Scabies - Treating scabies

See your GP immediately if you have scabies and you haven't had a previous infection. Delaying treatment places other people at risk.

As other more serious skin conditions can sometimes cause similar symptoms to the symptoms of scabies, your GP will need to rule these out.

If you have scabies, your partner will also need to be treated regardless of whether or not they have any symptoms. This is because it's highly likely that scabies will have been transmitted through close bodily contact, such as during sex.

To reduce the risk of reinfection, avoid having sex and other forms of prolonged close bodily contact, such as holding hands, until both you and your partner have completed the full course of treatment.

If you've been diagnosed with scabies, you may be advised to visit your nearest sexual health clinic to be checked and, if necessary, treated for other sexually transmitted infections (STIs).

Lotions and creams

Lotions and creams are commonly used to treat scabies. Your GP, pharmacist or nurse will be able to advise you about which treatment to use.

Applying the cream or lotion

To prevent reinfection, all members of your household and any close contacts, including recent sexual partners (see diagnosing scabies for further details), should be treated at the same time as you, even if they don't have any symptoms.

The cream or lotion should be applied to the skin of all of your body, except your head. Before you apply it, make sure your skin is cool and dry. Don't apply it after having a hot bath.

If you apply it when your body is hot, it will quickly be absorbed into your skin and won't remain on the area where the scabies burrows are.

You should also follow the advice outlined below.

• Read the patient leaflet that comes with the cream or lotion for details of where to apply it. Some products need to be applied to the whole body, including the scalp and face, whereas others must only be applied from the neck down.
• Pay particular attention to difficult-to-reach areas, such as your back, the soles of your feet, in between your fingers and toes, under fingernails, and on your genitals. 
• Use a cotton bud or old toothbrush to apply the treatment under fingernails and toenails. Put the cotton bud or toothbrush in a bag and throw it away afterwards.
• Leave the treatment on your skin for 8 to 24 hours (depending on the preparation used) before washing it off thoroughly. Follow the manufacturer's instructions regarding how long to leave the cream or lotion on for.
• Reapply the cream or lotion immediately to any areas of skin that are washed during the period of application.
• Wash bed linen, nightwear and towels after the first application.
• Repeat the treatment process seven days after the first application to ensure it's successful. The second application will ensure any mites hatched from existing eggs are killed.

Contact your GP if the itching hasn't improved after two weeks of treatment and you notice new burrows on your skin.

It can take a month after treatment for the general itching to subside completely, and longer for the lumpy genital lesions to resolve. Your GP may recommend repeating the treatment or they may prescribe a different lotion.

You should also speak to your GP or pharmacist if you experience any persistent side effects.

Infection control

On the day you first apply the cream or lotion, you should wash all bed linen, nightwear and towels at a temperature above 50C (122F).

If you're unable to wash certain items, place them in a plastic bag for at least 72 hours. After this time, the scabies mites will have died.

In cases of crusted scabies, you should clean the floors in your house and thoroughly vacuum your carpets and furniture, including the armchairs and sofa.

If you've been diagnosed with scabies, avoid close and prolonged physical contact with others until you've applied the cream or lotion. You should also avoid close contact with other members of your household until their treatment has been completed.

Children and adults can return to school or work after the first treatment has been completed.

Itchiness

Your GP should be able to prescribe treatments, such as a mild steroid cream, to reduce the itchiness. Menthol cream or gel, available from pharmacies without a prescription, may also help relieve itchy skin.

Oral sedative antihistamines are also available from your local pharmacy and can be used to control itching and help you get a better night's sleep.

As this type of antihistamine can cause drowsiness, you should avoid driving or operating heavy machinery if you're affected in this way.

Non-sedating antihistamines don't help relieve the itching of scabies. Check with your GP or pharmacist if you're unsure.

You may continue to experience itchiness for a couple of weeks after your treatment has been completed. This is because your immune system will still be reacting to the presence of dead mites and their droppings.

Visit your GP if you're still experiencing itchiness six weeks after completing your treatment.