Is it a scabies rash?

by James Hubbard, M.D., M.P.H.

The seven-year itch they used to call it, and if you’ve ever had it, you know the scabies rash itches like crazy—even worse at night.

As with head lice, I see more scabies cases when school starts back. It can also become a problem for shelters, nursing homes, even hospitals. Like head lice, the scabies mite feeds on the human body and likes to jump ship, so to speak, when people are in close contact.

But, in my opinion, tiny scabies mites aren’t as simple to diagnose as the bigger bugs.

6 Tricks to Diagnosing a Scabies Rash

All sorts of other things can cause an itchy rash that looks the same as scabies, such as other insect bites, dry skin, impetigo (bacterial infection), allergic reactions, and eczema. There’s even a condition called delusional parasitosis, which I’ll write about in my next post. But over the years, I’ve learned some tricks that make the scabies rash easier to diagnose.

  1. Don’t look for the mite. It’s so tiny you’re not going to see it. And there are only ten to fifteen mites on your body. The bumps and itch don’t start until the mites have been on your body for a couple of weeks. They, their eggs, and their feces cause you to have an allergic reaction with the resultant itchy rash. Doctors can scrape the skin and sometimes see a mite under the microscope, but diagnosing it this way in a disaster situation isn’t worth it because there are easier ways.
  2. If you’re lucky you can spot little streaks where the mites have burrowed just underneath the skin to lay eggs. But, just like the mites, these tunnels can be very hard to see, especially with an untrained eye.
  3. An easier way to see the burrows is to use a washable felt-tip marker to color in a square a couple or three square inches around some bumps. Clean off the ink with some alcohol pads. The burrows will be outlined by the ink they’ve soaked up and appear as thin, dark streaks.
  4. Also, a scabies rash can be on any part of the body except the face. It sometimes gets on the scalps of small kids but doesn’t affect their faces either.
  5. Another good clue I look for is the scabies rash often involves the webs between the fingers. That won’t be the only area of the rash, but scabies is the only itchy rash I can think of that involves other parts of the body and in-between the fingers at the same time.
  6. Especially in children, the itchy scabies rash can be on the soles of the feet. As with the webs of the fingers, that won’t be the only rash area, but in children, if there’s an itchy rash on various parts of the body, and it includes the feet, think scabies.

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Treatment for the Scabies Rash

Treatment options for a scabies rash are listed below. With any of them, be sure to:

  • Treat all close contacts.
  • Apply the treatment to every nook and cranny of your body, from the neck down. In small kids include the scalp. Don’t forget to treat under your fingernails since you may have eggs there from scratching.
  • Test your sensitivity to any topical medicine before putting it all over your body. Apply some to a patch of skin and wait a few hours to make sure you don’t have a reaction.
  • Treat everyone at the same time so no one will get reinfected. That means treating all close contacts even if they have no symptoms. You can have the mites up to two weeks before you have the slightest rash or itch.

As part of the treatment:

  • Wash all clothes and bed linens in hot water and dry them in a hot dryer if available. Do this at the same time you’re treating everyone. If a washer and dryer are not available, put everything in a sealed plastic bag for a couple of weeks to give time for all the mites to die. The mite can live up to three days off the body.
  • Vacuum rugs and cloth furniture and put the contents in a plastic bag.

Don’t be surprised if the itching continues for several weeks. It can take that long for the allergic reaction to go away. If you’ve diligently done all of the above, all you can do is wait it out and use something for the itching such as Benadryl, a steroid ointment, or whatever’s your favorite home remedy for itching.

Medicines for the Scabies Rash

Permethrin 5 percent (Elimite)
This is over-the-counter (correction-this is prescription) and can be used for children older than two months. Follow the directions to the letter, and rinse off the lotion after eight to fourteen hours. That should do it, but we compulsive types like to repeat it in seven days just to make sure.

This is oral medicine used for other parasites. If you’re in disaster and have some, it’ll work on scabies but be sure to read the precautions and drug interactions. The dose for scabies is a single dose of 200 micrograms per kilogram (2.2 pounds). Repeat in two weeks.

Neem oil
It can be used like the permethrin. (For adults: Rub it over clean, dry skin from your neck to the soles of your feet. After eight to fourteen hours, wash it off.)

Tea tree oil
A five percent solution can be used like the permethrin.

Sulfur mixed in petroleum
You can use anywhere from a two to a ten percent mixture. The problem, other than the odor and the discoloration of whatever it touches, is that it only kills the mites, not the eggs. I’d use it like the permethrin but repeat for three consecutive days, wait a week, and repeat one last time. Be sure you’re not allergic to sulfa products.


So, what about you? Are you prepared? What have you tried? How did it work?

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