Scabies: Symptoms, Prescription Treatment and How to Clear It From Your Home

Written by Cherlie Joseph, MSN, FNP-BC · Medically reviewed by Naurah Gaspard, DNP, FNP-C, FNP-BC · Updated November 2026

Scabies is a skin infestation by tiny mites that burrow into the skin, causing intense itching that is worse at night and small bumps between the fingers, on the wrists, waist, armpits and groin. It spreads through close skin-to-skin contact. It needs prescription treatment, usually permethrin cream or ivermectin pills, and everyone in close contact should be treated at the same time.

Signs of scabies

• Intense itch, often worst at night
• Small red bumps or blisters, sometimes in a line
• Burrows: thin, wavy, gray or skin-colored lines a few millimeters long
• Typical spots: between fingers, wrists, elbows, armpits, waistline, belly button, buttocks, nipples and genitals. The face and scalp are usually spared in adults.
• Others at home are itchy too, one of the strongest clues

If you have never had scabies, symptoms can take 2 to 6 weeks to appear after you are exposed, and you can spread it during that time. If you had it before, symptoms return within 1 to 4 days.

Crusted scabies is a severe form with thick, crusted skin and huge numbers of mites. It mostly affects older adults, people in nursing homes and those with weakened immune systems, is very contagious and needs more intensive treatment.

How scabies spreads

Scabies spreads mainly through prolonged skin-to-skin contact: living together, sleeping in the same bed, caring for someone, or sexual contact. A quick handshake or hug is unlikely to spread it. Sharing bedding, towels and clothing can spread it less often. Scabies has nothing to do with being clean; anyone can get it, and it is common in households, dorms, nursing homes and child care settings.

Pets do not spread human scabies. Animal mange mites can cause a brief itchy rash in people but do not survive on humans.

Prescription treatments compared

The CDC notes that no over-the-counter products are approved to treat scabies. A provider can prescribe:

Treatment	How it's used	Good to know
Permethrin 5% cream (first line)	Applied to the whole body from the neck down, washed off after 8 to 14 hours	A second application about a week later is often recommended
Ivermectin pills (first line)	Two weight-based doses, 7 to 14 days apart, taken with food	Not FDA-approved for scabies but works about as well as permethrin; not for pregnancy; check drug interactions
Spinosad 0.9%	Topical, FDA-approved in 2021	An alternative option
Crotamiton, sulfur, malathion	Topical alternatives	Less commonly used; some have more treatment failures

Tips for using permethrin well: apply to cool, dry skin, not right after a hot shower; cover every area including between fingers and toes, under nails, the soles of the feet, the groin and buttocks; and reapply to your hands if you wash them before the time is up. Crusted scabies needs both ivermectin and permethrin on a more intensive schedule.

Treat everyone at once. Household members, sexual partners and other close contacts should be treated at the same time, even if they do not itch yet, or the mites will pass back and forth.

Cleaning your home

Scabies mites usually die within 2 to 3 days away from human skin, so you do not need to fumigate or throw things out. On the day of treatment:

• Wash bedding, towels and clothing used in the past 3 days in hot water and dry on high heat.
• Seal items that cannot be washed, like pillows or stuffed animals, in a plastic bag for at least 72 hours.
• Vacuum furniture, mattresses and carpets.
• Insect sprays and foggers are not needed and can be harmful.

Why you may still itch after treatment

Itching often continues for 2 to 4 weeks after successful treatment, because your skin is still reacting to dead mites and their debris. This does not mean treatment failed. Cool compresses, a fragrance-free moisturizer, an antihistamine at night or a prescription steroid cream can help.

Signs you may need retreatment: new burrows or new bumps appearing more than a week or two after treatment, or itch that is getting worse rather than slowly fading after about 4 weeks. Contact your provider in that case.

Frequently asked questions

How do you know if you have scabies?

Intense itch that is worse at night, small bumps or burrows between fingers, on wrists, waist or groin, and others at home who are also itchy are strong clues. A provider can confirm it, sometimes with a skin scraping.

How long is scabies contagious?

You can spread scabies until you have been treated. Most people are no longer contagious about 24 hours after a full treatment, though itching can last for weeks.

Can scabies go away on its own?

No. Scabies needs prescription treatment. Without it, mites keep reproducing and spreading to others.

Sources

• CDC: Clinical Care of Scabies
• CDC: Clinical Overview of Crusted Scabies
• CDC STI Treatment Guidelines: Ectoparasitic Infections

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This article is for general education and is not a substitute for medical advice. Treatment, including any prescription, is decided by a licensed provider after reviewing your health history. OurTopClinic is not for emergencies; if you have a medical emergency, call 911. OurTopClinic serves adults located in Florida, New Mexico, Oregon and Washington. Learn more at ourtopclinic.com.