How Does Scabies Start In The First Place?

You may have heard of scabies before, but do you know how it actually starts? It’s a common question, and understanding the origin of scabies is essential in preventing its spread. Scabies is a highly contagious skin condition caused by tiny mites burrowing into the skin and laying eggs. These mites are typically passed from person to person through prolonged skin-to-skin contact, making crowded places like schools or nursing homes more susceptible to outbreaks. So, let’s uncover the mystery behind how scabies begins and how you can protect yourself from this pesky infestation.

Understanding Scabies

What is scabies?

Scabies is a contagious skin infestation caused by microscopic mites called Sarcoptes scabiei. These mites burrow into the upper layer of the skin, causing intense itching and a rash. Scabies is highly contagious and can spread easily from person to person. It is important to understand the causes, symptoms, and treatment options for scabies in order to prevent its spread and effectively manage the condition.

How is scabies transmitted?

Scabies is primarily transmitted through direct skin-to-skin contact with an infested individual. The mites can crawl from one person to another during prolonged physical contact, such as hugging, holding hands, or sexual activity. It is also possible to contract scabies by sharing personal items like clothing, towels, or bedding with an infected person. In rare cases, scabies can be acquired through contact with infested animals or during certain medical procedures.

Who is at risk of getting scabies?

While anyone can get scabies, certain individuals are more susceptible to infestation. Those who live in crowded conditions such as nursing homes, dormitories, or prisons have a higher risk of acquiring scabies due to close contact with others. Additionally, individuals with weakened immune systems, such as the elderly or those with certain medical conditions, are more vulnerable to scabies infestation. Sexual partners and household members of an infested person are also at increased risk of getting scabies.

What are the symptoms of scabies?

The most common symptom of scabies is intense itching, which tends to worsen at night. This itching often leads to a rash, characterized by small red bumps, blisters, or pimple-like irritations. The rash may appear as linear or wavy tracks on the skin, as the mites burrow and create tunnels. Common areas affected by scabies include the hands, wrists, elbows, armpits, genitals, and buttocks. In some cases, individuals may also experience sores, crusting, or thickened skin due to excessive scratching.

How is scabies diagnosed?

Diagnosing scabies involves a combination of clinical evaluation, visual examination, and identifying the characteristic signs and symptoms. A healthcare professional will usually examine the affected areas of your skin, looking for the presence of burrows, rash, or lesions. In some cases, a skin scraping or a sample of the skin may be taken to examine under a microscope. It is important to consult with a healthcare provider for an accurate diagnosis and appropriate treatment.

Is scabies contagious?

Yes, scabies is highly contagious. It can easily spread from person to person through close physical contact or sharing personal items with an infested individual. However, scabies cannot be transmitted through brief, casual contact such as a handshake or hug. It is important to note that scabies mites can survive for a short period away from the human body, so there is a potential for transmission through infested bedding or clothing. It is crucial to take necessary precautions and seek prompt treatment to prevent the spread of scabies.

Causes of Scabies

Sarcoptes scabiei mites

Scabies is caused by an infestation of the Sarcoptes scabiei mite, specifically the human variety (Sarcoptes scabiei var. hominis). These microscopic mites are eight-legged parasites that are barely visible to the naked eye. The female mites burrow into the outer layer of the skin, where they lay eggs and reproduce, leading to the spread of infestation.

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Direct skin-to-skin contact

The primary mode of transmission for scabies is through direct skin-to-skin contact. The mites can crawl from one person to another during prolonged physical contact, such as holding hands, hugging, or sexual activity. It is during this close contact that the mites can transfer from an infested person to a healthy individual.

Shared personal items

Scabies can also be transmitted through the sharing of personal items with an infested person. Clothing, towels, bedding, or even furniture that has been in contact with scabies-infested skin can harbor the mites and transfer them to a new host. It is important to avoid sharing personal items and ensure proper hygiene to prevent scabies infestation.

Crowded living conditions

Living in crowded environments where close contact with others is frequent increases the risk of scabies transmission. This is because the mites can easily pass from one person to another in settings such as nursing homes, dormitories, or prisons. The close proximity and shared living spaces in these environments facilitate the spread of scabies.

Sexual contact

Engaging in sexual activity with an infested individual can lead to scabies transmission. The mites can easily transfer from one partner to another during intimate contact. It is important to practice safe sexual behavior and maintain good personal hygiene to prevent the spread of scabies.

Infected pets

Although rare, scabies can be acquired from infested animals. Certain types of mites can infest animals, such as dogs, cats, or birds, and these mites may cause mange in animals. If an infested animal comes into close contact with a person, the mites can transfer to the human skin and cause scabies. Proper treatment of infested pets is important to prevent cross-species transmission.

Medical procedures

In rare cases, scabies transmission can occur through certain medical procedures that involve close contact with infested individuals. This can happen, for example, during the administration of IV fluids or when healthcare providers come into contact with scabies-infested skin. It is important for healthcare facilities to follow strict hygiene practices and take necessary precautions to prevent the spread of scabies.

Life Cycle of Scabies Mites

Egg stage

The life cycle of scabies mites begins with the female mite burrowing into the skin and laying eggs. The eggs are usually laid in the burrows made by the female mite, which provides a protective environment for the developing eggs. These eggs hatch within a few days, giving rise to the next stage of the mite’s life cycle.

Larval stage

After hatching from the eggs, the scabies mites enter the larval stage. The larvae are small and nearly transparent, making them difficult to see without a microscope. They move around the skin surface, searching for a suitable area to create new burrows. During this stage, the larvae undergo several molts, shedding their outer skin layers and growing into nymphs.

Nymph stage

The nymph stage is the next phase in the life cycle of scabies mites. The nymphs are larger than the larvae and have four pairs of legs. Like the larvae, they continue to move on the skin surface, searching for suitable areas to burrow and create new tunnels. The nymphs undergo further molting and growth before reaching the final stage of development.

Adult stage

In the adult stage, the scabies mites have grown to their full size and are capable of reproducing. They have eight legs and are around 0.3 to 0.4 millimeters in length. The adult mites continue to burrow into the skin to lay eggs and reproduce, starting the cycle of infestation all over again. It is during the adult stage that the intense itching and rash associated with scabies occur.

Initial Infestation

Mite penetration into the skin

The initial infestation of scabies occurs when the mites penetrate the skin. The female mites usually find a suitable spot, such as between the fingers, on the wrists, or in the genital area, to burrow into the upper layer of the skin. It is during this penetration that the mites cause microscopic breaks or lesions in the skin, leading to the onset of symptoms.

Burrowing and tunnel formation

Once the mites have penetrated the skin, they start burrowing and creating tunnels within the upper layer of the skin. These tunnels often appear as wavy or linear tracks and can be seen as tiny raised lines on the skin. The mites use their mouthparts to dig into the skin, creating these characteristic burrows as they move and reproduce.

Initiation of host immune response

As the scabies mites continue to burrow and reproduce, the immune system of the host organism recognizes their presence as foreign and mounts an immune response. This response involves the activation of immune cells and the release of various chemical mediators to combat the mites. The immune response contributes to the development of symptoms such as itching, redness, and inflammation.

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Onset of symptoms

The onset of symptoms typically occurs a few weeks after the initial infestation, as the immune response to the mites intensifies. The most common symptom is severe itching, which is often worse at night and can interfere with sleep. This itching is a result of the body’s immune response and reaction to the mites and their waste products. The appearance of a rash, characterized by small red bumps or blisters, is also a common symptom of scabies.

Factors Influencing Scabies Spread

Age and gender

Scabies affects individuals of all ages and genders. However, certain age groups may be more susceptible to infestation due to factors such as close physical contact or hygiene practices. Infants and younger children, for example, may be more prone to scabies due to their limited ability to practice good personal hygiene. Additionally, females may have a higher risk of getting scabies due to more frequent and prolonged physical contact during activities such as caregiving or childcare.

Poor personal hygiene

Poor personal hygiene can contribute to the spread of scabies. Regular bathing, washing of clothes and bedding, and maintaining cleanliness can help reduce the risk of infestation. Individuals who are unable to practice good personal hygiene, such as those with physical disabilities or limited access to sanitation facilities, may be at higher risk of scabies.

Weakened immune system

A weakened immune system can make individuals more susceptible to scabies infestation. Certain medical conditions or medications that suppress the immune system’s function can increase the risk of developing scabies or experiencing more severe symptoms. Individuals with conditions such as HIV/AIDS, cancer, or autoimmune diseases may be at higher risk.

Overcrowded living conditions

Living in overcrowded conditions, such as dormitories, nursing homes, or prisons, can facilitate the spread of scabies. Close physical contact with others in these settings increases the likelihood of mites transferring from person to person. Proper hygiene practices and measures to reduce overcrowding are essential in managing scabies outbreaks in such environments.

Contact with infested individuals

Direct contact with infested individuals is a significant risk factor for scabies transmission. Whether it is through prolonged physical contact, sharing personal items, or living in close proximity, being in contact with someone who has scabies increases the likelihood of acquiring the infestation. It is important to be aware of potential sources of exposure and take preventive measures.

Duration of contact

The duration of contact with an infested individual can influence the risk of scabies transmission. Prolonged close contact, such as living with an infested person or engaging in intimate activities for an extended period, increases the chances of mites being transferred. Brief and casual contact, such as a handshake or a hug, is unlikely to result in scabies transmission.

Intimate or sexual contact

Engaging in intimate or sexual contact with an infested individual increases the risk of scabies transmission. The mites can easily transfer from one partner to another during these activities. It is important to practice safe sexual behavior and maintain good personal hygiene to prevent the spread of scabies.

Preventing Scabies Infestation

Maintaining personal hygiene

Good personal hygiene is crucial in preventing scabies infestation. Regular bathing with soap and warm water helps remove any potential mites from the skin. It is also important to wash clothes, bedding, and towels regularly in hot water to kill any mites or eggs present. Keeping nails trimmed and clean can minimize the risk of secondary infections from scratching.

Avoiding direct skin contact with infested individuals

Avoiding direct skin-to-skin contact with individuals who have scabies is essential to prevent transmission. This includes avoiding hugs, handshakes, or any prolonged physical contact with an infested person. If living with an infested individual, it may be necessary to maintain distance and take additional precautions to prevent the mites from spreading.

Avoiding sharing personal items

To reduce the risk of scabies transmission, it is important to avoid sharing personal items with infested individuals. This includes clothing, towels, bedding, or other personal belongings that come into contact with the skin. Storing personal items separately and washing them thoroughly can help prevent the spread of mites.

Regular washing and drying of bedding and clothing

Regularly washing and drying bedding and clothing in hot temperatures can kill scabies mites and eggs. It is important to use hot water and a hot dryer cycle to ensure effective elimination of the mites. Paying special attention to items that have been in direct contact with the skin can help prevent reinfestation.

Treating pets for mites

If you have pets that are infested with mites, it is important to seek treatment for them as well. Certain types of mites can infest animals and may cause mange. Treating pets with appropriate medications and following veterinary advice can help prevent cross-species transmission of mites.

Educational campaigns and awareness

Educational campaigns and increasing public awareness about scabies can play a crucial role in preventing infestation. Providing information about the causes, symptoms, and preventive measures can help individuals recognize and take appropriate actions to protect themselves and others. Healthcare providers, educational institutions, and community organizations can collaborate to spread awareness about scabies and promote preventive practices.

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Treatment of Scabies

Topical medications

The primary treatment for scabies involves the use of topical medications such as permethrin, benzyl benzoate, or sulfur ointment. These medications are applied to the entire body from the neck down, following the prescribed instructions. It is important to cover all areas of the skin, including between the fingers, under the nails, and the soles of the feet. Treatment may need to be repeated after a certain period to ensure the elimination of mites.

Oral medications

In some cases, oral medications may be prescribed to treat scabies. These medications, such as ivermectin, are taken orally and work by killing the mites within the body. Oral medications may be recommended for individuals with severe or widespread infestations, those who are unresponsive to topical treatments, or when multiple family members are affected. It is crucial to follow the prescribed dosage and duration of treatment.

Environmental measures

To prevent reinfestation or spread of scabies, certain environmental measures should be taken. This includes thorough cleaning of the house, particularly bedding, clothing, and personal items that have come into contact with an infested individual. Hot washing and drying on high heat can help eliminate mites and their eggs. Vacuuming upholstery and carpets can also help remove any mites or eggs present.

Treating close contacts

If you have been in close contact with an infested individual, it is important to seek medical advice and discuss the need for treatment. Close contacts, such as sexual partners, household members, or individuals who have shared personal items, may require treatment even if they do not exhibit symptoms. Treating close contacts helps prevent the spread of scabies and reduces the risk of reinfestation.

Post-treatment precautions

After completing scabies treatment, it is important to follow certain precautions to prevent reinfestation. This includes avoiding close contact with infested individuals until they have completed treatment as well. Washing and drying bedding, clothing, and personal items used during treatment can help eliminate any remaining mites or eggs. Regular handwashing and good personal hygiene practices are also important in preventing the spread of scabies.

Complications and Risks

Scratched skin infections

Intense itching caused by scabies can lead to scratching and open wounds on the skin. Scratched skin becomes susceptible to secondary bacterial infections, such as impetigo or cellulitis. These infections may require additional treatment with antibiotics to prevent further complications.

Persistent itching and rash

In some cases, itching and the appearance of the rash may persist for several weeks or even months after successful scabies treatment. This is known as post-scabies syndrome or persistent scabies. It occurs due to an ongoing immune response to the remnants of dead mites and their waste products. Consulting with a healthcare provider is recommended for appropriate management.

Secondary infections

Secondary bacterial infections can occur as a result of scratching the skin and introducing bacteria into the open wounds. These infections can cause additional discomfort, pain, and prolonged healing. It is important to seek medical attention if you notice signs of infection, such as increased redness, warmth, or discharge from the affected area.

Transmission to others

If scabies is left untreated or undiagnosed, it can continue to spread to others. Infected individuals who have not received treatment remain contagious until all mites and eggs are eliminated. It is important to promptly seek treatment for scabies to prevent the further spread of infestation within the household or community.


Reinfestation can occur if the preventive measures or treatment protocols are not followed diligently. It is important to ensure that all individuals in close contact with an infested individual are treated simultaneously to minimize the risk of reinfestation. Adequate hygiene practices and maintaining a clean living environment are essential in preventing reinfestation.

Managing Scabies Outbreaks

Identifying and treating affected individuals

Identifying and promptly treating individuals with scabies is crucial in managing outbreaks. Early diagnosis, close monitoring, and rapid initiation of treatment can help prevent the further spread of infestation. Healthcare providers, community organizations, and educational institutions should collaborate to identify and treat affected individuals.

Isolating infested individuals

Isolating individuals with scabies can help prevent the spread of infestation within group settings, such as schools, nursing homes, or correctional facilities. Infested individuals should be separated from healthy individuals until treatment is completed, and preventive measures are in place. This can involve temporary relocation, limitations on group activities, or implementing appropriate infection control measures.

Educating the community

Raising awareness and educating the community about scabies is essential in managing outbreaks. Providing information about preventive strategies, recognizing symptoms, and seeking early treatment can help individuals take appropriate actions to prevent infestation. Educational campaigns, workshops, and distribution of educational materials can be effective in reaching a wide audience.

Collaborating with healthcare providers

Community healthcare providers play a crucial role in managing scabies outbreaks. Collaboration with healthcare professionals, such as dermatologists, nurses, or public health officials, can help ensure accurate diagnosis, appropriate treatment, and effective prevention measures. This collaboration can also facilitate surveillance, monitoring, and follow-up of affected individuals.

Monitoring and surveillance

Monitoring and surveillance of scabies outbreaks are important in understanding the extent of infestation and implementing control measures. This involves tracking the number of cases, identifying potential sources of transmission, and evaluating the effectiveness of preventive measures. Surveillance data can guide public health interventions and help prevent further outbreaks.


Understanding scabies is essential for effective prevention, diagnosis, and treatment of this highly contagious skin infestation. By knowing the causes, symptoms, and risk factors associated with scabies, individuals can take necessary precautions to reduce the likelihood of infestation. Timely diagnosis and treatment, along with proper management of outbreaks, are crucial in preventing the spread of scabies within communities. By practicing good personal hygiene and following preventive measures, you can help protect yourself and others from scabies infestation.