Intensely itchy, especially at night, and treatment has to cover everyone in the house at once.
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Scabies is caused by a tiny mite that burrows into the top layer of skin. It causes intense itching, characteristically worse at night, and it is passed on by prolonged skin-to-skin contact.
It has nothing whatsoever to do with hygiene. It spreads through households, care homes, university halls and relationships, and it is currently common in the UK.
Two things determine whether treatment works, and both are routinely got wrong.
1. Everyone in the household must be treated at the same time — including anyone with no symptoms at all. The itch is an allergic reaction that takes four to six weeks to develop after a first infestation. So people who are infested and infectious frequently feel completely fine. Treating only the itchy person guarantees reinfestation, and this is the single commonest reason scabies goes on for months.
2. The itch continues for two to four weeks after successful treatment. This is post-scabetic itch — an immune reaction to dead mites, not treatment failure. People re-treat repeatedly because of it, which causes an irritant dermatitis that itches in its own right, and the cycle becomes self-sustaining.
Thick, warty, scaly crusts, often on hands, feet and elbows — sometimes with very little itch. It occurs in people who are immunosuppressed, elderly or frail, and it carries thousands of mites rather than a handful. It is extraordinarily infectious, it is a common source of institutional outbreaks, and it needs specialist treatment.
Sarcoptes scabiei. The female burrows into the skin and lays eggs. In ordinary scabies there are usually only ten to fifteen mites on the whole body — the widespread rash and itch are an allergic reaction, not mites everywhere.
First infestation: the itch takes four to six weeks to start. During that time you are infested and infectious with no symptoms at all.
Reinfestation: the itch starts within a day or two, because the immune system already recognises it.
This is precisely why everybody in a household must be treated simultaneously, whether or not they itch.
Households, care homes and nursing homes, university halls, prisons, and among sexual partners. Outbreaks in care settings are common, and often begin with one undiagnosed case of crusted scabies.
Not a sign of poor hygiene or a dirty home. Anyone in close contact with an infested person can get it, and washing more does not prevent or treat it.
Scabies is diagnosed from the pattern — the itch, its timing, the distribution, and other people affected — and that suits a remote consultation well. Photographs of the finger webs and wrists help.
Intense night-time itch, a rash in the classic sites, and another itchy person in the household is enough to treat on. Waiting for visible burrows is not necessary and delays treatment.
Scabies in a care home resident or in a residential setting is a public health matter, not just an individual one — the whole setting needs assessment, or the outbreak simply continues.
All household members and close contacts, including sexual partners — on the same day, whether or not they itch. This is not a precaution; it is the treatment. Contacts who feel fine are frequently infested and will reinfest you within weeks.
The application is where treatment succeeds or fails:
Malathion is an alternative where permethrin is unsuitable.
Expect it to continue for two to four weeks. This is not failure:
Do not keep re-treating. Repeated permethrin causes an irritant dermatitis that itches, which people then treat with more permethrin. That loop is common and entirely avoidable.
Ivermectin — for crusted scabies, institutional outbreaks, treatment failure despite correct application, or where whole-body cream application is impractical. Usually two doses a week apart, often alongside topical treatment.
Scratching breaks the skin, and impetigo on top is common. Antibiotics where the picture fits — with spreading redness and fever needing in-person assessment.
Scabies is not an emergency. Seek prompt medical attention for:
Arrange prompt assessment for:
Book an appointment for:
Mites survive only about 24 to 36 hours away from skin, so this is simpler than people fear:
Awkward, and necessary. Anyone you have had prolonged skin contact with in the past two months needs treating — household, partners, anyone you care for. Since the itch takes weeks to appear on a first infestation, they may feel entirely well and still be infested.
Worth saying to them, and to yourself: this says nothing about anyone's cleanliness. It is a mite passed by ordinary close contact, and it is currently common.
Do not manage this alone. The whole setting needs coordinated treatment on the same day, with input from the local health protection team — otherwise the outbreak simply rotates through residents and staff indefinitely.
Do not judge treatment by whether the itch has stopped. It will not, for two to four weeks. Judge it by whether new spots and burrows are appearing. If they are not, the treatment worked.
Permethrin 5% cream is available over the counter and is the first-line treatment. Your NHS GP treats scabies free, and for anything beyond a straightforward case that is the right route.
The thing that determines success costs nothing and is where most treatment fails: everyone in the household must be treated at the same time, whether or not they itch, along with any sexual contacts. Treating one person is why scabies comes back — the untreated household member reinfects them within weeks.
The second most common failure is application. The cream goes on the whole body from the neck down, including between fingers and toes, under nails, the genitals and the soles — not just where it itches. It is left on for 8 to 12 hours, and repeated after seven days, which is the step most often skipped.
The itch continues for two to four weeks after successful treatment. That is an immune reaction to dead mites, not failure, and people frequently re-treat unnecessarily — which causes irritant dermatitis and more itch.
Where a consultation is worth paying for is speed and certainty, and — more usefully — a proper plan covering the household, since that is what actually breaks the cycle.
Crusted scabies, or scabies in someone immunosuppressed or in a care setting, needs specialist involvement rather than remote treatment.
NICE Clinical Knowledge Summary, Scabies, is the principal reference. It recommends permethrin 5% cream as first-line with malathion as an alternative, applied to the whole body and repeated after seven days.
CKS is explicit that all household members and close or sexual contacts should be treated simultaneously, regardless of symptoms — the basis for the point above.
CKS advises that post-scabetic itch may persist for two to four weeks after successful treatment and should not be interpreted as failure or trigger repeat treatment.
CKS covers application detail — whole body from the neck down in adults, including the head and neck in infants, older people and the immunosuppressed — and advises washing bedding and clothing at 50°C or above.
UK Health Security Agency guidance covers management of outbreaks in care homes and other institutional settings, and crusted (Norwegian) scabies, which is highly contagious and requires specialist management with oral ivermectin.
Because that is expected. The itch continues for two to four weeks after successful treatment — it is an immune reaction to dead mites, not evidence that treatment failed. Judge success by whether new spots and burrows are appearing, not by the itch. Repeatedly re-treating causes an irritant dermatitis that itches in its own right, and a great many people get stuck in exactly that loop.
Yes — and this is the single most important thing on the page. On a first infestation the itch takes four to six weeks to appear, so contacts who feel completely fine are frequently infested and infectious. Treat every household member and close contact on the same day. Treating only the itchy person is why scabies drags on for months.
Not at all. Scabies spreads through prolonged skin-to-skin contact — sharing a bed, caring for a child or an older relative, sex — and it is currently common in the UK. It has nothing to do with cleanliness, and washing more neither prevents nor treats it.
No. Mites survive only about 24 to 36 hours off the body. Wash bedding, towels and recently worn clothes at 60°C on treatment day, and seal anything unwashable in a bag for 72 hours. Vacuum once. That is genuinely all — no fumigation, no professional cleaning, and nobody should be paying for either.
The whole body from the neck down — not just the itchy parts. Include between every finger and toe, under the nails, the soles, the navel, the genitals and every skin fold. Reapply to your hands after any hand washing. Leave it on eight to twelve hours, then wash off, and repeat the whole thing seven days later. In babies, older adults and anyone immunosuppressed, include the scalp and face too.
Yes, from the day after the first treatment. There is no need for prolonged exclusion. Avoid prolonged skin-to-skin contact, including sex, until everyone in the household has completed the first application.
Then it is almost always one of two things: an untreated contact reinfesting you, or an application problem — missing the hands, not going under the nails, washing hands afterwards without reapplying, or skipping the second dose. Both are fixable. Oral ivermectin is also an option where topical treatment has genuinely failed.
It can be passed on sexually, since sex involves prolonged skin contact — but it is not exclusively sexually transmitted, and it spreads just as readily between family members and in care settings. If it was acquired sexually, partners need treating, and full STI screening is worth considering alongside.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
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If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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