It starts with one person scratching at night. A few weeks later the children are scratching too, then the grandparents. Creams from the chemist help for a day or two, and the itch is back. When an itch is worse at night, sits between the fingers and around the waist, and is shared by several people in one home, a dermatologist thinks of one thing first: scabies (often just called khujli).
Scabies is common, completely curable, and nothing to be embarrassed about. The trick is treating it the right way, once, and treating everyone together.
What scabies is
Scabies is caused by a tiny mite, too small to see clearly, that burrows into the outermost layer of the skin, lives there and lays eggs. The intense itch isn’t the bite itself: it is the body’s allergic reaction to the mites, their eggs and their waste. That is why:
- after a first infestation, itching usually starts two to six weeks later;
- if you’ve had scabies before, it can start within one to four days;
- the itch can continue for a few weeks after the mites are dead.
How it spreads
- Mostly by prolonged skin-to-skin contact: sharing a bed, caring for a child or an elderly relative, close physical contact.
- Less often through shared clothes, towels or bedding.
- It spreads easily in families, hostels, care homes and crowded settings, and a person can pass it on before they start itching.
- Away from human skin, the mites usually die within two to three days.
It has nothing to do with cleanliness. People who bathe twice a day get scabies too.
Signs of scabies
- Itching, worse at night, often enough to disturb sleep.
- Small red bumps, sometimes in a short line, and tiny wavy grey lines (burrows).
- Typical places: between the fingers, the wrists and elbows, the armpits, the waist and belt line, the buttocks, around the nipples, the genital area, and under rings or watch straps.
- Usually not on the face or scalp in adults.
- Other people at home itching in the same places.
- Scratching can lead to sores, crusts and skin infection.
In babies and young children, the rash can involve the palms, soles, scalp and face, often with small pus-filled bumps on the soles, and the child may be very irritable and feed or sleep poorly.
Crusted scabies is a severe form with thick, grey, crumbly crusts, seen in older people, people with weak immunity and those in care homes. It is very contagious and needs prompt medical treatment.
Why scabies keeps coming back
- Not everyone was treated. One untreated family member, often one without symptoms, passes it back.
- The cream wasn’t used correctly: only on itchy spots instead of all the skin from the neck down, washed off too soon, or the second application skipped.
- Steroid creams hid it. “Three-in-one” and steroid combination creams calm the itch for a while, but let mites multiply and change how the rash looks, so it’s missed for months. Our post on steroid creams on the face explains why these creams cause so many problems in India.
- Clothes and bedding weren’t washed at the time of treatment.
- It isn’t scabies. Other itchy rashes, such as eczema, hives, insect bites or fungal infection, can look similar and need different treatment.
How scabies is treated
Scabies needs a prescription treatment, chosen by a doctor for each person’s age and situation. The usual options are:
- Permethrin 5% cream: applied to all the skin from the neck down, including between the fingers and toes, under the nails, the genital area and the soles, usually at night, left on for 8 to 14 hours, then washed off. A second application about a week later is often advised. In infants and young children the scalp and face may need treating too, as advised by the doctor.
- Ivermectin tablets: for some adults and older children, often in two doses one to two weeks apart, or together with cream for widespread or crusted scabies. Not usually used in pregnancy or for small children.
- Something for the itch: an antihistamine, a soothing moisturiser and, if your doctor advises, a short course of a mild cream for the inflammation once the anti-scabies treatment is under way; antibiotics if sores are infected.
Babies, pregnant or breastfeeding women and people with other illnesses need a doctor to choose the treatment.
Treating the home at the same time
On the same day as the treatment:
- Treat everyone in the household and close contacts, with or without itching.
- Wash clothes, towels and bedding used in the last three days in hot water and dry them well in the sun or a hot dryer.
- Seal things that can’t be washed (pillows, soft toys, shoes) in a plastic bag for at least three days.
- Vacuum or sweep sofas, mattresses and carpets.
- No need for pesticides or fumigation of the home.
Children and adults can usually return to school or work the day after the first full treatment.
After treatment: what to expect
- The itch may get slightly worse for a few days, then ease.
- It can take two to four weeks for the itch and bumps to settle completely, because the allergic reaction takes time to fade. Small dark marks may stay longer on brown skin.
- See the doctor again if new bumps or burrows appear, the itch isn’t easing after two to four weeks, or the skin looks infected.
When to see a dermatologist
- Itching that is worse at night and lasts more than a week or two;
- more than one person at home itching;
- itch that keeps coming back after treatment;
- a baby or elderly person with an itchy rash, or thick crusts;
- sores, pus or fever, which suggest infection.
At OrnaSkin Madhur Nagar, the dermatologist examines the skin, often with a dermatoscope, to confirm scabies or find the other cause of the itch, then writes a clear plan for every member of the family. See our dermatology consultation page, our guide to psoriasis and eczema for other itchy rashes, and our post on hives if the itch comes with raised, moving welts.
The short version
Night-time itch between the fingers, at the wrists, waist and armpits, especially when several people at home are scratching, suggests scabies. It’s common, not about hygiene, and curable. Use the prescribed treatment exactly, on all skin from the neck down, treat everyone at home on the same day, wash bedding and clothes, and skip steroid “itch creams” on your own. Expect the itch to fade over a few weeks, and see the doctor again if it doesn’t.
