Scabies

Creator: Louis J Sisk
Published: 2025-08-23T08:00:36.269Z

Everything you need to know about Scabies - symptoms, causes, treatment options available in Australia, and when to see a doctor. Evidence-based medical information.

Dr. Louis J Sisk

BSc(Hons) MBChB MRCS(Glasg) MTrauma

August 23, 2025

6 min read

What You Need to Know - The Basics

Scabies is a skin problem caused by tiny bugs that make you really itchy.

The main things to know:

It makes your skin super itchy, especially at night.
You might see small red bumps or a rash on your skin.
It often affects people living in crowded places or communities with less access to healthcare.
Scabies is not dangerous and can be treated with medicine.

When to see a doctor immediately: If your skin is very sore, you see signs of infection like pus, or if you feel unwell.

Don't worry, scabies is treatable, and the itching will go away with the right care.

Overview

Scabies is a contagious skin condition caused by the infestation of the skin by the mite Sarcoptes scabiei var. hominis. The pathophysiology of scabies involves the female mite burrowing into the stratum corneum, where it lays eggs, leading to an inflammatory response characterised by intense pruritus and a papular rash. The immune response to the mite and its products is responsible for the clinical manifestations of the disease [1]. In Australia, scabies is particularly prevalent in certain demographics, with a significant burden observed in Indigenous communities and socioeconomically disadvantaged groups [2].

Statistics and Prevalence in Australia

Scabies prevalence in Australia is notably high among First Nations and socioeconomically disadvantaged communities. In remote Aboriginal and Torres Strait Islander communities, the prevalence of scabies in children can reach up to 33%, with some studies reporting rates as high as 60% in specific settings [2][4]. In the general Australian population, the incidence is lower, with laboratory-confirmed rates of 1.8–2.8% in adults in Far North Queensland, with higher rates observed in urban and Indigenous populations [1][5]. Children under two, the elderly, and immunosuppressed individuals are particularly vulnerable outside of Indigenous communities [5].

Symptoms and Clinical Presentation

The clinical presentation of scabies typically includes intense itching, which is often worse at night, and a papular rash. The rash commonly affects the hands, feet, and genitalia, but can spread to other areas of the body. Early signs include small, erythematous papules and burrows, which are linear or serpiginous tracks created by the mite [5]. In advanced cases, secondary bacterial infection may occur, leading to impetiginisation. Atypical presentations can occur in immunocompromised individuals, where crusted scabies (Norwegian scabies) may develop, characterised by thick crusts and a high mite burden [5]. Red flag symptoms requiring immediate attention include widespread crusting and severe secondary infection [6].

Causes and Risk Factors

Scabies is caused by the mite Sarcoptes scabiei var. hominis. Transmission occurs primarily through direct skin-to-skin contact with an infested individual, although it can also occur via fomites such as bedding and clothing [1]. Risk factors for scabies include crowded living conditions, poor hygiene, and close contact with an infested person. Indigenous populations and those living in remote communities are at higher risk due to socio-economic factors and limited access to healthcare [2][4].

Diagnosis

The diagnosis of scabies in Australia is primarily clinical, based on the characteristic signs and symptoms. Dermatoscopy can be a useful adjunct, allowing visualisation of the mites, eggs, or faecal pellets [5]. Parasitological confirmation can be achieved through skin scraping and microscopic examination to identify mites or eggs [1]. The Royal Australian College of General Practitioners (RACGP) and the National Health and Medical Research Council (NHMRC) provide guidelines for diagnosis, emphasising the importance of clinical examination supported by laboratory tests when necessary [6].

Treatment Options in Australia

The first-line treatment for scabies in Australia is topical 5% permethrin cream, which is effective in eradicating the mites. The cream should be applied thoroughly to the entire body, including under the nails, and left on for 8-14 hours before washing off. A second application is recommended one week later to address any mites that may have hatched from eggs [6]. Oral ivermectin is an alternative for severe cases or when topical treatment is impractical. It is particularly useful in crusted scabies or in outbreaks in institutional settings [9]. The Pharmaceutical Benefits Scheme (PBS) provides coverage for these treatments, ensuring accessibility for patients [9].

Living with Scabies

Managing scabies involves not only treating the individual but also addressing environmental factors to prevent reinfestation. All household members and close contacts should be treated simultaneously, even if asymptomatic, to prevent the spread of the infestation [6]. Bedding, clothing, and towels should be washed in hot water and dried on a hot cycle. Items that cannot be washed should be sealed in a plastic bag for at least 72 hours to ensure mites are killed [6]. Patient education is crucial, focusing on adherence to treatment protocols and hygiene measures to prevent recurrence [6].

Managing this condition is an ongoing process, but many people learn to live well with proper support and care.

Daily management:

Follow your treatment plan as prescribed
Keep track of your symptoms and how you're feeling
Stay in regular contact with your healthcare team
Learn about your condition so you can make informed decisions

Building your support network:

Talk to family and friends about your condition
Consider joining support groups
Work with healthcare professionals who understand your needs
Don't hesitate to ask for help when you need it

Self-care strategies:

Maintain healthy lifestyle habits where possible
Manage stress and get adequate rest
Stay as active as your condition allows
Focus on activities and relationships that bring you joy

Important: With proper management and support, many people with this condition live full and active lives.

Prevention

Prevention of scabies involves maintaining good personal hygiene and avoiding close contact with infested individuals.

In institutional settings, such as aged care facilities, regular screening and prompt treatment of cases are essential to control outbreaks [8].

Public health initiatives targeting high-risk communities, particularly Indigenous populations, are vital in reducing the how common it is of scabies.

These initiatives should focus on improving living conditions, access to healthcare, and education on scabies prevention and management [2][4].

Key Takeaways

• Scabies is a medical condition that can be effectively managed with proper diagnosis and treatment from healthcare professionals. • Treatment options are available in Australia through Medicare and PBS, making care accessible and affordable for most people. • Early detection and appropriate management can significantly improve outcomes and quality of life for people with this condition.

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