Scabies vs. Eczema: What Are the Differences?

If you find yourself with an itchy, red rash, you may wonder if it is eczema or scabies.

Both conditions can cause itching, red patches, and crusty, flaking skin. And both are more common in children than in adults, but that is where the similarities end.

Eczema is an inflammatory skin condition that has both environmental and genetic factors. Although eczema might run in families, it is not contagious.

Scabies, on the other hand, is caused by an infestation of microscopic skin mites (Sarcoptes scabiei) that burrow beneath the surface of the skin and lay eggs. The condition is contagious and is passed through close skin contact and fomites, which are shared objects that can carry scabies from one person to another.

Sexual contact is not required for transmission and condoms will not prevent the spread of scabies between two people who otherwise have close skin contact.

Here’s what you should know about scabies vs. eczema, including causes, symptoms, and treatment options for each.

Symptoms

Both eczema and scabies cause itching. Although eczema is almost always accompanied by a dry, red rash, scabies may or may not include a rash.

Scabies symptoms

The symptoms of scabies include an intense itching that might be most noticeable at night. Itchiness comes from an allergic reaction to the proteins and feces of mites.

In many cases, people with scabies will develop a rash that is red in appearance. You might notice lines, or burrows, connecting the red spots of the rash—this is one way to distinguish scabies from other skin conditions. The rash can include pimples or pus spots and may progress to blisters.

In severe cases, known as crusted scabies, the rash will develop a thick, gray crust on the skin.

Eczema Symptoms

The primary symptoms of eczema are dry, inflamed, and red skin. The skin might appear scaly and may develop pus-filled blisters or areas that ooze. Sometimes the skin can crack. All of this causes itchiness and pain.

Causes

Scabies is a contagious condition caused by skin mites.

Eczema, on the other hand, is caused by environmental and genetic factors and is not passed from person to person.

What Causes Scabies?

Scabies is caused by mites that burrow under the skin.

In order to contract scabies, you must be in close contact with someone who has mites on their skin or in close contact with fomites, objects that have come in contact with another person who has scabies.

The condition passes when a mite crawls from another person's skin onto yours or from a shared object onto your skin. Usually, this requires prolonged contact, like cuddles between a parent and child or close contact between two people who are physically intimate. Sexual exposure is not required.

Pets do not spread human scabies. The condition is only passed from human to human or from fomites.

Scabies outbreaks are common in places where there is close contact between at-risk groups, including:

• Day care centers
• Hospitals
• Nursing homes
• Dormitories
• Shelters 

What Causes Eczema?

The medical community isn't exactly sure what causes eczema. Some research has shown that people with eczema are more likely to have a genetic predisposition that causes the skin to have less of a barrier. Because of this, allergens and irritants can cause the skin to become inflamed. 

Eczema cannot be cured, but the condition typically occurs with flare-ups (when symptoms are worse) and periods of remission (when symptoms subside). Many people with eczema learn to identify their triggers, which might include:

• Stress
• Weather conditions
• Allergens

Learning your triggers can help you prepare for and avoid outbreaks. 

Diagnosis

In most cases, scabies and eczema are both diagnosed after speaking with a healthcare provider about your symptoms and undergoing a physical exam.

For eczema, your doctor will likely diagnose your condition by taking a medical history and then examining your skin, looking for symptoms like dryness, rashes, bumps, and scaling. The doctor may perform a patch test to rule out other conditions. An allergy skin test also may be performed, as well as blood tests to look for underlying causes of the rash. A skin biopsy (a sampling sent to a lab) may be needed to distinguish your rash from other causes.

Scabies can be definitively diagnosed by removing a mite, mite eggs, or a mite's fecal matter from your skin or by taking a skin sample from an affected area and examining it under a microscope. If mites, their eggs, or their fecal matter are not present, your healthcare provider will rely on an assessment of your rash or the skin sampling, risk factors, and a personal history to diagnose scabies and start a treatment plan.

A person can still be infested even if the mites, eggs, or fecal matter are not found. So, while finding a mite can diagnose the condition, absence of a mite does not exclude it.

Treatment

Your treatment plan will vary based on whether your rash is scabies vs. eczema.

While treatment for eczema focuses more on controlling symptoms, treatment for scabies focuses on killing the mites and their eggs.

Treatment is essential for stopping the spread of scabies, and healthcare providers usually recommend that people who live with someone diagnosed with scabies get treatment even if they haven’t started exhibiting signs. 

Treatment for Eczema

The treatment for eczema focuses on minimizing symptoms. As part of this, it’s important to work with your healthcare provider to identify your eczema triggers and limit exposure to them when possible. If you have eczema, you should moisturize, keeping the skin moist by using emollients can help reduce itching.

How Do You Treat Scabies?

If you have scabies the only way to get rid of the rash is by prescription treatment. It’s important to follow your healthcare provider's instructions.

Most often, scabies is treated with a skin cream that is applied from the neck down. The most common treatment for scabies is 5% permethrin cream, which is approved for use in people older than 2 months of age. The cream is put on once at night and washed off in the morning. Your healthcare provider might recommend repeating this treatment two weeks later if signs of scabies are still present.

In severe cases, a healthcare provider might also prescribe an oral antiparasitic medication called ivermectin.

Children and babies who have scabies might need a parent to apply the ointment to their face and scalp as well. Talk with your healthcare provider about whether this is necessary for your child. 

Even with treatment, it can take up to four weeks for scabies to resolve. In that time, your healthcare provider might recommend the following to control symptoms and make you more comfortable:

• Antibiotics to address any infection
• Antihistamines to reduce itch, particularly at night
• Steroid creams or pramoxine lotion (an anti-itch gel or spray) to help control itching

Prevention

There is little that you can do to prevent either scabies or eczema.

If you are predisposed to eczema, you’ll likely deal with the condition throughout your life. However, identifying your triggers and avoiding them can help you prevent additional flare-ups. 

Ways to prevent eczema outbreaks include:

• Bathing in lukewarm water instead of hot
• Drinking plenty of water
• Wearing loose clothing
• Avoiding extreme temperature changes
• Using mild soap and products labeled "fragrance free"
• Not scratching skin
• Avoiding stress

You can help prevent the spread of scabies by limiting skin-to-skin contact, not sharing towels, and washing bedding and other laundry in hot water.

In addition, be sure to treat the entire family for scabies at the same time. Remember, other family members, including babies, might have the condition but may not yet be showing signs.

People who work in day care centers, nursing homes, and hospitals, as well as those who are immunocompromised, are at higher risk for scabies. If you fall into one of these groups and experience a rash, you should reach out to a doctor immediately. That way you can get treated promptly and avoid passing scabies to others.

A Word From Verywell

Rashes can be itchy, disrupting your sleep and making you miserable. They can also be embarrassing when they cause red patches that affect how you feel about your appearance.

Sometimes one type of rash may look like another. It's important to see a a doctor to diagnose your condition and provide proper treatment.

Asking your healthcare provider about rashes, particularly if they’re in a vulnerable area like your genitals, can be uncomfortable. However, healthcare providers are adept at addressing rashes and getting you the treatment you need to resolve them quickly.

Frequently Asked Questions 

Should you tell someone you have scabies?

Scabies passes quickly between people who are in close contact with one another. In adults, scabies can be passed through partners who are physically intimate or who share objects that can carry scabies. If you are diagnosed with scabies, you should alert your family members and those with recent physical contact, since they may need treatment for scabies as well.

Remember that there is nothing to be embarrassed about. 

Can you self-diagnose scabies?

No, scabies is a highly infectious disease that should always be diagnosed by a healthcare provider. You may be infested—and able to pass on scabies—without ever seeing a mite, so a skin scraping may need to be taken and examined under a microscope. Also, nothing available over the counter can treat scabies, so a healthcare provider needs to be contacted in order for you to get the appropriate treatment.