The two main scabies symptoms are itching and a pimple-like rash on the skin. The itching can be severe and is usually worse at night or after a hot bath. The scabies rash starts as small itchy bumps, blisters or puss-filled bumps that can break when it is scratched.

Short, s-shaped lines may also be visible on the skin where the female mite burrows under the skin, but burrows may be easy to overlook.

Occasionally the actual mite can be seen as a tiny black dot at the end of the curvy burrow. Not every bump represents a mite and in most cases there are only 10 to 15 life mites active on the skin.

The most common areas on the body where the symptoms of scabies occur:

• The webs between the fingers;
• The wrists;
• The skin folds at the elbows or knees;
• The armpits;
• The shoulder blades;
• The area around or under the breasts (in women);
• The area around the bellybutton and
• The area around the buttocks.

The head, face and neck are usually not infected, except sometimes in babies or very small children.

It may be difficult to distinguish scratch marks from the burrows of the mites, as scratching usually destroys the burrows. Scratching may cause secondary infection in the scabies skin rash. The signs of secondary infection include redness, swelling, pus and pain in the area where the rash occurs.

What Do Scabies Feel Like?

Itching is the most distinctive characteristic of scabies. The itching starts off as subtle but then gradually becomes more intense until it is so severe that even sleeping may become difficult.

The itch can prevent a person from falling asleep and even wake one up in the middle of the night.

It is the relentless quality of the itching caused by scabies that distinguishes it from other itchy skin problems such as eczema or hives.

The itching associated with these conditions usually comes and goes and does not have the same intense quality of the scabies itch.

How Do I know I Have Scabies?

The diagnosis for scabies is usually based upon the symptoms (intense itching and the presence of a rash) and the history of contact with other people who have signs of scabies. Some other skin diseases may look like scabies, for example allergic drug reactions, contact dermatitis and shingles.

It is important to get a diagnosis from a medical practitioner if:

• Anyone in the family suddenly develops severe night time itching that does not go away within three to four days;

• There are any signs of a secondary skin infection (fever, pus, red streaks protruding away from the skin rash, pain or tenderness.)

• If the symptoms haven’t disappeared two to four weeks after treatment.

If uncertain about the diagnosis, the doctor may do a skin scraping to confirm that the scabies mites are present. For this procedure, the doctor will place a small amount of oil or saline on the rash and will then scrape the upper layer of skin with a scalpel.

Alternatively, if the doctor can see a tiny black dot at the end of a burrow, he may try to lift the mite out with a needle.

The material collected is viewed under a microscope to see if any mites or eggs are present. It may be very hard to find a mite or eggs, so even if the result of this test is negative and the doctor still strongly suspects scabies infestation he will prescribe treatment for it.

Scabies cannot be treated with over the counter medicine. It is important to go to a doctor as soon as scabies is suspected because the longer the infestation continues the more likely it is that it will be spread to other people.

Is Scabies The Same in Children And in Adults?

Children are more likely to get a scabies rash on their heads, faces and feet. Scratching marks are frequently also more pronounced in children than in adults.

In small infants, the diagnosis of scabies may be delayed because they cannot say what the itching feels like. The rash in infants and children can also appear to be more reddened with larger blisters.

Even though the scabies symptoms may differ slightly, the treatment for scabies in adults and children is the same.

Centers for Disease Control and Prevention, Parasites – Scabies – Scabies Index
Andrews, R.M., J. McCarthy, J.R. Carapetis, and B.J. Currie. “Skin disorders, including pyoderma, scabies, and tinea infections.” Pediatr Clin North Am 56 (2009): 1421-1440.
Heukelbach, J., and H. Feldmeier. “Scabies.” Lancet 367.9524 May 27, 2006: 1767-1774.