What Does Scabies Look Like? Plus Images and Treatments

Scabies mites are tiny parasites (Sarcoptes scabiei) that cause a terrible itch. If you look at these mites under a microscope, you’ll see what appear to be little bugs — but mites are different from lice or fleas. They can burrow beneath the skin, causing an allergy-like response from your immune system. This results in a rash that’s much itchier and more irritated than you might expect.

How do you know if you have scabies? How do you keep from spreading them? And how do you make them go away? Keep reading to find out more.

What are the signs and symptoms of scabies?

Scabies symptoms are caused from the mite burrowing in the skin. If you’ve never had scabies before, it can take up to 6 weeks for symptoms to start. If you’ve had them before, symptoms usually start within 1 or 2 days. 

Here are some signs and symptoms to look for:

• Intense itching, which is often worse at night

• A rash, that looks like tiny pink or brown bumps on the skin, depending on the underlying skin tone

• Sometimes the skin bumps can be larger, in more severe cases

• Burrows, which are short, squiggly pink or gray lines on the surface of the skin

• Scaly patches

• Fingernail scratch marks 

• Sores that develop from frequent scratching, and may get infected 

• Thick crusty spots (in severe scabies, more on this below)

Scabies can affect any part of your skin. But, these are the areas most likely to be itchy and have a rash:

• Hands, wrists, and between the fingers

• Elbow and armpit

• Penis and buttocks

• Nipples

• Head and face (in infants and young children)

What does scabies look like?

Scabies can look different depending on a person’s skin tone, what part of the body it affects, and how severe it is. Here are some pictures of the different types of scabies to help you identify it. 

Classic scabies

Classic scabies is the most common type. It causes a mild rash that would be easy to miss were it not for the intense itching. In adults, it usually shows up between the fingers and on the wrists. Other common locations include the penis, buttocks, and breasts. Young children can get it anywhere. 

Classic scabies can look like tiny bumps on the fingers and in between the fingers.

In fairer skin, scabies on the hands looks like tiny pink, crusty bumps on the fingers, palm, and between the fingers.

Nodular scabies

Nodular scabies causes one or more larger skin lumps (nodules). It most commonly affects the genitals, breasts, armpits, and buttocks. Nodules can continue after treatment and can be hard to treat. 

Nodular scabies causes larger violet-brown skin lumps.

Scabies can form larger individual violet skin bumps.

Crusted scabies

Crusted scabies usually happens in people who have a weakened immune system or in poor health. This is a severe infestation that can involve millions of mites (compared to the 10 to 15 mites in classic scabies). It can cause large pink, white, or gray crusty patches anywhere on the body. This type of scabies is extremely contagious. 

Crusted scabies causes many pink bumps and large, red, and crusty patches. (Photo courtesy of Maria Robinson, MD, MBA)

Crusted scabies can affect the hands as well as other parts of the body. (Photo courtesy of Maria Robinson, MD, MBA)

What causes scabies?

Scabies mites are tiny and burrow in the top layer of the skin. There they lay their eggs and multiply. This causes the itchy rash. Scabies mites move from person to person during skin contact. The longer you are in skin-to-skin contact with a person who has scabies, the more likely you are to catch them. Scabies mites can also live on surfaces, such as clothing, towels, and furniture for up to 3 days.

In sexually active people, scabies mites are often passed from person to person during sex. This can happen no matter where on the body scabies symptoms are visible.  

How is scabies diagnosed?

Under a microscope, a healthcare professional can sometimes see scabies mites, eggs, or feces scraped from the surface of the skin. This is the most certain way to diagnose scabies. Most cases of scabies don't involve very many mites, though, so finding them on a skin scraping can be a challenge. 

When a person has a classic itchy scabies rash — and especially if burrows are visible on the surface of the skin — that’s usually enough to make a diagnosis and start treatment. 

People who have symptoms that seem like scabies, or who have been exposed to others who could have scabies, might sometimes get treatment even without a definite diagnosis. That’s because the treatment for scabies is safe, the risks of them spreading are high, and diagnosing scabies can be very difficult. 

New tests for scabies, including a PCR test, have been developed for research use. At this point they aren’t widely available in medical offices.

What is the treatment for scabies?

Classic scabies is usually treated with a topical lotion, cream, or ointment. The medication is applied all over the skin, from the face to the toes, and left in place for the specified period of time before being washed away. Although the medication kills both mites and their eggs, it’s often necessary to use the same medication again a week later to end a scabies infestation completely. Options for treating scabies include:

• Permethrin (Elimite)

• Crotamiton (Crotan or Eurax)

• Sulfur ointment

Classic scabies can also be treated with oral ivermectin (Stromectol). Since this medication is taken by mouth, it can be easier to use than a topical lotion. That said, it doesn’t work any better than permethrin for treating scabies, and it comes with a higher risk of side effects, like a drop in blood pressure, rash, or seizures.

Crusted scabies requires both topical and oral treatments at the same time, often at higher doses than for classic scabies. Nodular scabies might require treatment with steroids or other medications to decrease the immune response. Referral to a specialist is often necessary for either of these latter two conditions.

How can I prevent scabies from spreading?

Scabies is highly contagious until you treat the condition, so it’s best to get treatment as soon as possible. If someone you know or live with has scabies, you’ll want to get treatment quickly, too. Delaying treatment isn’t just uncomfortable — it also increases the chances that scabies will spread to others. So, follow these tips:

• Clean thoroughly. Scabies mites can live on surfaces for about 3 days. Clothing, bedding, and towels that could carry scabies should be washed in hot water and dried on high heat to kill the mites, or they can be dry-cleaned. Other items should be sealed inside large plastic bags and left alone for at least 3 days. Furniture and carpets should be vacuumed thoroughly. 

• Treat the whole family. Because scabies spread easily between people who live together, it makes sense to treat all the members of a household — and their close contacts, including sexual contacts — at the same time. The goal is to keep scabies from jumping back and forth between treated and untreated individuals. 

• Warn close contacts. If you’ve never had scabies before, it might take 4 to 8 weeks for symptoms to show up after you catch scabies. (If you’ve had scabies before, your symptoms could show up faster.) Even if you aren’t showing symptoms, you can still pass scabies to other people during this time. That means when you start treatment for scabies, you’ll want to think back to everyone you’ve had close contact with in the past month. These people should all be checked and treated for scabies. 

Do you need to quarantine if you have scabies? 

People you live with, or have had close contact with, should be treated at the same time as you, so it’s not necessary to quarantine apart from each other. There’s no need to quarantine after you’ve completed your treatment for scabies.

Why trust our experts?

Written by:

Kerry R. McGee, MD, FAAP

Kerry McGee, MD, FAAP, has over a decade of experience caring for babies, children, and teenagers as a primary care pediatrician. She has a special interest in adolescent health, particularly in adolescent mental health.

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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Images used with permission from VisualDx (www.visualdx.com).