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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Photo and video assessment, prescription when appropriate.
- First-line treatment is usually permethrin 5% cream applied to the whole body and repeated after 7 days, with everyone in the household treated on the same day.[1]
- Scabies spreads mainly through prolonged skin-to-skin contact and is not a sign of poor hygiene.
- Mites separated from human skin die within days, so hot-washing bedding or bagging unwashable fabrics for 72 hours is enough.
- The itch can continue for two to four weeks after successful treatment; that alone does not mean it failed.
See a doctor in person instead if you have thick, crusty, scaly patches with less itch than expected (possible crusted scabies, above all with a weakened immune system or in older care-home residents), if the person affected is a small baby, or if scratched areas are weeping, hot and spreading with fever. For the classic intensely itchy rash with itchy household members, online assessment usually works well.
Can an online doctor treat scabies?
Often, yes. Scabies has a story doctors recognise: itch that turns ferocious at night, a rash in the finger webs, wrists and waist, and other itchy people at home. Photos plus a video consultation can often provide enough information to diagnose it and treat the whole household. Crusted scabies and babies need in-person care, and prescribing rules vary by country.
Scabies is also a condition where embarrassment delays care, pointlessly. It is a mite, not a hygiene verdict, and it moves through families, flatshares and care settings regardless of how clean anyone is. A video consultation with Mobi Doctor, an online healthcare service with licensed doctors, deals with it privately and quickly, without a waiting room.
Listen: Scabies Treatment Online
The audio version of this topic from the Mobi Doctor podcast. Open the episode.
How an online consultation helps with scabies
- Pattern recognition from photos: the distribution does the diagnostic work: finger webs, wrist creases, waistline, armpits and genitals. The doctor reads that map plus the night-itch story.
- A whole-household plan in one sitting: scabies treatment fails when contacts are missed. You leave knowing exactly who needs treating, when, and how, all on the same day.
- Application coaching that prevents failure: most "treatment-resistant" scabies is under-applied cream. The doctor walks through the neck-down routine, the 8–12 hours, and the day-7 repeat.
- Honest expectations about the itch: you will probably still itch for weeks after the mites are dead. Knowing that in advance stops panic re-treating and steroid misuse.
📷 Take daylight close-ups of the itchiest areas with the camera in sharp focus: between the fingers, the sides of the wrists, and any bumps on the genitals or around the waist. Burrows are tiny (fine, greyish, wavy lines a few millimetres long), so use your camera's macro or zoom and steady your hand. Wider shots of both hands and the trunk help show the spread. Our guide to photographing a skin problem for an online doctor covers the technique.
What the doctor checks in an online scabies consultation
The diagnosis rests on distribution, timing and contacts, so the consultation is structured around exactly that. The doctor will typically assess:
- Where it itches: finger webs, wrists, elbows, armpits, waist, buttocks and genitals are classic; in adults the head is usually spared, while in babies and the very elderly the scalp, face, palms and soles join in.[3]
- When it itches: itch that peaks at night and after hot showers is a strong scabies signature.
- Burrows and bumps: fine wavy lines in the finger webs and wrists on your close-ups, and firm, very itchy nodules on the genitals or around the waist, which are highly suggestive.
- Itchy contacts: anyone else in the household or a recent partner scratching too is one of the strongest diagnostic clues there is.
- The timeline: in a first infestation the itch starts 3–6 weeks after catching the mite; after previous scabies it can restart within days, which often explains confusing stories.[2]
- Your skin tone: on darker skin the bumps can look skin-coloured, grey or darker rather than red, and scarring or pigment change may dominate; the doctor reads the pattern, not just the colour.
- Risk of crusted scabies: immunosuppression, older age, frailty or care-home living, where thick scaly crusts carry huge numbers of mites and need urgent in-person care.[3]
- Infection signs: weeping, golden crusting or spreading hot redness in scratched areas, which change the plan.
How do you get scabies, and what does it look like?
Scabies is an infestation with the human itch mite, which burrows into the top layer of skin and lays eggs. It spreads mainly through prolonged skin-to-skin contact: sharing a bed, holding hands, sexual contact, caring for someone. Brief handshakes rarely pass it on, and it is common worldwide in all social settings; the World Health Organization estimates hundreds of millions of cases globally each year.[2]
The rash and the itch
The visible rash is a mix of tiny red or skin-coloured bumps, scratch marks and, when you can find them, burrows: fine, greyish, slightly raised wavy lines a few millimetres long, most often in the finger webs and wrist creases. Firm itchy nodules on the genitals or buttocks are common and can persist after cure. The itch itself is an allergic reaction to the mites and their eggs, which explains two odd facts: it starts weeks after infestation the first time, and it continues for weeks after the mites are dead.[1]
Is it scabies or something else?
Widespread night-time itch is not always scabies. Eczema tends to live in the elbow and knee creases and lacks burrows; hives come and go within hours, leaving no marks behind; insect bites cluster where skin was exposed. The combination that points firmly at scabies is web-space bumps plus night itch plus itchy household members, and that combination is exactly what photos and a video conversation establish.
Whole-household treatment: why everyone is treated on the same day
This is the message that decides whether treatment works. Everyone in the household, plus recent close skin contacts and sexual partners, should be treated on the same day as you, even if they have no symptoms at all.[1] The reason is the incubation gap: a contact infested last week can carry mites for weeks before itching starts, and an untreated carrier quietly re-infests everyone who has just been cured. Treating one person at a time turns scabies into a months-long game of ping-pong.
On the same treatment day, deal with fabrics: machine-wash bedding, towels and worn clothes from the previous few days at 60°C or hotter, tumble-dry hot, or seal what cannot be washed in a closed bag for at least 72 hours, because mites separated from human skin die within days.[2] Mattresses and sofas need nothing more than a vacuum; house-wide fumigation is unnecessary and does not help. In shared settings such as care homes and student accommodation, coordinated treatment is essential, and the doctor helps you plan who counts as a contact.
How do I apply permethrin cream correctly?
Apply permethrin 5% cream to cool, dry skin over the whole body from the jawline down, leave it on for 8–12 hours (overnight works well), wash it off, and repeat the entire process 7 days later. Everyone being treated does this on the same day. Missed patches are the main reason treatment fails.[1]
- Cover everything below the jaw: between fingers and toes, under nails (trim them and brush cream underneath), wrists, armpits, genitals, buttocks and the soles of the feet.
- Include the scalp, face and ears when advised: standard in babies, older people and anyone with crusted patches or previous failure; your doctor confirms this for each person.[1]
- Reapply after washing: if you wash your hands, or any area, during the 8–12 hours, put cream straight back on that area.
- Repeat on day 7: the second application catches mites that hatch from eggs after the first, and skipping it is a classic cause of relapse.
- Change into clean clothes and bedding after each application, with the wash-or-bag routine above.
Which scabies treatment might the doctor recommend?
Treatment follows the presentation and who is affected. This is the framework our doctors use, aligned with the cited guidance:[1][3]
Swipe sideways to compare →
| Presentation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| Classic itchy rash in finger webs and wrists, itchy household contacts | Permethrin 5% cream for the whole household on the same day, repeated after 7 days | Usually yes | Diagnosis unclear, or two correctly applied courses have failed |
| Itch persisting 2–4 weeks after correct treatment, no new burrows | Reassurance, emollients and itch control while the allergy settles | Usually yes | Itch worsening after 6 weeks, new burrows or newly itchy contacts, which suggest re-infestation |
| Persistent itchy genital or buttock nodules after cure | Review and, case by case, a topical anti-inflammatory plan | Usually yes | Nodules that keep growing or look atypical are examined in person |
| Thick crusted, scaly patches, often with surprisingly little itch, or scabies in someone immunosuppressed or frail | Urgent in-person and dermatology care, typically oral ivermectin plus topical treatment and contact tracing | No: assessment and urgent referral only | Always: crusted scabies carries enormous mite numbers and spreads easily[3] |
| Scratched areas weeping, hot and spreading, or fever | Same-day assessment for bacterial infection alongside mite treatment | Often, case-dependent | Rapidly spreading redness or feeling very unwell: in-person care the same day |
Availability of individual medicines and who may prescribe them vary by country; your doctor confirms what applies where you are.
Not sure which row is your itch? A doctor can tell you in one consultation.
See available times →Treatment options for scabies
What you can do yourself
Nothing from the bathroom cabinet kills scabies mites reliably, so self-care is about limiting spread and easing itch while proper treatment does its work: the hot-wash-or-bag routine for fabrics, keeping nails short to limit scratch damage, cool showers and emollients for the itch, and warning your contacts honestly so they can be treated with you. In some countries permethrin is sold without prescription; even then, a consultation earns its keep by confirming the diagnosis, planning contact treatment and coaching the application, because a perfectly applied cream for the wrong condition helps nobody.
Prescription treatment
A prescription is never issued without a consultation. After assessment, the usual first choice is permethrin 5% cream for every household member and close contact on the same day, repeated after 7 days; benzyl benzoate or malathion lotion are alternatives in some countries.[1][4] Oral ivermectin is used for crusted scabies, outbreaks and treatment failures, usually through in-person or specialist pathways, and its availability differs across Europe.[3] For the after-itch, the doctor may suggest emollients, an antihistamine at night or a short course of a mild steroid cream once the mites are dead. Antibiotics enter only when scratched skin shows real signs of bacterial infection, such as spreading redness, weeping or golden crusts; they do nothing to the mite itself.
Why am I still itching after scabies treatment?
Expect it. The itch of scabies is an allergic reaction to the mites and their debris, and it commonly continues for 2–4 weeks after successful treatment, occasionally up to six, while your skin clears the remains.[1][5] Continuing to itch in week two does not mean the treatment failed, and repeating mite-killing creams week after week irritates skin into itching more, which convinces people they are still infested. It is a loop worth knowing about in advance.
The signs that genuinely suggest failure or re-infestation are different: brand-new burrows, itch that is getting worse rather than slowly better after 4–6 weeks, or a household member who was never treated starting to scratch. That is a review consultation, not a shame spiral: the commonest causes are missed skin areas, a skipped day-7 repeat, or an untreated contact, all fixable.
Scabies in special situations
In pregnancy and breastfeeding, permethrin is generally considered the preferred treatment, with practical adjustments the doctor explains; tell the doctor, and treatment is planned around it.[1] Babies under two months are treated in person, not online. Children can normally return to school or nursery once the first whole-body application is complete, which takes the pressure off families. In care homes, hostels and student flats, scabies behaves like the institutional problem it is: tell the management honestly, because coordinated same-day treatment of residents, staff and visitors is what actually ends outbreaks. And for travellers and expats, who often pick scabies up from shared accommodation weeks before the itch starts, an online consultation means diagnosis and a pharmacy prescription wherever in Europe you happen to be when the itching begins.
When we treat scabies online, and when we refer you
We treat online: classic scabies with a recognisable distribution and story; household and close-contact treatment planning on the same day; post-treatment itch reviews and after-nodules; and suspected re-infestation where the cause (a missed contact, a skipped repeat) can be found and fixed.
We refer or redirect you: suspected crusted scabies, urgently, along with scabies in anyone significantly immunosuppressed, frail or very elderly; babies under two months; diagnoses that stay uncertain after photo review, where in-person skin scrapings settle it; spreading bacterial infection with fever the same day; and institutional outbreaks that need coordination with local public-health teams. Scabies is one of many itchy skin conditions our doctors assess online, and saying clearly which cases need hands-on care is part of the job.
When to get in-person care
Scabies itself is rarely dangerous, but get same-day in-person care for thick crusted patches in anyone frail or immunosuppressed, for a baby under two months, or for scratched skin that is weeping, hot and spreading with fever. If a skin infection comes with high fever, confusion, rapid breathing or a fast heartbeat, call 112 immediately.
Treating scabies at home: why home remedies fail
This is one condition where the internet’s home remedies genuinely do not work. Tea tree oil, vinegar, bleach baths and essential oils do not reliably kill scabies mites or their eggs, and every week spent trying them is a week the infestation spreads across your household.
What home care cannot do: clear the mites. Scabies needs a prescription insecticide cream or lotion, applied properly to the whole body and repeated, with everyone in the household treated on the same day and bedding and clothing hot-washed. What home care can do is the laundry and the patience: itching normally continues for two to four weeks after successful treatment, which is the immune system settling, not treatment failure.
You do not have to leave home for that step either: a video consultation is at-home care with a licensed doctor in it, usually within about 15 minutes, and if treatment is right for you the prescription follows to a pharmacy near you. Book a video consultation: no subscription, exact price before payment.
Is scabies contagious?
Very, through prolonged skin contact and, less often, shared bedding and clothing, which is why it moves through households and couples rather than passing acquaintances.
How long are you infectious? Until treatment is properly done; standard advice treats everyone in the household on the same day so the mites have nowhere to circle back from.
The itch that stays is not contagion: itching for two to four weeks after successful treatment is the immune system settling, not treatment failure and not ongoing infectiousness, though a new burrow-type rash appearing weeks later deserves a re-check.
How Mobi Doctor works
- Book a time that suits you: open daily 7am–11pm. Most patients speak to a doctor within about 15 minutes of their booked time. no subscription, exact price up front.
- Upload your skin photos, then speak to a licensed doctor: a private video call: you describe what you feel, the doctor asks what matters, and you agree the right plan together.
- Leave with your plan: everything agreed before you hang up: any prescription reaches a pharmacy near you in most EU countries, or a full refund.
No sign-up needed
Tick what you feel to see every condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Not sure this is the right page? Find your symptom in the symptom navigator, or book and describe it to a doctor.
Frequently asked questions about scabies
Can an online doctor prescribe permethrin for scabies in Europe?
Yes, an online doctor can prescribe permethrin for scabies after a consultation. A prescription is never issued without one: the doctor assesses your photos, itch pattern and contacts by video first, then prescribes when the diagnosis fits. Prescriptions can be sent to a pharmacy near you in most EU countries, and rules on prescribing for household contacts vary by country; your doctor confirms what applies to you.
How much does a scabies consultation cost?
The exact price of a video consultation is shown before payment, and there is no subscription. If the doctor can’t treat you online, you get a full refund and clear directions to the right care.
Do family members without any itch really need treatment?
Yes, family members without any itch still need treatment, and on the same day as you. Scabies can incubate for 3–6 weeks before the itch starts, so a contact who feels fine can still carry mites and quietly re-infest everyone who has just been treated. Same-day treatment of the whole household and recent close contacts is what makes the cure stick.
How soon after treatment am I no longer contagious?
After the first correctly applied whole-body treatment, you are generally no longer considered infectious, and children can usually return to school or nursery the next day. Finish the plan anyway: the day-7 repeat application catches newly hatched mites, and fabrics from the previous few days need the hot-wash-or-bag routine.
I finished treatment two weeks ago and still itch. Has it failed?
Probably not: the itch is an allergic reaction to the mites and their debris, and it routinely continues for 2–4 weeks after successful treatment, occasionally six. Failure looks different: new burrows appearing, itch clearly worsening after 4–6 weeks, or an untreated contact starting to scratch. Those are reasons for a review, not automatic re-treatment.
Can you catch scabies from bedding, towels or a sofa?
It is possible but much less common than skin-to-skin spread, because mites separated from a human host die within about three days. That is why the advice is practical rather than drastic: hot-wash or tumble-dry recently used fabrics, seal unwashable items in a bag for at least 72 hours, vacuum, and stop there. Fumigating your home is unnecessary.
Is scabies a sign of poor hygiene?
No: scabies is a mite that spreads through prolonged skin contact, and it affects hundreds of millions of people worldwide in every social setting, from family homes to hospitals. Washing more does not prevent it and does not cure it; the only things that do are proper mite treatment and treating contacts at the same time.
How quickly can a doctor look at my rash?
Appointments are available daily from 7am to 11pm, often within about 15 minutes. One consultation is usually enough to assess the rash from your photos, confirm whether it fits scabies, and set up treatment for you and your household in a single plan.
- Scabies: Clinical Knowledge Summary, NICE Clinical Knowledge Summaries, revised 2024.
- Scabies: fact sheet, WHO, World Health Organization, 2023.
- Scabies, DermNet New Zealand Trust, reviewed 2024.
- Ivermectin and permethrin for treating scabies, Cochrane Database of Systematic Reviews, 2018.
- Scabies: symptoms, causes, diagnosis and treatments, HSE, Health Service Executive (Ireland), reviewed 2024.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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