If someone at home is itching intensely at night, mostly between the fingers and on the wrists, here is the thing to know straight away: scabies has to be treated for the whole household at the same time, including anyone who is not itching at all yet. Treating only the person who itches is the most common reason scabies “never clears up”.
Recognising scabies
The cause is a very small mite, almost invisible to the naked eye, which tunnels into the top layer of skin to lay its eggs. The itching is persistent and builds up; it does not flare and then settle.
- Intense itching, clearly worse at night — many people lose sleep because of it.
- Small pimple-like bumps, sometimes with tiny blisters; skin scratched raw.
- The mite's burrow: a fine, slightly raised, greyish-white line that winds like a faint pencil mark.
- Common sites in adults: between the fingers, the inner wrists, elbows, armpits, around the waistline and navel, buttocks, the areola, and the genital area.
- In young children and babies, scabies also appears on the palms, the soles, the scalp, the face and the neck.
- Several people in the same house itching one after another — the strongest signal of all.
According to CDC, someone with scabies for the first time usually only starts itching around four to eight weeks after becoming infested, and remains able to pass it on throughout that symptom-free period. That is why a household usually contains someone who looks “fine” — in fact they have simply not reached the itching stage.
What it is mistaken for
| Mistaken for | The difference you can see |
|---|---|
| Chickenpox | Blisters appear in waves all over the body, including the scalp, usually with a fever. Scabies itches persistently, without fever, and stays between the fingers and in skin folds. |
| Eczema, hives | Eczema: dry skin, red patches with an indistinct edge. Hives: bumps that rise and fade and move around. Neither has burrows, and nobody else in the house starts itching. |
What to do now
Diagnosing and prescribing is the doctor's job. The following needs no prescription, and it decides whether the treatment clears the problem for good:
- Write down everyone in the household plus anyone with prolonged skin-to-skin contact: people who share a bed, anyone who carries the baby a lot, carers, partners. Take that list to the appointment so the doctor prescribes for the right people.
- Cut fingernails short and scrub them clean, children especially — scratching breaks the skin, and mites also collect under the nails.
- Clothes, towels, bed sheets and pillowcases used over the last few days: wash hot and tumble-dry hot, or dry-clean. Anything that cannot be washed goes into a sealed plastic bag for a few days up to a week.
- For now, stop sharing towels, clothes and beds. Note down the date each person started itching.
What not to do
- Do not use a scabies medicine prescribed for someone else, or what is left in a tube from a previous episode. Which product, which areas to apply it to and for how long all depend on age, pregnancy and how extensive the problem is.
- Do not mix up sulphur preparations at home, do not apply crushed leaves, warming balms, alcohol or toothpaste — broken skin is how infection gets in.
- Do not apply scabies medicine to a newborn or a young child without being told to — a child's skin absorbs medicine differently from an adult's.
- Do not spray insecticide and do not fumigate the house — CDC says plainly not to do this. The mite lives on human skin.
- Do not treat only the person who is itching and call it done, and do not stop part-way through because things seem better.
Doctors commonly prescribe topical permethrin, benzyl benzoate, or oral ivermectin, with an antibiotic added if the scratched areas have become infected. Which one, where to apply it and for how long is for the doctor or the pharmacist to decide.
Still itching after treatment — did the medicine fail?
This is where people end up applying medicine they do not need. According to CDC, itching can continue for several weeks after treatment even when every mite and egg has been killed, because the body is still reacting to what remains of the mite in the skin. Whether the itching has stopped is not the measure of whether the medicine worked. What is worth worrying about is NEW lesions appearing, or itching getting steadily worse after about two to four weeks — at that point the doctor needs to look again, and whether to treat a second time is the doctor's decision.
When you must be seen
Be seen TODAY, do not wait, if: the scratched areas are swollen, hot and red, oozing pus, with red streaks spreading outwards, or there is a fever as well — that is a skin infection on top of the scabies; the skin is forming thick crusted plaques that are spreading, particularly in an older person, someone bed-bound or someone with a weakened immune system (crusted scabies, which is highly contagious and handled differently); or the patient is a newborn or a pregnant woman. Call 115 (the emergency number in Vietnam) if there is a high fever with drowsiness, or the infected skin is spreading quickly over a few hours.
Be seen by a doctor within 24–72 hours, and stop self-treating, if:
- You suspect scabies but are not sure, or several people at home are itching — scabies needs an in-person examination and prescription medicines for exactly the people who have to be treated at the same time.
- You have already treated it and new lesions are appearing, or after about two to four weeks the itching is no better.
- The itching has cost several nights of sleep; or the patient has an underlying condition, takes medicines that suppress the immune system, or is an older person confined to bed.
What can be done at home, and what needs a medical facility
Scabies is not an emergency, but it does need an examination to get a prescription, and it is a condition of the whole household. At home, Y Te Xanh (GreenCare) doctors and nurses can: photograph the lesions for assessment, go carefully through who in the house has itched and since when so nobody who needs treating is missed, and care for the broken skin as prescribed. What needs a medical facility: suspected crusted scabies, a skin infection that is spreading, newborns and pregnant women.
According to CDC, scabies spreads mainly through prolonged skin-to-skin contact, and what has to be done is to treat everyone in the household along with close contacts at the same time as the patient. Source: CDC. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.
Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.
Sources
- CDC — About Scabies
