Scabies: intense night itching and how to treat the whole household

Scabies is caused by a microscopic human itch mite that burrows into the top layer of the skin to live and lay eggs. The itch is an allergic reaction to the mite and what it leaves in the skin. If you itch but no one else at home is scratching, see also itchy skin.

It spreads mainly through direct, prolonged skin-to-skin contact with someone who has it: sharing a bed, hugging and carrying children, or sex. Spread through clothing, towels or bedding is less common, and pets do not spread human scabies. That is why whole families often get it, and why outbreaks happen in nursing homes, child care centers and dorms. Scabies is not the same as head lice, which live in the hair on the head.

The first time, symptoms take 4 to 8 weeks to appear, and you can spread it during that time.

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Scabies is handled in a doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. A doctor’s note after your visit is included at no extra charge. See all prices.

The most common signs are:

• Intense itching, worse at night
• A pimple-like rash
• Thin lines on the skin, like pencil marks (the mite’s burrows)
• Itching between the fingers, on the wrists, elbows, armpits, waist or genital area
• In babies and young children, a rash on the head, face, neck, palms and soles as well

Scabies is treated with prescription creams, lotions or pills that kill the mite (scabicides); it does not go away on its own. According to the CDC, over-the-counter products do not treat scabies, and prescription permethrin 5% cream is used from 2 months of age. Insecticide sprays don’t work either. The cream goes on the whole body from the neck down, on clean skin, and is usually repeated after a week; in young children it also goes on the head and neck. Follow the instructions exactly.

The CDC recommends treating all household members and close contacts, sexual partners included, at the same time as the person with scabies, even without symptoms, so the mite doesn’t pass back and forth. The doctor decides with you who is treated and, if appropriate, prescribes for each person. Avoid skin-to-skin contact until treatment is done, and tell anyone you had close contact with in the past two months.

The itch can last 2 weeks or more after treatment, even when the mites are dead. If it continues after 2 to 4 weeks or new spots appear, the doctor decides whether to repeat treatment in a follow-up visit.

• Wash clothes, towels and bedding used in the 3 days before treatment starts in hot water and dry them on high heat (CDC).
• Seal anything you can’t wash in a plastic bag for several days to a week.
• Vacuum carpets and upholstered furniture.
• For the itch, a cool bath or calamine lotion helps.

A severe form, crusted (Norwegian) scabies, causes thick crusts and huge numbers of mites. It mostly affects older adults and people with a weakened immune system, and it spreads very easily. If crusted scabies is possible, or if scratching has infected the skin (pus, yellow crusts, a red and warm area), you need to be seen in person. See impetigo and cellulitis.

For your safety: go to the emergency room or call 911 if you have any of the warning signs on this page.