Scabies is a contagious skin condition caused by the human itch mite Sarcoptes scabiei. The mites burrow into the skin and lay eggs, causing intense itching and a pimple-like rash. Scabies spreads rapidly through close physical contact, so if one family member has scabies, it’s likely that other members of the household have been exposed as well.
Should everyone in the family be treated if one person has scabies?
Yes, the Centers for Disease Control and Prevention (CDC) recommends that all members of a household be treated for scabies at the same time, even if they do not show symptoms yet. This is because scabies is highly contagious and can spread easily between family members through prolonged skin-to-skin contact or sharing clothing, towels, or bedding. Treating the entire household at once is the most effective way to eliminate the infestation and prevent reinfection.
How is scabies treated?
Scabies is treated with prescription medications that kill the mites. Typical treatments include:
- Permethrin cream (Elimite): Applied from the neck down and washed off after 8-14 hours
- Ivermectin tablets: Taken orally
- Sulfur ointment: Applied topically
For severe infestations, a combination of permethrin and ivermectin may be prescribed. All family members should be treated with the same medication at the same time, even if they are not showing symptoms.
How should you treat the home for scabies?
In addition to treating the skin, it is important to treat the home environment since scabies mites can survive for 2-3 days without a human host. Recommended steps include:
- Wash all clothes, bedding, and towels used in the last 3 days in hot water and dry on high heat
- Vacuum upholstered furniture, mattresses, carpets, and rugs thoroughly
- Wipe down surfaces with disinfectant or hot, soapy water
- Store stuffed animals, shoes, pillows, etc. in a sealed plastic bag for at least 72 hours
- Mites cannot survive without a human host for more than 2-3 days
How soon after treatment is scabies no longer contagious?
Scabies mites will die within 24-48 hours after effective treatment. However, the itching and rash may persist for 2-4 weeks after the mites have been eliminated. To prevent spread to others, the CDC advises waiting until itching and rashes have resolved before returning to school, work, or other close contact situations.
| Time After Treatment | Contagious? |
|---|---|
| 24-48 hours | No longer contagious |
| 1-2 weeks | Possibly contagious due to lingering mites |
| 2-4 weeks | No longer contagious once itching resolves |
When is a second treatment needed?
A second treatment 7-10 days after the initial treatment is often recommended to kill any lingering eggs or mites that may have survived. If itching continues more than 2-4 weeks after treatment, contact your doctor as a second application or different medication may be needed.
How can scabies spread be prevented at home?
To avoid spread within a household, the CDC recommends:
- Treating all household members at the same time, even if asymptomatic
- Avoiding close personal contact until all treatment is complete
- Washing clothes, bedding, and towels used by infested individuals in hot water and high heat
- Vacuuming and cleaning home environment thoroughly
Keeping fingernails short and clean can prevent spread from scratching. Careful handwashing and showering after contact with an infested person are also important prevention measures.
Can young children and pregnant/breastfeeding women use scabies medications?
Scabies medications are considered safe for children, infants, pregnant women, and breastfeeding mothers. However, permethrin is typically the preferred treatment in these groups:
- Infants 2 months and younger should receive permethrin only, not ivermectin
- Permethrin is the preferred treatment for pregnant or breastfeeding women
- Ivermectin requires a higher dosage for children over 15 kg based on weight
Talk to your doctor about the appropriate scabies treatment options for your family members. Carefully follow dosage and application instructions.
When can my child return to school after scabies treatment?
Children should not return to school until 1-2 days after completing scabies treatment, according to the American Academy of Pediatrics. This helps ensure adequate time for medications to work and prevents spreading scabies to classmates. Children may return 24-48 hours after first treatment application, provided they have no new burrows or intense itching.
Can scabies treatment irritate or worsen the rash?
Yes, scabies treatments such as permethrin cream can temporarily worsen itching and skin irritation as a reaction to the dead mites in the skin. Using anti-itch creams and taking antihistamines as directed by your doctor may help relieve this reaction.
Notify your doctor if irritation persists longer than a few days after treatment or worsens significantly. New burrows or rash appearing 2 or more weeks after completing treatment likely indicates treatment failure rather than worsened reaction.
Tips for managing scabies treatment side effects:
- Use cool compresses on itchy areas
- Keep fingernails short and clean to minimize scratching
- Apply hydrocortisone cream to reduce inflammation
- Take oral antihistamines as recommended by your doctor
- Avoid hot showers or baths, as heat can worsen itching
Does my dog or cat need to be treated if we have scabies?
No, scabies mites that infect humans are a different species than those that infect domestic animals. Pets do not need to be treated for scabies simultaneously or isolated from household members receiving scabies treatment. There is no evidence that human scabies can spread to or from cats and dogs.
Can scabies recur after treatment?
Yes, it’s possible for scabies to return if the infestation was not fully eliminated with the first treatment course. Recurrence happens most often when:
- Not all household members were treated
- Treatment instructions were not followed appropriately
- Spread from an untreated environment (e.g. clothing, bedding)
Using medications as directed and taking proper steps to treat the home will help prevent recurrence. A second treatment after 7-10 days may be recommended to ensure any leftover eggs and mites are killed.
Conclusion
Scabies spreads quickly in families and households through prolonged skin contact. To eliminate the infestation, all members of the household should receive scabies treatment at the same time, even if they aren’t showing symptoms yet. Common medications include permethrin cream, ivermectin pills, and sulfur ointment. The home environment must also be thoroughly cleaned and treated to prevent reinfestation.
Children, pregnant women, and breastfeeding mothers can be safely treated for scabies but special considerations may apply. Follow your doctor’s instructions carefully and take steps to reduce itching while waiting for treatments to take effect. With coordinated efforts, an entire household can eliminate scabies and prevent recurrence in family members.
