order

ectoparasite prep

Full details

Tests to consider

skin biopsy

Full details

Emerging tests

epiluminescence light microscopy

Treatment algorithm

ACUTE

nonpregnant/nonlactating adults or children over 5 years

infants and children 2 months to 5 years and pregnant or lactating females

infants under 2 months

Contributors

Authors

Ryan Harris, MD

Dermatologist

Treasure Valley Dermatology and Skin Cancer Center

Boise

Disclosures

RH declares that he has no competing interests.

Acknowledgements

Dr Ryan Harris would like to gratefully acknowledge Dr Pooja Khera and Dr Laura Korb Ferris, previous contributors to this topic.

Disclosures

PK and LKF declare that they have no competing interests.

Peer reviewers

David Cassarino, MD, PhD

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles

Disclosures

DC declares that he has no competing interests.

Roderick J. Hay, DM, FRCP, FRCPath, FMedSci

Chairman

International Foundation of Dermatology

London

Disclosures

RJH declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Chosidow O. Clinical practices. Scabies. N Engl J Med. 2006 Apr 20;354(16):1718-27. Abstract

Heukelbach J, Feldmeier H. Scabies. Lancet. 2006 May 27;367(9524):1767-74. Abstract

Hengge UR, Currie BJ, Jager G, et al. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis. 2006 Dec;6(12):769-79. Abstract

Strong M, Johnstone PW. Interventions for treating scabies. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000320.Full text Abstract

Rosumeck S, Nast A, Dressler C. Ivermectin and permethrin for treating scabies. Cochrane Database Syst Rev. 2018 Apr 2;(4):CD012994.Full text Abstract

Johnstone P, Strong M. Scabies. Clin Evid. 2006 Jun;(15):2284-90. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Impetigo
- Xerotic dermatitis
- Folliculitis
More Differentials
Guidelines
- Sexually transmitted infections treatment guidelines, 2021: ectoparasitic infections
- European guideline for the management of scabies
More Guidelines
Patient information
Scabies
More Patient information
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Scabies

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

nonpregnant/nonlactating adults or children over 5 years

infants and children 2 months to 5 years and pregnant or lactating females

infants under 2 months

Contributors

Authors

Ryan Harris, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

David Cassarino, MD, PhD

Disclosures

Roderick J. Hay, DM, FRCP, FRCPath, FMedSci

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice