Scabies is a common, treatable skin condition caused by a tiny mite that burrows into the upper layer of the skin. It is intensely itchy and easily spread, which is why treating it properly — and treating the right people at the right time — matters so much. Most treatment failures are not because the medicine did not work, but because it was applied incompletely, the essential second dose was skipped, or close contacts were left untreated and passed the mite back. This guide covers how scabies spreads, how to apply permethrin cream correctly, who else needs treating, and why the itch can linger long after the mites are gone.
What scabies is and how it spreads
Scabies is caused by the mite Sarcoptes scabiei. Female mites tunnel into the skin to lay eggs, and the body reacts to the mites and their waste with an intensely itchy rash. The itch is characteristically worse at night. Common sites include the finger webs, wrists, elbows, armpits, waistline, and the genital area; in the folds of skin you may see fine, thread-like burrow lines alongside small red spots.
It spreads mainly through prolonged, direct skin-to-skin contact — for example within a household, between sexual partners, or in settings such as care homes. Brief contact like a handshake rarely passes it on, but sharing a bed or repeated close contact readily does. A key point that trips people up is timing: the first time someone gets scabies, it can take up to six weeks for the itch to appear, so people can pass it on before they have any symptoms at all. That delay is exactly why contacts are treated even when they feel completely well.
Scabies is usually diagnosed from the pattern of symptoms and the appearance and distribution of the rash, sometimes helped by spotting a burrow. It is easily mistaken for eczema, an allergic reaction or insect bites, which is one reason a clinician assessment is useful before treating — particularly if a first course of treatment has not worked. Anyone can catch scabies; it is not a sign of poor hygiene, and there is no need for embarrassment in seeking help. What does matter is acting promptly and treating the right people, because the longer it goes unrecognised, the more contacts can be affected.
Permethrin 5% cream — how to apply it correctly
In the UK, permethrin 5% cream is the first-line treatment for classic scabies. How thoroughly it is applied makes the difference between success and a frustrating repeat. Apply it to cool, dry skin — not straight after a hot bath, which can increase absorption and reduce how long it stays where it is needed.
For adults, the cream is spread over the whole body from the neck down, taking care to cover every area, including between the fingers and toes, the soles of the feet, the genitals, and under the fingernails and toenails (trimming nails first helps). Older adults, young children, and anyone with a weakened immune system may also need the scalp, face, neck and ears covered — a clinician will advise if that applies. Leave the cream on for 8 to 12 hours, ideally overnight, then wash it off. If you wash your hands or any other area during that window, reapply the cream to that area straight away.
The second step is not optional: a repeat application about 7 days after the first is essential. The first treatment does not reliably kill eggs, and the second dose deals with mites that hatch afterwards. Skipping this second application is one of the most common reasons scabies appears to come back.
Treating household and close contacts
Because scabies spreads through close contact and can be silent for weeks, treating one person alone rarely clears it. All household members and close physical contacts — including sexual partners from the past couple of months — should be treated at the same time, even if they have no itch or rash. Treating everyone on the same day, and repeating the second application together a week later, stops the mite being handed back and forth between people who take turns developing symptoms.
Where permethrin cannot be used, malathion aqueous lotion is an alternative your clinician may recommend. Whichever treatment is used, the same principles apply: cover the skin completely, leave it on for the full time, repeat after a week, and treat contacts together.
It helps to plan the treatment as a single coordinated event rather than something each person does when they get round to it. Agree a date, make sure everyone has enough cream to cover their whole body, and carry out both the first application and the repeat a week later on the same days across the household. If a contact develops symptoms later on, the whole group may need re-treating together — treating one person in isolation while others remain infested is the classic route to a scabies problem that never quite goes away. Where several households are linked, such as extended family who visit regularly, it is worth thinking about who has had close contact so no one is missed.
Dealing with clothing, bedding and the home
The mite does not survive long away from human skin, so the home does not need fumigating. On the day of the first treatment, wash clothing, bedding and towels used in the previous few days at 60°C or above and dry them thoroughly, or tumble dry on a hot setting. Anything that cannot be washed can be sealed in a plastic bag for 72 hours, by which time any mites will have died. Doing this alongside the skin treatment, rather than obsessively cleaning the whole house, is the sensible balance UK guidance supports.
Why the itch can persist after treatment
One of the most confusing parts of scabies is that the itch often continues for 2 to 4 weeks after successful treatment. This is not usually a sign of ongoing infestation — it is an immune reaction to the dead mites and their remnants still in the skin, which takes time to settle. Understanding this in advance saves a lot of worry and prevents people from over-treating.
In the meantime, the itch can be eased. A moisturising emollient applied regularly soothes the skin, and a mild steroid cream is sometimes advised for itchy spots. A sedating antihistamine such as hydroxyzine taken at night can help both the itch and sleep while things calm down. If new burrows or spots keep appearing more than a couple of weeks after the second treatment, though, that suggests the infestation itself may not have cleared and warrants review.
When to seek review
It is worth seeking clinical advice before treating if you are pregnant or breastfeeding, if the person affected is a baby or young child, or if someone involved has a weakened immune system — a more severe form called crusted scabies needs specialist management. You should also seek review if the skin becomes infected (increasing redness, warmth, pain or weeping), or if symptoms persist despite two correctly applied and correctly timed treatments. A clinician can confirm the diagnosis, check that the technique and contacts were covered, and advise on the next step.
Working with your Farmeci clinician
A consultation typically covers your symptoms, who else in the household or among close contacts may be affected, and any factors — pregnancy, young children, other health conditions — that influence which treatment is suitable. From there, a clinician can confirm whether scabies is the likely cause and advise on treating everyone correctly and at the same time. For related skin conditions, our Skin & Hair guides include overviews of fungal nail infections and the acne treatment ladder.