16th July 2026

Scabies

Scabies is a highly contagious parasitic skin infestation caused by the mite *Sarcoptes scabiei* var. hominis. It is transmitted through prolonged skin-to-skin contact and is especially common in crowded living environments.

Clinical Features and Diagnosis

The hallmark symptom is intense pruritus, particularly at night. Characteristic lesions include burrows, papules, and vesicles located in the finger web spaces, wrists, anterior axillary folds, areolae, and genitalia. In infants, the scalp and soles may also be affected.

Diagnosis is clinical, but dermoscopy may reveal the ‘delta wing jet’ sign (mite in burrow). Microscopy of skin scrapings may also confirm the diagnosis by revealing mites, eggs, or faecal pellets.

Management

First-line treatment is topical permethrin 5%, applied to the entire body (including the scalp and face in infants), repeated after 7 days. All close contacts must be treated simultaneously, regardless of symptoms. Bedding and clothing should be washed at high temperatures. Oral ivermectin is reserved for crusted scabies or outbreaks in institutional settings.

A post-scabetic rash or persistent pruritus may last for weeks after successful treatment and does not indicate treatment failure. Antihistamines or mild topical corticosteroids can be used for symptomatic relief.