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What can be mistaken for scabies?
People may mistake skin conditions such as psoriasis, eczema, or contact dermatitis for scabies. Unlike these conditions, though, scabies occurs due to a mite known as Sarcoptes scabiei.
In this article, we look at what a scabies rash looks like. We also look at other rashes that are similar in appearance and their treatment options.
Scabies is a common condition that occurs as the result of an infestation of a microscopic skin mite called Sarcoptes scabiei. The mites burrow under the skin, causing intense itching and a rash.
The Centers for Disease Control and Prevention (CDC) describes the rash as pimple-like. On darker skin, the rash may be more difficult to see, but a person should be able to feel it.
According to DermNet, a scabies rash is varied in appearance, and may appear as:
- pimple-like on the limbs and trunk
- widespread or coin-shaped
- small blisters
- lesions in the armpits, groin, navel, areolas, scrotum, buttocks, and along the penile shaft
The American Academy of Dermatology Association notes that the rash may cause small bumps that form a line.
The rash can affect many parts of the body, including the:
- spaces between the fingers and toes
A scabies rash causes intense itching that is normally worse at night.
The itchiness normally starts within 1–4 days in people who have had scabies before, but can take 2–6 weeks to appear in those that have not had scabies in the past.
Some people have a variant of scabies known as crusted scabies.
This occurs when thousands or even millions of mites infest the skin surface. People with crusted scabies have a scaly rash and the itchiness may not be present, or may be minimal. This type of scabies often occurs in people who are immunocompromised.
Other skin conditions may present similarly to scabies, some of which are discussed below.
Psoriasis is an autoimmune skin condition where the body makes new skin cells at a fast rate. This causes the cells to pile up on the skin surface, which results in scaly patches. Unlike scabies, psoriasis is not contagious.
In about 80–90% of people with psoriasis, plaques develop. This is called plaque psoriasis.
When this occurs, often there are raised patches that will have scales coated on top. Because of this, psoriasis can sometimes appear similar to crusted scabies.
The symptoms of plaque psoriasis include :
- thick skin patches normally found on the elbows, scalp, knees, lower back, face, palms, and soles of the feet
- silvery scales on the patches
- plaques of different sizes
On lighter skin, psoriasis will be red or pink. On browner skin, psoriasis appears salmon-colored and the scales are silvery-white.
On dark skin, psoriasis patches are violet in color and the scales will appear gray.
A variety of treatment options are available for psoriasis depending on the type of psoriasis present and its severity.
Topical treatments are the first line of treatment for mild psoriasis. A 2020 study found that topical treatments remain effective in treating mild psoriasis.
- Emollients: These include moisturizers and anti-itch creams.
- Coal tar: Coal tar can help reduce the itchiness and flakiness of psoriasis as well as reduce the redness and swelling, and slow the growing skin cells.
- Topical corticosteroids: This includes creams such as hydrocortisone. These help decrease the itchiness and inflammation.
- Salicylic acid: Salicylic acid can help soften the scales and reduce swelling.
- Topical retinoids: This is a synthetic form of vitamin A. The retinoid that can treat psoriasis is called tazarotene.
For moderate to severe psoriasis, a person may require phototherapy, systemic therapy, and biologics.
Eczema, or atopic dermatitis, describes a group of conditions that cause the skin to be itchy, inflamed, and irritated.
Atopic dermatitis is an inflammatory skin condition that is not contagious. It is more common in children, although it can affect people of all ages.
The symptoms of atopic dermatitis include:
- itchiness, which can be severe
- dry patches of skin that are red to dark brown in color
- hardened or thickened skin
- itching that can disrupt sleep
Treatment of atopic dermatitis includes medications, skin care, and phototherapy.
A 2019 study found that NB-UVB phototherapy treatment was effective in treating atopic dermatitis.
Medication that may be prescribed includes:
- steroids to reduce swelling and clear the rash
- antibiotics to help prevent infections
- antihistamines to reduce irritation
A dermatologist may recommend that a person:
- avoids scratching the skin
- uses a moisturizer
- uses soap that is fragrance-free
- applies lubricating ointments and moisturizers to damp skin after washing
A person can also try bleach baths. The National Eczema Association advises that a person uses regular, unconcentrated household bleach, which contains 5.25% sodium hypochlorite.
People should always consult a healthcare professional before trying a bleach bath.
Additionally, people should:
- avoid using excessively cold or hot water
- avoid adding any other ingredients to the bath
- avoid soaking for longer than 15 minutes
- avoid submerging the head and face
Contact dermatitis occurs when a substance comes into contact with the skin and causes irritation or an allergic reaction.
Irritant contact dermatitis can occur due to detergents, solvents, acids, and more.
When the substance causes an allergic reaction, this is called allergic contact dermatitis.
Symptoms of contact dermatitis include:
- itchiness, which can be intense
- tender skin
- dry and cracking skin
- fluid-filled blisters
- blisters that ooze, crust, and scale
Allergic contact dermatitis can also cause hives to appear.
The treatment of contact dermatitis involves avoiding the trigger. A healthcare professional may also prescribe certain topical and oral medications, including :
- strong corticosteroid cream to reduce inflammation
- prednisone to suppress the immune reaction
- antihistamines to control the itchiness
This is a reaction to insect bites. According to DermNet, the symptoms include itchy clusters of bumps.
Fleas and mites that live on pets are typically responsible.
The bumps commonly form on the legs, forearms, and face.
Treatment will likely include:
- topical steroid cream
- antiseptic cream
This is a skin infection that develops in the hair follicles. It looks similar to acne.
It occurs when the hair follicles become damaged, and germs such as Staph aureus cause an infection.
Unlike with scabies, itching is not always present with folliculitis.
Mild folliculitis should resolve itself without medical attention. A person can apply a warm compress to affected areas three to four times a day. Widespread folliculitis will often require treatment with a topical or oral antibiotic.
There are other conditions that also present similarly to scabies.
These include , but are not limited to:
- Dermatitis herpetiformis: This is a rare, chronic condition that causes severely itchy blisters and raised lesions. They commonly appear on the scalp, lower back, buttocks, elbows, and knees. This skin condition occurs alongside celiac disease.
- Prurigo nodularis: This is a skin condition that causes firm, itchy bumps. They typically begin on the lower arms and legs. They may occur as the result of scratching or picking.
- Insect bites: Bites from mosquitoes, fleas, bed bugs, chiggers, and other mites, can look similar to scabies.
Scabies is caused by the Sarcoptes scarbiei mite. It causes a rash so itchy that it interrupts sleep. It can be treated with certain ointments or pills.
What is scabies?
Scabies is a skin condition caused by the Sarcoptes scabiei var hominis mite. These little bugs make tunnels (burrow) under your skin and cause small red bumps and severe itching. Scabies spreads easily from person to person, especially among people who live close together. If one family member has scabies, a provider should check and treat other family members and close contacts at the same time.
Scabies is a worldwide problem but happens most often in tropical areas and in very crowded places.
Scabies is also known as sarcoptic mange. Animals can also get scabies, but the mites are slightly different. Usually, the mites that affect pets can’t adapt to living on humans. However, you might have some type of reaction to mites on your pet.
Where do scabies mites live on your body?
The mites live in the folds and narrow cracks of your skin. Common mite sites include:
- Folds in between the fingers and toes.
- Folds in your thighs and genital area.
- Bends at your wrists and knees.
- The area around your waist.
- Under fingernails.
- Under rings, watch bands and bracelets.
- The area around your nipples.
Who gets scabies?
Anyone can get scabies. It’s not a disease caused by poor hygiene. Some people are more likely to get scabies, including:
- People who live in close, crowded conditions.
- Infants and children. (Children have a lot of close physical contact with their parents, friends, family members and classmates.)
- People who are elderly, especially those living in nursing homes.
- Healthcare workers who care for people who aren’t aware they have scabies.
Are there different types of scabies?
Yes, there are different forms in addition to the classic form. Other types include:
- Crusted (Norwegian): This type often happens in people with faulty immune systems. It tends to form crusted areas covering a large area of skin. If you have crusted scabies, you might have millions of mites instead of the 10 to 15 mites common with classic scabies.
- Nodular: This type is more common among children. The brown-red nodules can still be there long after the mites are gone.
- Bullous: In adults, this type of scabies can be mistaken for bullous pemphigoid, another condition involving skin blisters.
- Scalp: This type occurs on your scalp and may not present symptoms except for scales that may look like psoriasis.
Symptoms and Causes
What are the symptoms of scabies?
You can be infected with scabies for four to six weeks before having the early symptoms of the red rash and bumps. The tiny spots might look like bumps or pimples.
The rash spreads slowly over a period of weeks or months. In addition to the rash, signs and symptoms of scabies include:
- Intense itching, which is worse at night and could make it hard to sleep.
- Bumps that sometimes become infected as a result of scratching.
- A later rash that looks grayish or skin-colored lines on the skin.
Children with scabies may have itching all over their bodies and might be cranky or tired from lack of sleep due to itching at night.
Diagnosis and Tests
How can I know if I or my child has scabies?
If you think you or your child has scabies, make an appointment with your healthcare provider. Most cases of scabies can be confirmed just by looking closely at the skin. Your healthcare provider may also apply mineral oil to the rash and use a scalpel to get a small sample of skin (scraping). The sample is placed under a microscope and examined for mites and mite eggs.
Can I see the mite?
The scabies mite is very small, about the size of the tip of a needle and very difficult to see. It’s white to creamy-white in color. It has eight legs and a round body, which you can see if the mite is magnified.
Management and Treatment
How is scabies treated?
Your healthcare provider must order a cream that contains a medicine called permethrin to treat scabies. The cream is applied to your whole body below your head, including the hands, palms, and soles of the feet.
In children with scabies, the cream may need to be applied to the scalp. Be sure that skin is clean, cool and dry before applying the cream.
Permethrin cream is left on the skin for eight to 14 hours and then washed off. (The cream is most often applied at night and washed off in the morning.)
Ivermectin is another option for treating scabies. This is an antiparasitic pill given in a single dose, followed by a second dose one to two weeks later.
If you’re pregnant or lactating, you shouldn’t use ivermectin. If your child weighs less than 35 pounds (15 kilograms), they shouldn’t use ivermectin.
Your provider might also suggest antihistamines, which can be taken by mouth and as a cream, to relieve itching. Your provider will also treat any type of infection that may be present.
How soon are the mites killed?
The mites that cause scabies are killed after one treatment. The treatment doesn’t need to be repeated unless the infection doesn’t go away or comes back.
How soon does the itching stop?
The itching may take two to four weeks to go away, even though the mites have been killed.
How soon does the scabies rash go away?
Red bumps on the skin should go away within four weeks after treatment.
How can I prevent spreading scabies?
You can prevent spreading scabies by:
- Washing bed linens, towels and clothing in hot water and machine dry.
- Making sure family members and others in close contact with the infected person get checked for scabies.
- Limiting close contact with others if you know you’ve got scabies.
Outlook / Prognosis
If my child has scabies, how soon can they return to school?
Your child can return to school the day after treatment.
Can a person get scabies more than once?
Yes. You can get scabies any time that you come into close contact with an infected person.
When should I see my healthcare provider?
Call your healthcare provider if:
- You’ve been treated for scabies but still have symptoms or skin issues after a month.
- You’ve developed signs of a bacterial infection, like redness or sores with pus. These types of infections can lead to more severe medical issues.
- You have some type of side effect from the medication or the condition that is worrying you.
Frequently Asked Questions
What’s the difference between scabies and eczema?
Scabies and eczema are both skin conditions that give you itchy red rashes. However, scabies is caused by a parasite, a mite that invades your body. Sometimes you can see patterns that look like lines where the burrows are.
Eczema is a type of rash with an unknown cause. It can come and go seasonally. It can show up as red spots or weeping blisters. Unlike scabies, eczema isn’t contagious. Eczema treatments are designed to manage your symptoms. Scabies treatments rid your body of the mites.
If you have a rash that is red and itches, contact your healthcare provider. It’s important to catch scabies as soon as possible so you can get rid of them and not infect other people. If it’s eczema, your provider can suggest remedies that will help your symptoms.
Will scabies go away on its own?
No, scabies won’t go away on its own. If you don’t treat it, you’ll probably continue to spread the disease to other people. In addition, the constant itching will probably lead to constant scratching and will cause some type of bacterial infection of the skin.
Is scabies hard to get rid of?
Scabies is treatable, but they can be hard to get rid of completely. Certain forms of scabies are harder to treat, such as the crusted form. In addition, you might need more than one round of treatment to make sure all of the mites are gone.
A note from Cleveland Clinic
If you have a rash and it’s so itchy that you can’t sleep, make sure you contact your healthcare provider. You may have scabies, which is an infectious disease. You and other people close to you should be tested and treated. You’ll want to contact your healthcare provider if you have any kind of skin rash that doesn’t go away and that causes problems for you. Scabies, like many other types of red itchy rashes, can be treated successfully.