On this page
Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Scabies is recognised from the itch pattern, the burrow sites and itchy household contacts by photo and video, with a mite-killing cream prescribed for everyone in the household; crusted scabies, babies and infected scratches with fever need in-person care.
- What it is: infestation of the skin by the scabies mite, which burrows between the fingers, at the wrists, elbows, waist, genitals and nipples; about 200 million people worldwide have scabies at any time, in every social setting.
- Timelines: the itch starts 3 to 6 weeks after a first infestation but within 1 to 4 days of a repeat one; a correctly applied cream kills the mites within 24 hours, and the itch can continue for 2 to 4 weeks afterwards without meaning failure.
- Whole household: everyone who shares the home or bed, and recent close contacts, is treated at the same time whether itchy or not, with the cream repeated after 7 days to catch newly hatched mites.
- Fabrics: mites separated from human skin die within about 3 days, so hot-washing or tumble-drying recently used bedding, towels and clothes, or bagging unwashable items for 72 hours, is enough; fumigation is pointless.
- Emergency: scabies itself is never an emergency; call 112 only if infected scratches come with high fever, confusion, rapid breathing or a racing heart.
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.
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 a licensed doctor on Mobi Doctor 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.
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 the 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 |
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 scabies is treated online, and when you need in-person care
Treated 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.
In-person care: 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 the 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, and if treatment is right for you, the prescription can be used at a pharmacy near you. You can see a doctor over video, usually within 15 minutes. 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 CET. You can see a doctor over video, usually within 15 minutes. 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: your plan, and a prescription to use at a pharmacy near you where medication is clinically right for you. If your doctor decides you need to be seen in person, you get a full refund.
No sign-up needed
Not sure it’s scabies? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Not sure this is the right page? Look up any symptom in the full symptom checker, or book and describe it to a doctor.
Frequently asked questions about scabies
What is scabies?
Scabies is an infestation of the skin by a microscopic mite, Sarcoptes scabiei, whose females burrow into the top layer of skin to lay eggs. The body's allergic reaction to the mites, their eggs and droppings causes the intense itch and rash. Scabies is spread by prolonged skin contact, affects about 200 million people worldwide at any time, and is cured by a mite-killing cream used correctly by everyone exposed.
How do you catch scabies?
Scabies is caught by prolonged skin-to-skin contact with someone who has it, typically 10 minutes or more: sharing a bed, sex, holding hands, caring for a child or an older relative. It spreads readily in families, care homes, student halls and nurseries. Brief contact such as a handshake rarely passes scabies on, and animals do not carry the human mite.
What does scabies look like?
Scabies causes an intense itch, worst at night and after a hot bath, with tiny red spots and scratch marks between the fingers, on the wrists, elbows, armpits, waist, buttocks, nipples and genitals, usually sparing the face and scalp in adults. Fine, grey, wavy lines a few millimetres long, the burrows, are the giveaway; itchy lumps on the genitals or in the armpits can last weeks.
Can an online doctor prescribe treatment for scabies in Europe?
Yes, after a consultation. A prescription is never issued without one: the doctor assesses your photos, itch pattern and contacts by video first, then prescribes a mite-killing cream for you and every household member when the diagnosis fits, with the prescription sent to a pharmacy near you. Crusted scabies and scabies in a small baby are directed to in-person care.
Do family members without any itch really need scabies treatment?
Yes, and at the same time as you. Scabies can incubate for three to six weeks before the itch starts, so a contact who feels fine can still carry mites and quietly re-infest everyone once your treatment is done. Everyone who shares the home, a bed or close care is treated together, with a repeat application after seven days, which is the single biggest difference between cure and months of recurrence.
How soon after scabies 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-seven repeat application catches newly hatched mites, and fabrics used in the three days before treatment are hot-washed or bagged, so scabies is not passed back.
I finished scabies treatment two weeks ago and still itch. Has it failed?
Probably not: the itch of scabies is an allergic reaction to the mites and their debris, and it routinely continues for two to four weeks after successful treatment, occasionally six. Failure looks different: new burrows appearing, itch clearly worsening after four to six weeks, or an untreated contact in the household. A mild steroid cream and an antihistamine settle the after-itch meanwhile.
Can you catch scabies from bedding, towels or a sofa?
It is possible but much less common than skin-to-skin spread, because scabies 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 fabrics used in the three days before treatment, seal unwashable items in a bag for 72 hours, and vacuum the sofa and mattress once. No sprays or fumigation are needed.
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 scabies and does not cure it; only the mite-killing cream, applied correctly by everyone exposed, does. The embarrassment many people feel delays treatment and spreads it further.
How do I apply scabies cream correctly?
Apply the scabies cream to cool, dry skin over the whole body from the jawline down, including between fingers and toes, under nails, the soles, the genitals and skin folds, ideally with help for your back; leave it on for the time stated, usually 8 to 12 hours, then wash off. Reapply to hands after washing them during that time, treat everyone at the same time, and repeat after seven days.
How long does scabies last?
Untreated, scabies continues indefinitely and spreads to others, because the mites keep breeding. With correct treatment the mites are dead within a day, the rash fades over two to four weeks, and the itch settles in the same period, sometimes a little longer. Scabies that is still producing new spots or burrows six weeks after treatment means a missed contact or a misapplied cream, not a resistant mite.
How can I prevent scabies coming back?
Prevent scabies returning by treating every household member and recent close contact at the same time, repeating the cream after seven days, hot-washing or bagging fabrics, telling sexual partners and anyone who shared a bed in the previous six weeks, and checking care homes or nurseries where an outbreak may be running. There is no vaccine and no preventive cream; the whole-household plan is the prevention.
Is scabies different in pregnancy, in babies, in older people or with a weakened immune system?
In pregnancy, scabies is treated with the standard mite-killing cream, which is considered safe, and the household plan is unchanged. Babies and young children are treated in person, with the cream applied to the scalp and face as well. Older people in care homes and anyone with a weakened immune system can develop crusted scabies, with thick scaly patches and little itch, which is highly contagious and needs in-person treatment.
- 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.
- Scabies, NHS, National Health Service (UK), reviewed November 2023.
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.
Related conditions
Speak to a doctor about scabies over video, usually within 15 minutes
Licensed doctors · open daily 7am–11pm CET · exact price before payment
See available times →