How to know if you have it and what to do about it

Er zol hobn paroys makes bashotn mit oybes krets!

He should have Pharaoh's plagues sprinkled with Job's scabies

Yiddish curse


Scabies are tiny mites that burrow under the skin. They are different than head, body, or pubic lice. Scabies can be diagnosed by health professionals. Often people have scabies literally before they know it, while people who think they have scabies really don't (more on this below).

Scabies are mostly spread through direct contact and is said to be highly contagious. People can conceivably get it from simply hugging. I've known others who, mysteriously, have had extensive contact with infected persons and apparently not been infected. You can get it from infected people's clothing or bedding if it has been less than two weeks since they used it. On the other hand, there is virtually no risk of getting or transmitting scabies by walking through or touching hard surfaces in public places. Nor is it transmitted by animals.

The main problem with scabies is (1) that it causes itching and scratching which can lead to secondary infection, and this can be dangerous, especially in the case of infants and pregnant women, and (2) that a newly infected person can pass on scabies even if they have no symptoms, because symptoms can take from a week to two months to show up.

To definitely prevent the spread of scabies we recommend the following: If you have come into contact with anyone with symptoms (or their clothing or bedding), treat yourself as soon as possible. If you have hugged, traded clothes, slept, etc. with anyone without symptoms who has done this with anyone who does have symptoms, you may also be infected, and we recommend treatment.

Of course in a touchy-feely community this may mean that practically everyone needs to treat themselves, and, perhaps worse, avoid touching each other for a while. This may seem extreme, but remember how contagious scabies seems to be: some people seem to have gotten it through hugs and you could be spreading it before you know you have it.

It's also clear, on the other hand, that this cannot just be dealt with on an individual basis. Like the books say, "Each individual in the group, whether obviously infected or not, should be treated. Nothing short of mass therapy at one time for the entire community at risk is likely to have a lasting effect where scabies is epidemic" (National Pediculosis Association). We're all in this together.


Scabies mites are tiny, round, eight-legged critters, 0.4 mm across, and are pretty much invisible. The most classic symptom of scabies is itching, worse at night (why, we don't know). The itching is supposed to be "severe" but this strain, for most people at least, seems to be relatively mild. Generally the more oily your skin, the milder it is.

Of course you can itch for any number of reasons (insect bites, hives, eczema, folliculitis, contact or atopic dermatitis, impetigo, rosacea, psoriasis, lymphoma, drug reactions,...) so look for little red bumps (where female mites have burrowed under the skin to live and lay their eggs). These bumps can be very subtle and look like hives, tiny bites or pimples. People have had them mostly on the lower body: especially ankles, tops of feet, knees, thighs, as well as elbows or wrists, buttocks or belt line, around the nipples for women and on the genitals for men. They are rarely found on the neck, face or head.

Scabies is supposed to show up most commonly between the fingers, but no one that we know of seems to have them there much at all. Also, don't bother looking for the short tunnels that books tell you the mites dig; you've usually already scratched them away and if not they are really hard to find. There's also an ink test and microscopic examination of a skin scraping, but even when you know what you're looking for, they're extremely hard to find.

To sum things up, to this day I don't know when I really have had and not had scabies. To be specific, a year after getting it in winter, I got very similar itches again ('right on schedule') but with no apparent cause. I did an Elimite treatment (see below), but the itches came back. I ignored them, and they went away. So I'd say don't freak out if you have one or two annoying itches over a few days, especially in the dry winter season.

You can get a diagnosis and a prescription at your local health department. Often, if you're unemployed or make under a certain amount a year (you need to show 'proof' of income in this case) they will see you for free, otherwise you pay on a sliding scale according to income. A local clinic here in Asheville where I live takes walk-ins for free who state that their income is under a certain amountper month. You don't need to show any paperwork. Both clinics will give you lindane (Kwell) for free. I don't recommend using lindane, however; get a prescription for Elimite instead (see second paragraph below).

Treating your body

The sooner you do it the fewer mites and eggs that you or anyone else will have to deal with. One doesn't itch right away because it takes most people some time to become 'sensitized' to the bugs.

The cheap medical prescription is usually lindane, a pesticide with the brand name of "Kwell." It is highly toxic and can cause permanent nerve damage. Needless to say, we don't recommend it. More effective and less toxic (and more expensive) is another pesticide, synthetic pyrethrin, sold by prescription in 5% concentration as "Elimite" cream (available at several pharmacies for $31/60g tube, enough for two single treatments, usually with a little left over). You put this on everywhere from your chin down and leave it on for 8-13 hours.

There are several over the counter 1% pyrethrin treatments for lice that are probably somewhat effective against light infestations. Be sure not to use any of these treatments if they contain piperonyl butoxide (or "PBO"), which is the active ingredient in many bug sprays. "Rid," for example, has 4% PBO: twice the amount as in a can of Raid, and the directions on the can say not to get it on your skin!

Should you choose to use any synthetic pesticide, do not bathe just before applying it. You'll open your pores and absorb more of the poison. The mites are on or just beneath the surface anyway. With any treatment be sure to keep your nails cut short and to treat under them.

Sulfur has been used as a scabicide since Roman times. You can buy it as a powder at pharmacies. The directions are to mix it into petroleum jelly at 10% concentration (by volume?), spread it on everywhere up to your chin and leave it on for 3 days straight, reapplying it twice a day and/or after bathing. We use salve (a wax/oil balm) as a base instead.

Unlike Elimite, sulfur is incredibly cheap and apparently equally as effective (i.e., no one says it isn't; granted, it didn't seem to work for us). The main problem with sulfur is the smell it leaves permanently on the clothes it gets on. It also tends to stain whites grey. The treatment is also much more time-consuming than Elimite. But it's nontoxic– unless you are allergic to it. To check this, put a little on a spot on your skin and wait an hour or so. If you don't get a rash or drop dead, etc. you're probably okay.

Remember, don't expect the medical establishment to speak highly of cheap options. Crotamiton 10% cream is often listed before sulfur even though it's only 60% effective and has frequent side effects.

It's not clear whether it's necessary to repeat any of the above treatments, say, a week later. You may want to do this to be extra sure it worked.

Over the counter Clear cleansing rinse for (nit) lice-egg removal probably will kill mites by itself due to the enzymes in it (which basically melt protein, the main ingredient in exoskeletons). In Asheville, this is available at B&B Pharmacy and it costs $9. "Not-Nice-to-Lice" also has enzymes but we haven't been able to locate it. We expect that it's too expensive anyway. Note: The enzymes may eat natural dyes.

There's a whole list of other substances with insecticidal or repellent properties, and these can be used for bathing or on the skin (as well as for laundering, spraying things with or soaking stuff in). These are available as soaps, powders, extracts, or essential oils. They are: coconut, any oil, especially olive, borax, rosemary, thyme, peppermint, bergamot, garlic, tea tree, neem, balsam of Peru, cedar, lavender, tide soap pastes, betadyne (iodine), beer, tobacco juice, etc. (If you were a bug, what would kill or drive you crazy?).

Our impression is that concentrated oils should generally be diluted 10:1 for application or put 5-25 drops in a bath. Poke root and black walnut oils (available from Red Moon Herbs) can be applied straight. Also, since mites are very sensitive to heat (see below), hot baths and esp. saunas can be effective (yum-good excuse!). Susun Weed says violet tincture taken internally (up to three droppers full a day) is helpful, as well as anything that supports your immune system and healthy skin growth (since secondary infection from scratching is a possibility).

Treating your home

Mites can not survive more than 48 hours away from the human body. Their eggs hatch in 3-5 days. Based on these two figures (which vary according to who you ask), it is recommended that any clothing and bedding used in the last week or two be treated. Here's how it works: mite drops off your body, lays an egg two days later with its dying breath, that mite hatches in five days and lives two. Viola. Makes Hannukah look a little less miraculous.

Treat clothing, bed linens, pillows, and blankets (what you don't have to do, e.g., throw out your furniture, will be discussed below).

Heat (over 120 degrees F for at least 15 minutes or 130 degrees for at least five) will kill mites and their eggs. Since most tap water is usually this hot, you can either wash your things on hot or soak them in a vat of hot water. Washing in cold or lukewarm water will not harm them.

You can also put them in a dryer. Since we measured one dryer's temperature and it was only 100 degrees, be careful to pick a suitable length of time (in this case, half an hour?). If the clothes are dry to begin with we imagine that the time can be shorter than if they're going in wet. Steam cleaning or pressing with a hot iron will also work.

You can also isolate things, typically by sealing them in a garbage bag, for 2 weeks (see starving mite life expectancy above).

Vacuuming is the safest and best way to clean anything that you can't deal with as directed above, such as: upholstered furniture, rugs, stuffed animals, (child) car seats, mattresses, carpets, bedrooms and mats. It's generally not considered necessary to clean carpets, drapes, floors, etc.: things people typically don't spend a lot of time rubbing against.

Best of all, I'm told that freezing for 48 hours will kill both the mites and their eggs. If this is true that means that if it stays cold enough, you can just put your stuff outside (on the porch, etc.) for a couple days. Nothing could be easier!

How to know if it worked

Don't expect the itch to go away immediately even if you kill all the bugs: you will be irritated by the presence of their bodies until your body gets rid of them. Itching could subside in two weeks or it could take months. More importantly, you need to see whether you start itching in new places or not (I've gone so far as to keep notes; I even made a little graphic chart; I hope it will be worth something someday).

Furthermore, re-infestation is very common. Scabies has been called the "seven-year itch." We know people who have even temporarily moved out of their homes before they were finally cured. If you are re-infected, since you are already sensitized to the critters, itching will commence immediately (I assume that this sensitivity lasts indefinitely).

For more information, you can reach the National Pediculosis Association (and hear a recorded educational message on scabies) at 781-449-NITS or 617-449-6487.

Good luck and good riddance!