Eczema vs. Scabies: How to Tell These Common Skin Conditions Apart (With Photos)

Believe it or not, there’s a common skin condition where bugs crawl underneath your skin: scabies. With this skin infection, small mites (Sarcoptes scabiei) burrow into your skin and multiply, causing an intensely itchy rash. And because people usually don’t know about it, it’s often mistaken for other common rashes, like eczema. But knowing how to tell the difference between eczema and scabies is important. 

Scabies is highly contagious through close contact. It often causes outbreaks in places where people are close together. In many cases, if one family member gets scabies, the rest of the family does, too. Schools, nursing homes, and other institutions are also common outbreak centers. 

So, spotting scabies early can make sure you get the right treatment right away — and stop it from spreading to other people in your household and close contacts. 

What do scabies and eczema rashes look like?

It can be hard to tell eczema and scabies rashes apart, but there are some clues that can help. 

Scabies

Scabies can develop on any part of the body, but common locations include the hands, wrists, armpits, belly button, and genitals. The face and scalp are usually only affected in infants and children. 

Scabies usually cause tiny clusters of skin bumps. In fair skin, these look pinky-red. In darker skin tones, the rash is brown or violet. Sometimes you can see tiny lines where the mite burrows in the skin. In severe scabies, the rash can look scaly or crusty. 

Here are some pictures of what scabies typically looks like in different skin types and tones, and body locations. 

Scabies causes tiny itchy bumps on the finger and in the web spaces of the hand.

The wrist is another common location for scabies, and the tiny bumps can form a line.

Scabies can cause larger violet and brown bumps (called nodules).

Scabies is common on the feet, and scratch marks are often visible.

Eczema

Like scabies, eczema can happen anywhere on the body. But it’s most common on the inside of the elbows, wrists and hands, behind the knees, and the neck. 

Eczema causes a skin rash that’s bumpy with scaly patches. The rash is pinky-red in fair skin, and violet or brown in darker skin tones.

Here are some pictures of what eczema typically looks like in different skin types and body locations. 

In darker skin tones, eczema causes dark brown scaly patches, as seen here behind the knees.

In fair skin, eczema causes red patches on the insides of the elbows.

Eczema on darker skin can cause violet brown patches.

Eczema is common on hands.

What are the symptoms of eczema vs. scabies?

Eczema and scabies can have similar symptoms, but there are some differences. 

Timeline of symptoms

The timing of the rash can also be a helpful clue. When did it start? How long has it been going on? 

If you don't usually get rashes, but you develop an itchy rash after staying in a crowded living space, it could be scabies. On the other hand, if you’ve had rashes that come and go in the same areas over the years, it’s more likely to be eczema.

But sometimes, things aren’t so clear-cut. That’s why it’s a good idea to see your primary care professional or dermatologist if you’ve had an itchy rash for more than 2 weeks that’s not getting better. A dermatologist can help test for scabies. They do this with a scabies prep, a quick test that involves taking a few scrapings of the skin. The skin scrapings then get examined under the microscope, to look for the scabies mite. 

How do you treat eczema vs. scabies?

Eczema and scabies have very different treatments. There’s no cure for eczema. In many cases eczema is chronic, so long-term treatment with creams (typically topical steroids like hydrocortisone or triamcinolone) may be necessary to help manage symptoms. 

On the other hand, there’s treatment for scabies that completely resolves it. Standard treatment involves both topical treatments (creams) and medications you take by mouth. These kill the mites and stop them from multiplying.  

• Permethrin is the most common cream for scabies. You must apply the cream to your entire body and leave it on the skin for 8 to 10 hours before rinsing it off. For the best results, sometimes you need two treatments, 1 week apart. 

• Ivermectin is an oral treatment that helps to kill the scabies mite. Healthcare professionals usually recommend it along with the cream for a comprehensive treatment plan. This is especially true if the infection is severe or widespread.

Sometimes it can be hard to tell if scabies has gone away. You may feel itchy for 6 weeks or more after scabies treatment. That’s because residue from the mites can linger in the skin despite treatment — meaning the itch persists, too. 

You can treat a persistent itch with skin moisturizers and antihistamines. But, if you’re itchy and you’re still developing new rashes, you could still have scabies. Your medical care team can check your skin and advise whether you need more treatment. 

Pictures of other rashes that can be mistaken for scabies

Scabies can look like other common skin rashes. Here are some pictures of other conditions that can be mistaken for scabies.

Contact dermatitis

Contact dermatitis is caused by an allergic reaction or an irritation to something that comes into contact with the skin. A common example is nickel. The rash is itchy, and it’s usually red, violet, or brown. Patches can look scaly or crusty. One key feature: It only develops on skin that comes into contact with the product. 

Contact dermatitis can develop from exposure to nickel in a buckle.

Allergic contact dermatitis can happen on the eyelids.

Heat rash

Heat rash is also called miliaria. It happens when sweat glands are blocked. It’s most likely to develop in covered skin, when it’s hot and humid. Like with contact dermatitis, the rash only develops in specific areas of skin. In this case, areas of skin that are covered up. The rash causes pink, red, brown, or violet skin bumps. Sometimes, these can be fluid-filled with clear liquid, or less commonly, pus. 

In darker skin tones, miliaria, or heat rash, causes many tiny light brown skin bumps.

In fair skin, heat rash causes pink-red bumps and patches.

Bug bites

Bug bites (like from mosquitoes or bed bugs) are itchy and can cause small red, violet, or brown skin bumps. Sometimes they can appear in clusters, too. And, they can also become crusty  with scratching. Unlike scabies, bug bites go away within a week without any treatment. 

In darker skin tones, bug bites cause individual purple-brown skin bumps.

In light skin, bug bites cause many small pink bumps.

Hives

Hives can develop as a reaction to an allergy, an infection, medication, or certain foods. They cause smooth, raised skin patches that feel warm and itchy. They’re typically red in fair skin and skin-colored or violet in darker skin tones. 

Hives cause red, raised patches in fair skin.

Hives in darker skin tones may not be as obvious.

What happens if you don’t treat scabies?

You shouldn’t ignore scabies or leave it untreated. The mite infestation will only continue to worsen. And this can lead to serious complications, like infection. 

Scabies is very contagious, so it's important for your close contacts and household members to get treatment, too. The scabies mite can survive on surfaces, clothing, and fabric for up to 3 days. So you’ll need to separate any clothing, sheets, or towels you may have come in contact with. 

If you have access to a laundry unit, experts recommend washing all fabric items in hot water and drying them in high heat. You can also place the items in an airtight container and leave them in an isolated place for at least 4 days. This allows the mites to die on their own so they can no longer infect you. Once you remove the items, you can wash them and then use them like usual. 

Why trust our experts?

Written by:

Alina Goldenberg, MD, MAS, FAAD

Alina Goldenberg, MD, MAS, FAAD, is a board-certified dermatologist in private practice in San Diego. She is also an assistant clinical professor in the Department of Internal Medicine at the University of California, Riverside School of Medicine.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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