Signs and Symptoms of Scabies

Scabies is a contagious skin condition caused by tiny human itch mites (Sarcoptes scabiei var. hominis). The mites can spread through prolonged skin-to-skin contact or the sharing of items like towels, bedding, or clothing with someone who has scabies. Once they're on you, the mites burrow into the upper layer of skin to live, feed, and lay eggs. The mites' waste products trigger an immune response, leading to intense itching and a pimple-like rash.

The time it takes for scabies symptoms to show depends on whether you've already had the condition in your life. If it's your first time with scabies, it can take four to eight weeks for symptoms to appear. If you've had scabies in the past, symptoms appear much sooner, often within one to four days after exposure.

Most people with scabies experience a gradual onset of symptoms. At first, you may notice intense itching that keeps you up at night. As the infestation worsens, symptoms can become more severe. The rash and itching may be in one area or widespread on the body.

Common Symptoms 

Severe, intense itching that worsens at night is the hallmark symptom of scabies. The itching is caused by an allergy-like immune response to the mites and their waste products. The itching can be so intense that it may interfere with sleep and daily activities. 

Rash is another common symptom. It will look like small, red bumps, often forming in a line. The bumps may resemble hives, small bites, or pimples.

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The itching and rash usually develop where the mites most often like to burrow, which would include:

• Hands, especially in the webbing between fingers
• Wrists
• Elbow creases 
• Armpits
• Nipples 
• Belly button
• Waist/belt line
• Buttocks 
• Penis
  

Another common sign of scabies are burrows. Burrows are thin, wavy, raised lesions on the skin created by female mites as they lay eggs. Burrows are typically less than 1 centimeter long and are skin-colored or grayish-white. They may be hard to see with the naked eye.

Less Common Symptoms

Scabies symptoms are similar from person to person, but there can be differences. For instance, for some people, a scabies rash might look less like pimple and more like eczema, causing scaly patches.

Some people might also develop sores if they scratch the itch. The sores might eventually become infected with bacteria.

Crusted Scabies

Some people may have thick, crusted spots on their skin. This happens if they've developed a severe form of scabies known as crusted scabies, or Norwegian scabies. Crusted scabies is most common in people with weakened immune systems or neurological disorders. It can also affect older adults and people who live in places like assisted living residences.  

A typical scabies infestation involves 10-15 mites, but people with poor immune responses are less able to fight off the mites and so may have hundreds or thousands of mites living in their skin.

The gray-colored crusts can develop anywhere on the body but are most common on the palms of the hands, soles of the feet, ears, face, scalp, and elbows. The skin around the lesions may be scaling and flaky or crumbly and may easily slough off when touched.

Someone with crusted scabies might not experience the itching or rash that typically comes with scabies.

Symptoms in Children

Scabies is a common skin condition in children, especially children who spend time in crowded places such as daycares. In infants and toddlers, scabies may cover most of the body, including the scalp, soles of the feet, and palms of the hands. In older children, scabies often develops on the hands, feet, genitals, armpits, and belly button.

Scabies symptoms in children are similar to those experienced by adults and include:

• Severe itching, especially at night
• Thin, wavy burrows on the skin
• Rash with small, red bumps 
• Irritability 
• Difficulty sleeping
• Loss of appetite 

When to Contact a Healthcare Provider

Scabies itching and rash can sometimes be mistaken for other skin issues, such as eczema. Scabies requires treatment to go away; early diagnosis and treatment can help relieve your discomfort and prevent complications. See a healthcare provider if you have:

• Severe itching that keeps you up at night
• A rash that is spreading or worsening 
• Recent close contact with someone who has scabies 
• Small, tunnel-like lines on your skin

A Quick Review 

Scabies is a contagious skin condition caused by mites that burrow into the top layer of skin. Common symptoms include severe itching that intensifies at night and a rash with small, red, pimple-like bumps. You might also be able to notice thin, wavy lines on the skin. Scabies can be found anywhere on the body but most often appears in the webs of the fingers, wrists, elbows, armpits, groin, and buttocks. Crusted scabies is a more severe form of the condition that affects people with weakened immune systems and older adults. It is a severe infestation of the mites, which can lead to thick, crusty, scaly plaques on the skin that may or may not be itchy. Recognizing scabies symptoms early can help in getting the treatment you need sooner and in preventing any complciations.