Scabies is a common skin infestation of tiny mites called Sarcoptes scabiei. The mites burrow into the top layer of human skin to lay their eggs, causing small itchy bumps and blisters.
A child with scabies may have a bumpy red rash. Occasionally, raised wavy lines where the mites have burrowed may appear, especially on the inner part of the wrist or between the fingers or toes.
How Do People Get Scabies?
Scabies is contagious, and is usually transmitted by prolonged skin-to-skin contact or through sexual contact with someone else who is infected with it. The infection spreads more easily in crowded conditions and in situations where there is a lot of close contact — like within a household, childcare centers, college dorms, or nursing homes.
Mites can live for about 2 to 3 days in clothing, bedding, or dust, making it possible to catch scabies from people who share the same infected bed, linens, or towels.
It may take up to 4 to 6 weeks after infection for symptoms to appear in someone who’s never had scabies before. In people who have had scabies previously, symptoms may appear in just a few days.
Signs and Symptoms
The most common symptom of scabies is severe itching, which may be worse at night or after a hot bath.
A scabies infection begins as small, itchy bumps, blisters, or pus-filled bumps that break when scratched. Itchy skin may become thick, scaly, scabbed, and crisscrossed with scratch marks. The itching is due to a hypersensitivity reaction to the mite and/or its feces and eggs.
The areas of the body most commonly affected by scabies are the hands and feet (especially the webs of skin between the fingers and toes), the inner part of the wrists, and the folds under the arms. It may also affect other areas of the body, particularly the elbows and the areas around the breasts, genitals, navel, and buttocks.
If a child with scabies scratches the itchy areas of skin, it increases the chance that the injured skin will also be infected by bacteria. Impetigo, a bacterial skin infection, may occur in skin that is already infected with scabies.
In infants and young children, the rash can be on the scalp, palms, and soles of feet. Rashes in infants and young children can appear to be more reddened or with larger blisters.
Scabies infections need to be treated by a doctor. Call the doctor or dermatologist any time your child has a skin itch or rash that will not go away, especially if the itch is worse at night and occurs around the wrists or in the webbed part of the fingers.
If scabies is suspected, the doctor may scrape a small part of the affected skin and examine the scrapings under a microscope for signs of scabies mites.
Doctors treat scabies by prescribing a medicated cream or lotion to kill the mites. The cream will need to be applied to the skin all over the body, not just the area with the rash, and usually must remain on the skin for 8 to 12 hours before it can be washed off. After applying it, don't wash your hands — scabies mites love the area between the fingers! You may want to apply the medication before your child goes to bed, then wash it off in the morning.
Most often, the treatment needs to be repeated in 1 week.
Sometimes the doctor may choose an oral medication instead of topical lotion to treat scabies in older children.
Since scabies is highly contagious and can cause re-infestations, other members of your household should also be treated, even if they have no symptoms. Because scabies can be sexually transmitted, sexually active teens with scabies should be examined for other sexually transmitted diseases (STDs) too. Any sexual partners will also need to be treated for scabies.
The doctor might prescribe antibiotics if your child develops a bacterial skin infection such as impetigo in addition to the scabies infection. The doctor also may prescribe an antihistamine to help relieve the itching.
Once a child starts receiving treatment for scabies, it usually takes about 1 to 2 days for the itching to go away; however, sometimes the itching can last for a few weeks. If the itching remains severe, the doctor may prescribe a topical steroid cream like hydrocortisone. Such a steroid cream should only be used if recommended by your doctor because certain infections can become worse with its use.
If the treatment is effective there should be no new rashes or burrows after 24 to 48 hours.
Direct physical contact — like holding hands — is the most common way to transmit scabies, but because the mites that cause scabies can live about 2 to 3 days in clothing, bedding, or dust, it's possible for kids to catch scabies from another person who shares the same infected bed, linens, or towels.
If someone in your family is being treated for scabies, all other members of the household should be treated, too. Clothing, sheets, and towels should be washed in hot water. Stuffed animals can be sealed in a plastic bag for minimum 3 days since the mites cannot survive for too many days away from human skin. Each room in the house should be vacuumed, and the vacuum cleaner bag should then be thrown away.
Most children can return to school the day after the treatment is complete.