Kids Health Info

Scabies - symptoms and treatment

  • Scabies is caused by a small, eight legged mite called Sarcoptes scabiei.  Scabies is spread by close physical contact and is common in school-aged children. If left untreated, scabies will usually spread to all members of a child's family. The mites and their eggs may live on clothes or bed linen for one to two days.

    Signs and symptoms

    It is often difficult to diagnose scabies because the symptoms vary and the signs can be very subtle. Commonly, the symptoms include:

    • Bullae: raised, clear fluid-filled spots or lesions that are bigger than one centimetre in diameter.
    • Papules: solid, raised areas of skin with distinct borders less than one centimetre in diameter.
    • Pustules: raised, fluid-filled spots that appear yellow.
    • Vesicles: raised spots filled with clear fluid.

    Lesions or spots are areas of skin disease and are generally small.

    A number of mites burrow into the skin, particularly between the fingers, around the wrists and elbows, the armpits, nipples and penis. In infants and young children, there are often vesicles and pustules on the palms and soles and sometimes on the scalp. It is the allergic reaction to these mites that causes the rash and symptoms.

    Sometimes the only symptom is an itch without a rash. The itch is usually worse at night and after a hot bath or shower. Bathe your child in warm water as hot water may make the itching worse.

    Your doctor may make a diagnosis by scraping a burrow and looking at that skin under a microscope. Scabies may be easier to diagnose by rubbing a black marking pen over a suspected burrow and then wiping it off with an alcohol swab. This leaves a burrow outlined with the ink from the pen.

    Treatment

    • The child and all close contacts should be treated at the same time.
    • Five per cent permethrin cream is recommended and should be applied to all body surfaces from the neck down, paying particular attention to hands, under the nails and the genitals, and left on overnight. This treatment can be bought from a pharmacy.
    • Treatment should be repeated a second time one week later.
    • In young babies, six per cent precipitated sulphur is preferred.
    • In central and northern Australia, in children less than 1 year of age and older people, scabies above the neck is common. This means treatment should also be applied to the face and hair, but carefully avoiding the eyes, nose and mouth.
    • Bedding and clothing should be washed in hot water and, if possible, dried in a machine on a hot setting.
    • Items that cannot be washed and dried this way can be put in air-tight containers or bags for 36 hours or in the freezer for a couple of days.
    • Infected children can return to school when two treatments - one each week for two weeks - have been completed.

    Do not apply the initial treatment more than twice. The itching caused by scabies may take up to three weeks to go away after treatment. In fact, the treatment itself may cause some irritation. Your doctor can prescribe a corticosteroid cream for the itch if needed.

    Sometimes nodules (raised, solid lesions) caused by scabies can last for months, even with the corticosteroid cream. If this happens, see your doctor for further treatment.

    Key points to remember

    • Scabies is spread by close physical contact and is common in school-aged children.
    • If left untreated, it will usually spread to all members of a child's family.
    • The mites and their eggs may live on clothes or bed linen for one to two days.
    • Five per cent permethrin cream is recommended and should be applied to all body surfaces from the neck down.
    • In extremely young infants, six per cent precipitated sulphur is preferred.
    • Treatment should be repeated a second time, one week later.

    For more information

     

    Developed by the RCH Dept of Dermatology and Emergency Department. First published in April 2008. Updated November 2010.

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Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.