Scabies

Key points

• Scabies is a contagious skin condition caused by an immune reaction to the mite Sarcoptes scabiei.
• The typical clinical presentation of infestation is intense itching associated with burrows, nodules and redness.
• Crusted scabies, also known as Norwegian scabies is a more severe form of scabies with a hyper infestation of lots of scabies mites.
• Outbreaks are most common in winter and tend to occur in populations in close, prolonged contact.

Symptoms

• Intense itching, especially at night.
• A raised rash or spots.
• The spots may look red but they may be more difficult to see on dark skin, you should be able to feel them.

See the NHS website (opens in new window) to see images and visual examples of scabies.

Transmission

• Scabies mites are not able to jump or fly.
• Transmission usually occurs through direct and prolonged periods of skin to skin contact (approximately 10 or more minutes), although it can be spread indirectly through the sharing of towels and bedding.
• Crusted scabies is highly contagious and can occur even after brief skin to skin contact, such as a handshake.

Incubation period

• Can be up to 8 weeks following exposure.

Treatment

• Recommended treatment is permethrin (5%) cream (Lyclear).
• The cream is usually applied at night and needs to stay on for 24 hours.
• Follow manufacturer’s instructions.
• 2 applications of treatment are required 7 days apart.
• Any contacts should be treated at the same time as the index case.

IPC precautions

• Standard precautions required, although for close contact work long sleeved gowns or sleeve protectors can be used.
• Isolation for scabies is not usually required after the first course of treatment, however those with crusted scabies are highly contagious and must be isolated until treatment has been completed in full.
• Treat linen as contaminated (red alginate bag).
• Patient clothing worn in the period prior to completion of the first 24-hour treatment to be laundered as infectious.
• Cleaning for scabies: routine cleaning regime will be sufficient.
• Cleaning for crusted scabies: twice daily environmental cleaning with Chlor-Clean (1,000ppm).
• Terminal clean of the room required for crusted scabies when isolation is discontinued.
• Notify the IPC team of any confirmed inpatient cases:
  • Phone: 03000 214872
  • Email: rdash.ipcteam@nhs.net

Page last reviewed: August 30, 2024
Next review due: August 30, 2025