Scabies Rash: Diagnosis and Treatment

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Is It Really Scabies? Felt-Tip Markers and Other Diagnostic Tricks

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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  • Ivy

    What a good article, thanks Dr.

    Today is Day 4 after my first Permethrin treatment, the itch significantly reduced and no new itchy spots show up. I use Aveeno Active Naturals Daily Moisturizer Lotion to get over the itch. As scratching is a big no no prior and after the treatment, I got this lotion. It’s natural, it works as good as Benadryl for my case, worth a try. I cleaned all my clothes, bedding which I have contacted in the past week with HOT water + dry it at hot setting for 30mins. For clothes that I cannot washed, I put them in the sealed plastic bag and vacuum the air out. I still change my towels and clothes everyday. Just in case if the dead mites get on my clothes, I don’t have to have them near me to cause allergy reaction.

    I bought a bottle sawyer spray and sprayed it on my car seat, floor. I haven’t been inside the car since I started the treatment.

    I wonder if there is anything else I need to do/ observe. One thing I regret that I didn’t do was… I did not vacuum my carpet in the bedroom. After the treatment, I didn’t spend much time in the bedroom except sleeping and brushing my teeth, etc. I had so much to clean that I forgot to vacuum the carpet. I am worried if the mites would crawl up from carpet back on me.

    • James Hubbard, MD, MPH

      Just the things I mentioned in the post.

  • KarVer

    3 year old is having red marks that come an go with clear like bumps that come an go in the red and it cam an when almost every 2 hrs…

    • James Hubbard, MD, MPH

      Scabies rashes don’t come and go like that.

  • Lee

    My daughter and I were diagnosed 3 weeks ago – Used the 5% cream – immed relief – retreated one week later- as advised because we saw some new bumps – her dad has treated twice in his home -altho no symptoms – we have been washing bedding everyday, towels everyday etc.. have vacuumed, including furniture -applied rid to furniture as well – 3rd week in- daughter had a pimple like rash on her bottom – and a very itchy neck – one line that appeared to be a track on her neck -not sure if it was a mistake- but retreated both of us again – daughters rash went away only to come back 2 days later.. I dont know if this is scabies or a reaction – so paranoid – every itch, red mark, pimple – I think is scabies – I dont want to retreat again.. dont really have a grasp on what to expcet post scabies or from that darn cream- which initially helps, but then seems to get worse – -I can see the original marks clearing up – But what about the new? so afraid to let any mark go untreated- but feel this cream may now being causing the problem… exhausted and emotionally drained.

    • James Hubbard, MD, MPH

      Call your doctor or see her/him again. If he has a microscope he may be able to scratch off some superficial skin and see, or not see, the scabies mite or some eggs. Or possibly he could send you to a lab to have the test.

  • whats that itch

    hello doc, this is amazing that you actually read and respond here. I have been suffering for months from Scabies. I just recently found out what it was and treated. 15 days ago with perm. again 8 days ago. Nothing went away so used Verm. 2 days ago. Since then I have been getting swollen, flat bumps randomly on my skin. They are enflamed at first, then subside. I never had these with scabies. Is this a reaccurance? I would think Im going crazy, but my girlfriend moved exactly 3 weeks ago, and has been on the same exact treatment (minus the verm.). She too in the past two days has all of a sudden been getting the same enflamed, swollen, random mequito type bytes around her body (arms, stomach, butt) that are super itchy only for the first few hours. What is this? Could it be a reaction to the perm that we are both getting several states away from eachother? PLease Help. I am at my witts end being constantly itchy for months! Thank you!

    • James Hubbard, MD, MPH

      It’s time you went to a doctor if you haven’t. The bumps could be a reaction to one of the medicines, a bacterial infection, or scabies to name a few. The treatment would depend on the cause. If you’ve already seen a doctor, call back and give them your symptoms but they’ll probably want to see you to look at the bumps.

  • Gerald Michael

    I’m confused. In late January I came down with maniacal itching that started on one shoulder blade for two weeks. It then spread to the legs mostly at night. Itching was down to the bone, the worst imaginable on earth, then itching on the mid-torso that caused some bruising. Never a rash or “bites.” In early April, still no rash but maniacal itching, I went to dermatologist who said it was drug reaction from long-term BP meds. I stopped meds. Went back three weeks later after flat rash finally developed on inner thighs with horrible itchy scrotal nodules. She remained solid in her medical reaction diagnosis. I next went to my replacement General Practitioner who looked at rashes and agreed with dermatologist. Last week I went to my actual General Prac. after her vacation return, and she said scabies, although rash is much diminished but obviously present, all scrotal nodules long gone, and I have NOT had any problem itching for more than a month, and I am now on new BP meds after a two-monh wait/gap. She told me to go back to dermatologist, but that’s a month-long appointment wait. I started using sulphur creams and soaps just in case. In any event, never “classic” scabies signs (no trails, patterns, intra-fingers, personal contacts), but some symptoms (scrotum, bumps) matched exactly. Now, I have sort of a permanent thigh rash, some eczema-like foot and leg marks that look like scabies that itch only when I pick at them, but really, no itch anywhere else whatsoever. Blood tests ruled out thyroid, lymphoma, kidney, liver, etc., and no fungus, I am confused but no longer itch and feel good.

  • Sunil

    I contacted a doctor online and he is doubting that I have scabies. I need to travel tomorrow and can’t postpone my trip. The fear of making so many people infected is making me uncomfortable. What shall I do? Please advise.

    • James Hubbard, MD, MPH

      Have a doctor check you today. Either your personal doctor or an urgent care clinic.

      • Sunil

        I would surely go tomorrow. But at a glance, do these bumps and rashes look like scabies?

        • James Hubbard, MD, MPH

          Sorry, I couldn’t say. I don’t diagnose by photos. Could it be scabies? Yes. Is it? I have no idea.

          • Sunil

            So, if someone with scabies have to travel urgently, what should he do? Is there any way to travel, without infecting others? Please guide. I promise this would be my last question.

          • James Hubbard, MD, MPH

            If someone has scabies they should be treated before traveling. Otherwise you run the risk of infecting others. Not those you come in common contact with, but those whose sit in a cloth chair you’ve been sitting in for a long time, or from sleeping in the bed.

          • Sunil

            Thanks a lot Dr. Hubbard for your help. My dermat is not in town and its a small town in India where there is only one board certified dermat. I think I should stay at home, but my other three family members are going for the trip. I hope they dont have the infection and dont infect others.

  • Sunil

    Hi Dr.
    Is it possible to get scabies from a pharmacy while buying medicine (other than scabies) from there? I am so scared of scabies that I never buy drugs from my nearby pharmacies. Any advice will be appreciated.

    • James Hubbard, MD, MPH

      Scabies doesn’t spread by casual contact.


    Hi Dr Hubbard…I am desperate for advise and guidance and pray that God delivers my answer through you….I have been suffering for the last 3 months dealing with FIGHTING scabies for my 3y old and I…I have seen 3 different Doctors who all have said no more scabies…we have treated with numerous timesof permerthrin in addition to 3 rounds of Ivermectin for me. His dad we believe brought it home after a brief incarceration stint and has since been cleared and no longer have symptoms…I on the other hand hs been suffering and STRESSED out of my mind…my face now have raised red bumps showing up in two’s on my cheeks, under my chin, and I continue to suffer with random pin pricks or lil stings in my face near the corner of my mouth where several bumps are…I have never been one to suffer from severe acne but the last Dr I saw outside of my network said she wants to treats my acne…no one is explaining why I am still experiencing what I am feeling…they have concluded to it’s in my head…and that I have had a build up of stress that just seemed to cause me to have a nervous break down…I hav argued with my fmaily & friends b/c they believe that the Doctors cant be WRONG but no one is explaining WHY I am stilling feeling these symptoms…not to mention I am seeing random bruises on my legs & arms and a couple of raised bumps on my neck near my shoulder blade..and I have very small paper cuts on my knuckles and my son has had the same paper cut like scratches that have shown up in his face on his hands, near his elbows…I am at my wits end…we went and stayed at my moms for a week and now i am worried b/c I noticed a few raised red bumps on the front of her hand and she is OLD school…and she has really bad exzema that flair when she uses cleaning chemicals which she says is the reason for the bumps..a few of the bumps on her hand have scabbed…very small though…so now I am just standing on GOD’s word and seeking the answers to to give me comfort and assurance so I can MOVE on with my life…HELP..ANYONE

  • Michelle

    So, what is the reason scabies don’t go on the face?

    • James Hubbard, MD, MPH

      Excellent question. And I don’t know the answer. The mite just doesn’t like that area for some reason. It’s not an absolute especially in babies, but it’s really rare in other age groups.

  • xoltol

    question, i’ve had scabies before (I worked in dorms and in public school settings) but this itch has presented itself differently than it has in the past. appearing on the scalp (no its not lice, i’ve checked), face, eye lids, back, not so much fingers and toes, with no real marks. i did find these “scratches” on my back and tried the marker test, wasn’t sure if this is what you meant by the darkening along the line. i’m sorry its not a better picture, i’m kinda solo. i have no other signs that indicate as such, but i’m so paranoid about it its always the first thing i go to when i get itchy. i also suffer from eczema and have noticed a lot of contact dermatitis, and allergies in the last few year that I never had issues with in the past. I just lost my job so i’m without insurance and don’t have the $80 for the perimethrin cream unless that’s what it is. i’m about to treat my house and i just wanted to check before i called the dr to treat my skin. my boyfriend thinks i’m paranoid, and maybe so… any help is appreciated

    • James Hubbard, MD, MPH

      I can’t diagnose specifically without a direct exam. Though, in general, scabies affects the top of the hands, the arms, and around the waist more than anywhere else. It also causes intense itching. Again, in general, scabies does not tend to affect the back only.

      • xoltol

        awesome, i realize you are unable to “diagnose” without a direct exam, and i do not take this advice as a diagnosis; but i figured you could offer the best professional opinion for me. I appreciate your getting back with me so quickly.