Scabies

Scabies is a contagious skin condition caused by a microscopic mite (Sarcoptes scabiei) that burrows into the skin. It is a common global disease that can affect anyone — men, women, children, and infants — regardless of personal hygiene. In fact, good hygiene alone does not prevent infection, as the mites penetrate deep into the skin layers.

The most common form is classic scabies. In individuals with weakened immune systems — such as chronically ill patients, the elderly, or people living with HIV — a more severe and highly contagious form called crusted scabies may develop.

How is Scabies Transmitted?

Scabies spreads mainly through prolonged skin-to-skin contact, such as sleeping in the same bed, living together, or sexual contact. Brief contact (like a handshake or hug) usually does not result in transmission. Mites can survive up to 36 hours on fabrics like bedding or towels, so indirect transmission is possible.

Symptoms

Symptoms usually appear 2 to 6 weeks after initial infection (or within 2 days in the case of re-infection):

• Intense itching, especially at night or after a warm shower

• Red rash, small blisters, or visible burrows in the skin

• Common areas in adults: between fingers, wrists, elbows, armpits, waist, buttocks, nipples (in women), and genitalia (in men)

• In infants and children: face, scalp, neck, palms, and soles

Possible Complications

• Secondary bacterial infection (e.g., impetigo) due to scratching

• Worsening of pre-existing skin conditions such as eczema

• Crusted scabies — a severe form with millions of mites in the skin, often requiring special medical care or hospitalization

Diagnosis

Scabies is usually diagnosed based on clinical presentation — that is, the doctor evaluates the skin’s appearance, the pattern and location of the rash, and the presence of itching.

When an experienced doctor sees the combination of intense itching with the specific appearance and location of the rash, they can often diagnose scabies without further testing.

In less clear cases (for example, if eczema or a secondary infection is masking the rash), a skin scraping may be done for microscopic examination to look for mites, eggs, or fecal matter.

Treatment

The main treatment is the application of medicated creams:

• Permethrin 5% — requires a prescription

• Malathion — may be available over the counter

The cream should be applied over the entire body from the neck down, paying special attention to skin folds, between fingers and toes, and under the nails.

In young children, the elderly, or immunocompromised patients, the cream should also be applied to the face and scalp. It should remain on the skin for 8–12 hours (permethrin) or 24 hours (malathion). A second application is usually recommended after one week.

When Is Oral Treatment (Systemic Therapy) Required?

While most cases of classic scabies can be treated with topical creams or lotions, there are situations where oral medication is advised:

• Crusted scabies — a highly contagious and severe form with thousands or millions of mites. Common in immunocompromised individuals, such as the elderly or people with HIV or on chemotherapy.

• Failure of topical treatment — if symptoms persist despite proper use, or there is concern about reinfection.

• Widespread outbreaks in institutions — such as nursing homes or dormitories, where oral medication may help contain the spread.

The most commonly used oral medication is ivermectin, which is safe and effective but requires a prescription and must be adjusted for certain conditions (such as pregnancy or very young children).

In crusted scabies, oral treatment is usually combined with repeated topical therapy to ensure complete eradication.

Is It Safe to Treat Scabies Without Medical Supervision?

It is not recommended to treat scabies without seeing a doctor. Although some products are available without a prescription, a proper diagnosis is essential, as other skin conditions (eczema, allergic reactions, infections) can look similar. Using the wrong treatment may worsen the condition or delay proper care.

Household Instructions

• All household members and close contacts should be treated, even if asymptomatic

• Wash clothes, towels, and bedding in hot water (above 50°C)

• Seal non-washable items in a plastic bag for at least 72 hours

• No need to disinfect furniture or carpets

• Pets do not carry or transmit human scabies

When Should You See a Doctor?

• Unexplained itching or rash

• Symptoms persisting more than 6 weeks after treatment

• Signs of secondary infection (redness, pain, pus)

• Suspected crusted scabies

At our clinic in Tel Aviv, we offer professional diagnosis and treatment for scabies — including care for travelers and tourists in the city. If you suspect an infection, consult a doctor in Tel Aviv as soon as possible for accurate diagnosis and to prevent further transmission.