Skin

Scabies

Also called: scabies mites, itch mite infestation, crusted scabies, Norwegian scabies

Scabies is an itchy skin rash caused by tiny mites that burrow into the skin. It spreads by close skin contact, often within families. Anti-mite cream or tablets cure it, but everyone in the home must be treated at the same time.

General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor

Overview

Scabies is a common skin problem caused by tiny mites (very small insect-like creatures) called Sarcoptes scabiei. The female mite digs short tunnels, called burrows, in the top layer of the skin and lays eggs there. The body reacts to the mites and their droppings, and this causes strong itching and a rash. Most people with ordinary scabies carry only 10 to 15 mites.

Scabies spreads through close skin-to-skin contact, such as living in the same house, caring for someone or sexual contact. A quick handshake is unlikely to pass it on. It is not caused by being dirty, and you cannot catch it from pets. Itching usually starts 3 to 6 weeks after the first infestation, so people can spread it before they know they have it. In someone who has had scabies before, itching can start within a few days.

Scabies is found all over the world, but it is most common in hot countries and in crowded homes and places. The World Health Organization estimates that at least 200 million people have it at any one time, and many are children. Crusted scabies is a rare, severe form in people with weak immunity. It involves huge numbers of mites and is very easy to catch. Scabies is easy to treat with anti-mite cream or tablets, but the whole household needs treatment together to stop it coming back.

In Pakistan

A hospital study in Peshawar found scabies was strongly linked with crowded homes of six or more people, poor living conditions and low income, and almost all patients had been in contact with someone who had it. Treating the whole household at the same time is especially important in large joint families.

Symptoms

Strong itching, usually worse at night
A rash of small raised red spots or bumps; on brown or black skin the spots may be harder to see but can still be felt, and may leave darker marks
Short, thin, wavy lines in the skin (burrows) made by the mites
Rash between the fingers, on the wrists, elbows, armpits, waist, belly button, groin, bottom and feet
Itchy lumps (nodules) on the penis or scrotum, or around the breasts
In babies, young children and older people, a rash that can also affect the head, neck, palms and soles of the feet
Other people in the family or close contacts who are also itching
In crusted scabies: thick, dry, scaly or flaky crusts, often on the hands, feet, elbows and knees, sometimes with little or no itch

Causes and risk factors

Causes

The scabies mite (Sarcoptes scabiei), which burrows into the top layer of the skin and lays eggs
The body's allergic reaction to the mites, their eggs and droppings, which causes the itch and rash
Close skin-to-skin contact with someone who has scabies, including sharing a bed and sexual contact
Less often, sharing clothes, bedding or towels, which matters most with crusted scabies

What makes it more likely

Living in a crowded home or a large household
Living or working closely with others, such as in hostels, boarding schools, nurseries, nursing homes, hospitals or camps for displaced people
Being a child in a poor or crowded community
Having a family member or close contact with scabies
Having a new sexual partner who has scabies
A weak immune system, for example from HIV, which raises the risk of crusted scabies

Complications

Scratching breaks the skin and lets germs in. This can cause impetigo (infected skin sores), especially in hot climates. Skin infection can spread deeper, causing boils and abscesses (collections of pus), and rarely it can reach the blood and cause sepsis, which is life-threatening. Skin sores caused by streptococcal germs after scabies are linked with kidney inflammation (post-streptococcal glomerulonephritis) and possibly with rheumatic fever and rheumatic heart disease. In poor areas, kidney damage has been found in up to one in ten children with infected scabies, and it can last for years. Crusted scabies is very contagious, can cause outbreaks in hospitals and care homes, and can be life-threatening. Itching can also disturb sleep and make it hard to concentrate at school or work.

When to see a doctor

Signs of skin infection, such as weeping sores, pus, yellow crusts, boils or spreading redness: see a doctor soon, as you may need an antibiotic
Fever or feeling very unwell together with infected or spreading skin sores: get urgent medical help, as infection can spread into the blood
Thick, crusted or flaky rash on the hands, feet, elbows or knees, especially in someone with weak immunity: see a doctor urgently
A baby under 2 years old with an itchy rash, or a baby in a home where someone has scabies: see a doctor, as shop or pharmacy treatments are not suitable without advice
You also have eczema or another skin condition: see a doctor before treating
Still itching 2 to 4 weeks after finishing treatment, or new burrows appearing: see a doctor, as the treatment may have failed or you may have caught it again

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Diagnosis

Scabies is usually diagnosed by looking at the skin and hearing your story. The doctor asks about itching that is worse at night and whether family members or close contacts are also itching. They look for the typical rash in the usual places and for burrows, which are the best sign but can be hard to find. Other people in the home may have the rash before they start to itch.

In places where scabies is common, tests are usually not needed. If the diagnosis is unclear, the doctor may gently scrape a burrow and look for mites or eggs under a microscope. They may also use a dermatoscope (a hand-held magnifying light) or put ink on the skin to show up burrows. Scabies can look like other conditions such as eczema, psoriasis or impetigo, so a doctor should check rashes that do not fit or do not get better with treatment.

Treatment

See a doctor or pharmacist to confirm it is scabies. Tell them if you are pregnant, breastfeeding, or if the person with the rash is a baby or young child.
Treat everyone in the home, current sexual partners and other close contacts at the same time, even if they have no itch or rash. This stops the mites passing back and forth.
Use an anti-mite cream or lotion, usually permethrin, on the whole body as your doctor or pharmacist explains. In babies, young children, older people and people with weak immunity the face and scalp are usually treated too, avoiding the eyes. Treatment does not kill the eggs, so a second treatment is usually needed; your doctor or pharmacist will tell you when.
If creams are not suitable or the scabies is severe, your doctor may prescribe ivermectin tablets instead. It is not used in pregnancy or in small children. Your doctor decides the dose.
On the first day of treatment, wash clothes, bedding and towels used in the last few days in hot water and dry them with heat or in strong sunlight. Seal items that cannot be washed in a plastic bag for at least 3 days.
Expect the itch to last up to 2 to 4 weeks after the mites are dead. A doctor may suggest an antihistamine at night, a soothing cream or a mild steroid cream to ease it. See a doctor if the skin looks infected, as antiseptics or antibiotics may be needed.
Crusted scabies needs specialist care with both tablets and creams, repeated several times, and careful cleaning of the home to stop spread.

Medicines in Pakistan

Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Group	Role	Medicines
Anti-mite creams and lotions (topical scabicides)	First choice for most people. Permethrin cream is the main treatment and is used in pregnancy, breastfeeding and in babies over 2 months on medical advice. Benzyl benzoate is another option listed by WHO, but it is less effective and more irritating to the skin. Usually applied to the whole body, and a second treatment is usually needed; the doctor or pharmacist says when	Permethrin (78 brands), Benzyl benzoate (7 brands)
Oral anti-mite medicine	Tablets that work about as well as permethrin cream; useful for severe or widespread scabies, for outbreaks and, together with creams, for crusted scabies. WHO says it should not be used in pregnant women or in children weighing under 15 kg. Your doctor decides the dose and when to repeat it	Ivermectin (23 brands)
Antihistamines	A sedating antihistamine at night can ease itching, help sleep and reduce scratching; it does not kill the mites. In pregnancy, try to avoid them, especially in the first three months, and ask your doctor first; chlorpheniramine is the usual choice if one is needed	Chlorpheniramine (6 brands)
Mild topical corticosteroids	A mild steroid cream can calm itching that carries on after successful treatment, but only once the doctor is sure the mites have gone	Hydrocortisone (69 brands)

Also used (not yet in our price list): Malathion lotion (anti-mite lotion used when permethrin is not suitable), Sulphur ointment (anti-mite ointment; considered safe for very young babies), Crotamiton cream (eases itch after treatment; also an anti-mite cream, but treatment failure is common), Emollients (moisturisers) for dry, irritated skin after treatment, Antiseptics or antibiotics for infected skin sores, chosen by your doctor, Lindane lotion: older treatment that can harm the nervous system; CDC says it should not be used in pregnancy, in infants or children, or in crusted scabies

Self-care and prevention

Self-care

Use the treatment exactly as your doctor or pharmacist explains, and make sure everyone in the home is treated on the same day
If you wash your hands during the treatment time, put the cream back on your hands
Wash clothes, bedding and towels in hot water on the first day of treatment and dry them with heat or in strong sunlight
Put things that cannot be washed in a sealed plastic bag for at least 3 days
Do not share beds, clothes or towels, and avoid sex and close body contact until the full course is finished
Try not to scratch, as broken skin can become infected
Children aged 5 and over and adults can usually go back to school or work once treatment has started, but should avoid close contact for the first 24 hours

Prevention

Avoid close skin contact with anyone who has an itchy rash until they have been treated
When one person in the home has scabies, treat all household members at the same time
Tell sexual partners and close contacts so they can be treated too
Wash and heat-dry or sun-dry bedding and clothes of the infested person, and clean or sweep rooms after treatment, especially with crusted scabies
Get treated early, as mites usually die within 2 to 3 days away from human skin

Common questions

Why am I still itching after scabies treatment?

The itch is an allergic reaction to the dead mites and can last 2 to 4 weeks after the mites are gone. It may even feel worse for a week or two at first. See a doctor if you are still itching after 2 to 4 weeks or see new burrows, as you may need another treatment.

Does everyone in my family need treatment?

Yes. Everyone in the home, sexual partners and other close contacts should be treated at the same time, even if they have no rash or itch. People can carry mites for weeks before itching starts, and treating only one person lets scabies pass back again.

Is scabies caused by poor hygiene?

No. Anyone can get scabies, and it is not a sign of being dirty. It spreads through close skin contact, so it is more common in crowded homes and places where people live closely together. You cannot catch it from pets.

Can I use scabies treatment in pregnancy or on a baby?

Permethrin cream is the usual choice in pregnancy and breastfeeding, and ivermectin tablets are not used in pregnancy or in small children. Babies under 2 years should be seen by a doctor before any treatment. Always tell the doctor or pharmacist if you are pregnant, breastfeeding or treating a young child.

How long do scabies mites live on clothes and bedding?

Away from human skin, mites usually die within 2 to 3 days. That is why washing items in hot water, drying them with heat or sunlight, or sealing them in a bag for at least 3 days is enough. Spread through clothes and bedding is uncommon with ordinary scabies but matters more with crusted scabies.

Sources

World Health Organization (fact sheet). Scabies (2023).
Centers for Disease Control and Prevention (CDC). Clinical Care of Scabies | Parasites - Scabies | CDC (2023).
British Association for Sexual Health and HIV (BASHH) Clinical Effectiveness Group. 2016 UK National Guideline on the Management of Scabies (2016).
NHS. Scabies - NHS (n.d.).
Journal of Pakistan Association of Dermatologists. Risk factors and diagnostic criteria for scabies in a population of Khyber Pakhtunkhwa, Pakistan: Unmatched case-control study (2021).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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Impetigo Eczema (atopic dermatitis)Hives (urticaria)Fungal skin infection (ringworm, tinea)

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