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.

Ivermectin
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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  • Brainbuster

    Most popular, well-reviewed remedy for scabies on earthclinic is borax + hydrogen in the bath.
    Fill tub with water, pour in a cup or two of borax (you can usually find it in the laundry section of the store) and a cup or two of hydrogen peroxide.

  • hate rashes

    Would cortisone cream on its own make the rash go away and start up in another area? For instance has rash under right breast ..put cortisone on it and it cleared up after 3 days of this. a week later it appeared on left breast..did same thing and it is clearing up but have a couple patchy spots on my stomach now. It itches and is really red and swollen when the rash is there.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If you’re talking about a general rash and not scabies, cortisone cream can definitely help many times, and it would not make a rash start up somewhere else. Perhaps it’s a yeast infection. One thing you could try is yeast infection cream and make sure your breasts are not directly touching the skin of your trunk by putting a piece of cotton cloth between the two. But if it continues, or is spreading, you should see your doctor.

  • joe

    i’ve been diligent with cleaning, used the permethrin (two doses, 6 days apart) -this was about 2 months ago- and still experienced the biting itch. went with natural scabies killer oil (neem and tea tree) and enzyme cleaner; nothing. still seeing new rash (which i’m beginning to debate whether it is scabies or something else???) … should i just simply try another permethrin round? i hate the idea of insecticide all over my body though with possible carcinogens … any suggestions? i’m waiting for a sulfur soap to arrive to give that a try. pretty sure i got this rash/biting from a camping trip and the symptoms arrived about 3 weeks later. any ideas before approaching doc again for iver or something else??

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Joe, you should have a doctor check and make sure that’s what it is.

  • Liz

    Hi, can you have a burrow with no itching initially?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Liz, I guess it’s possible. But it’s not the usual case.

      • Liz

        Thank you so much! You really provide a very valuable service. There is a lot of misinformation out there and it’s hard to know what to believe. It’s certainly enough to drive a sane person crazy with worry.

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          You’re welcome, Liz. Thanks for the encouragement.

  • Danielle May

    My son was diagnosed with Scabies, and prescribed the cream to put on overnight. We did that On Friday night it is now Sunday and it seems the rash is spreading..Does it spread BEFORE it gets better? Also the itching he said seems less.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      It shouldn’t spread much. If it’s still spreading tomorrow, check with or call your doctor.

      • Danielle May

        Thank you…

  • Juniper

    Can you get scabies without human contact? I was just diagnosed with Scabies, but I am not close with anyone at the moment (single/work long hours). I did stay in a hotel room about three weeks ago, but I didn’t think that would be possible. Any ideas?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      You can get scabies from infected bed linen. See treatment.

  • Due_Process

    I was out cleaning up my garden area a week ago. Later that evening I had a mosquito flying around me in my living room. The next morning I woke with what I believed to be many mosquito bites and a dead mosquito in the web of my middle finger and the one next to my pinky finger. After closer examination, it appeared there were several bites in that web and the one between my index & middle finger. There were also and handful of bites on my wrist and on top of a couple of fingers & thumb. In short, it looked like I got attacked by a swarm of mosquitos.

    As the days passed, the “bites” grew in size and started to become a series of red bumps – they itched like crazy. A few days later, what looks like a blister formed in the fold of my wrist where my hand meets my arm. I did a search on the net for “rashes in the web of fingers” and scabies came up.

    I spoke with a pharmacist who suggested hydrocortisone 1% cream to relieve the itch but the “rash” got worse. Tonight I saw a completely different pharmacist who believes it’s poison ivy.

    Any thoughts? In this case, I’d LOVE it to be poison ivy!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Sounds like it’s time to see a doctor. I do have posts on poison ivy. Just type in “poison ivy” in the custom search rectangle in right upper column of this page.

      • Due_Process

        One more question Doctor… do scabies and poison ivy rashes look similar? Is there any distinctive difference between the two?

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          I think if you’ll read all the posts you’ll see they do. The poison ivy rash occurs where the poison ivy touched you. Rarely the rash can cover your body that’s very uncommon. The rash can be bumps, blisters, or lines of where the vine touched. The scabies rash is usually multiple, tiny red spots that continue to spread. Yes, it can be in the webs of the fingers, then over the backs of the hands, then onto the wrists, etc. Another place they like is around the waist.

      • Due_Process

        Thank you Doc!

  • L G

    One more thing, he never was diagnosed with scabies. But, he was in close contact with my mother who suffered for months on end from a nursing home visit. Apparently her scabies had turned into a crusted type. So, he must have contacted it but refused to treat himself. Please advise.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Did he have the scabies rash? If not, it’s unlikely you would. Other than the suggestions I posted, such as vacuuming, I’d agree with your doctor. More treatment without symptoms is just likely to irritate your skin. And, yes, many people will itch and worry if they’ve come in contact with scabies even if they don’t ever get it.

  • L G

    Hi Dr. Hubbard. My brother came to visit just during day hours and I took him to his motel room at night. He came over a period of 3 days for approximately 12-16 hours per day. He sat on our furniture, car, and one office chair. I took precautions, sprayed and vacuumed, did all the bedding in hot water/hot dryer 3 days in a row, and vacuumed throughout home normally. My husband and I used Nix creme rinse on our bodies (!% permethrin) and left on for 8 hours. I then used tea tree soap. We also have two year old that we only used the tea tree soap on. It has been 9 days since his first day here and I am really in a panic. I have been itching but wonder if it is because of the products used on my body. A bite or something appears here and there. I actually broke out the second day his visited with a couple of random small bites. What shall I do at this point? I went to a doctor on Saturday and she said to wait it out because too soon to tell. Please advise. Desperate to make sure we don’t have these pests!

  • Marianne

    Might want to check for allergies to Permethrin before you douse yourself in it. I wound up with a double whammy; scabies and hives. At least I knew that when my son came home with head lice.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Good point, Marianne. Thanks.