Scabies — treatment and preventing reinfestation
Reviewed by the My London Pharmacy clinical team, Zeenah Araim, Pharmacist Independent Prescriber
·29 July 2026
·8 min read
Quick answer
Scabies is an itchy skin condition caused by tiny mites that burrow into the skin. It spreads through close skin contact and causes an intense itch, often worse at night, with a rash. Treatment is usually a Permethrin cream applied over the whole body, and treating close contacts at the same time prevents reinfestation.
What scabies is
Scabies is a common and very itchy skin condition caused by tiny mites that burrow into the top layer of the skin. The mites are too small to see easily, but their presence and the body's reaction to them cause the characteristic itching and rash. Scabies is not a sign of poor hygiene; anyone can get it, and it is common in places where people are in close contact, such as households, care settings and university halls.
The condition spreads mainly through prolonged, direct skin-to-skin contact, which is why it often passes between family members and partners. Less commonly it can spread through shared bedding or clothing. Because the mites can be passed on before symptoms appear, scabies can spread within a household before anyone realises it is present. The mites themselves are only about a third of a millimetre long, so what you notice is not the mites but the itch and rash caused by the body reacting to them and to the tiny burrows they make. A brief handshake or hug is unlikely to pass scabies on; it usually takes more prolonged skin contact, which is why it tends to travel between people who live together or are in a close relationship.
Recognising the signs
The hallmark of scabies is intense itching, which is often worse at night or after a warm bath. The itch is caused by an allergic reaction to the mites and can be severe. Alongside the itch, you may notice:
- A rash of small red spots or bumps, sometimes resembling tiny blisters
- Fine, thread-like burrow lines, often between the fingers or on the wrists
- Itching that spreads across the body, even where there is no obvious rash
Common sites include the hands, especially between the fingers, the wrists, elbows, armpits, waist, and the genital area. In adults the scalp and face are usually spared, though they can be affected in young children and older people. Scratching can break the skin and occasionally lead to a secondary bacterial infection, which is one reason it helps to treat the itch as well as the mites.
Why symptoms can be delayed
One of the tricky things about scabies is that symptoms often do not appear for several weeks after you first catch it. In someone who has never had scabies before, it can take up to six weeks for the itch to develop, because it takes time for the body to become sensitised to the mites. If you have had scabies before, symptoms may appear much more quickly.
This delay matters because you can pass scabies on during that symptom-free period. It also explains why treating everyone in a household at the same time is so important, even those who do not yet feel itchy, as they may already be affected without knowing it.
Treating scabies correctly
Scabies is treated with a medicated cream or lotion applied to the skin. Permethrin 5% Cream (generic Lyclear) is the usual first-choice treatment in the UK. How you apply it is just as important as the treatment itself. It should be applied to the whole body from the neck down, including easily missed areas such as between the fingers and toes, under the nails, the soles of the feet, and the genital area. In young children and older people the scalp and face may also need treating.
The cream is left on for the recommended time, usually a number of hours or overnight, then washed off. If you wash your hands during the treatment period, reapply the cream to them. A second application about a week later is normally advised to catch any mites that hatch after the first treatment. Following the instructions carefully, and not washing the treated areas during the treatment period, gives the best chance of clearing the infestation.
Managing the itch after treatment
An important point that surprises many people is that the itch does not stop the moment treatment finishes. Because the itching is an allergic reaction, it can continue for two to four weeks after successful treatment, even though the mites are dead. This lingering itch does not mean the treatment has failed.
Soothing measures such as moisturisers, and treatments to calm itching, can help during this period. However, if new burrows appear, or the itch is still worsening after four weeks, it is worth seeking advice, as this may suggest reinfestation or that a repeat treatment is needed. A clinician can help you tell the difference.
A more severe form to be aware of
Most scabies is what is called classical scabies, where relatively few mites are present but the itch is intense. There is a much less common but more serious form, known as crusted or Norwegian scabies, in which very large numbers of mites are present and the skin becomes thickened and crusted. It tends to occur in people whose immune system is weakened or who are unable to scratch, and it may be less itchy than classical scabies despite being far more contagious.
Crusted scabies spreads very easily, including through brief contact and contaminated surfaces, and can cause outbreaks in settings such as care homes. It usually needs more intensive treatment, sometimes combining a cream with oral medication, under close medical guidance. Recognising that this form exists is useful, because someone with a thickened, crusted, scaly rash, particularly if they are unwell or have reduced immunity, needs prompt specialist assessment rather than standard self-treatment.
Preventing reinfestation
Preventing scabies from coming back depends on treating everyone who could be affected and decontaminating items that could harbour mites. All members of the household and any recent close contacts, including sexual partners, should be treated at the same time, even if they have no symptoms, to break the cycle of reinfestation.
On the day of treatment, wash bedding, towels and clothing used in the previous few days at a hot temperature, at least 50 degrees, and dry them on a hot setting. Items that cannot be washed can be sealed in a plastic bag for around 72 hours, as the mites cannot survive long away from the skin. Coordinating treatment so everyone is treated together, and cleaning items on the same day, is the key to stopping scabies returning.
Common mistakes that lead to treatment failure
When scabies does not clear, it is often not because the treatment failed but because of how it was used. Frequent slip-ups include applying the cream only to the visibly affected areas rather than the whole body, missing places such as under the nails, between the toes or the genital area, washing the hands and not reapplying, and not doing the second application a week later. Skipping the treatment of household members and close contacts is another common reason the mites return, as untreated contacts simply pass them back.
It also helps to remember that continued itching is expected for some weeks and is not, on its own, a sign that treatment has not worked. Reapplying antiscabies treatment repeatedly because of ongoing itch is unnecessary and can irritate the skin. If you are unsure whether treatment has succeeded, a clinician can help you judge whether the itch is simply settling or whether genuine reinfestation has occurred, and advise on the right next step.
When to seek advice
It is worth seeking advice if you think you have scabies, so that treatment can be confirmed and everyone who needs treating is included. Seek further advice if the itch is still getting worse more than four weeks after treatment, if new burrows appear, or if the skin becomes infected with increasing redness, pain or crusting.
A clinical consultation allows scabies to be assessed and suitable treatment recommended, along with clear guidance on how to apply it and how to treat contacts and the home. All treatment is subject to suitability, and a clinician can advise on the safest approach for your circumstances.
Scabies can feel distressing, and there is sometimes embarrassment attached to it, but it is a common condition that has nothing to do with cleanliness and is entirely treatable. The most important things to get right are applying the treatment thoroughly and to the whole body as directed, treating everyone who needs it at the same time, and decontaminating bedding and clothing on the day of treatment. When these steps are followed together, scabies is usually cleared effectively, and the lingering itch settles over the following weeks. Being open with close contacts, so they can be treated too, is the single most reliable way to prevent it passing back and forth, and a clinician can support you through the process so nothing important is missed.
Frequently asked questions
How is scabies treated?
Scabies is usually treated with a permethrin cream applied over the whole body from the neck down, left on for the recommended time and then washed off. A second application about a week later is normally advised.
Why am I still itching after treatment?
The itch is an allergic reaction to the mites and can continue for two to four weeks after successful treatment. This does not mean the treatment has failed, but persistent worsening beyond four weeks is worth reviewing.
Do my family need treating even without symptoms?
Yes, all household members and close contacts should be treated at the same time, even without symptoms, because they may be affected before the itch appears. Treating everyone together prevents reinfestation.
Why does scabies treatment sometimes fail?
Most often because the cream was not applied to the whole body, an area was missed, the second application was skipped, or close contacts were not treated. Applying it thoroughly and treating everyone together avoids this.
How does scabies spread?
It spreads mainly through prolonged, direct skin-to-skin contact, and less commonly through shared bedding or clothing. It can be passed on before symptoms appear.
What should I do with bedding and clothes?
Wash recently used bedding, towels and clothing at a hot temperature on the day of treatment, and dry them on a hot setting. Items that cannot be washed can be sealed in a bag for about 72 hours.