Scabies (Khaarish): Symptoms, Treatment and How to Stop It Spreading

It begins with an itch that is worse at night. Then come tiny red bumps between the fingers, on the wrists and around the waist, and soon the whole family is scratching. Scabies (khaarish, or khujli wali bimari) is far more common in Pakistan than most people realise, especially in crowded homes, hostels and schools. It is not a sign of dirt, and it is curable.

This guide explains what scabies is, how to recognise it, how treatment works step by step, why the itch can last for weeks after the mites are gone, and what to do about bedding and clothes.

What is scabies?

Scabies is a skin infestation caused by a tiny mite that burrows into the top layer of the skin to lay eggs. The intense itch is an allergic reaction to the mites and their waste. A person who has never had scabies before may not feel itching for two to six weeks after catching it. During that time they can still pass it on.

How does it spread?

• Close skin-to-skin contact with an infected person, such as sleeping in the same bed or holding hands for a long time.
• Sharing bedding, towels or clothing, although this is less common than direct contact.
• Crowded living: large families, hostels, prisons, care homes and relief camps.

Scabies mites cannot jump or fly, and pets do not carry the human type. Good hygiene alone does not prevent it. Anyone can catch it.

Signs and symptoms

• Severe itching, worse at night and after a hot bath.
• A pimple-like rash or tiny blisters, often in lines or small clusters.
• Common places: between the fingers and toes, wrists, elbows, armpits, waistline, buttocks and genitals. In babies and young children it can also appear on the scalp, face, palms and soles.
• Thin, wavy grey lines on the skin, called burrows.
• Scratch marks and sores, which can become infected.
• More than one person at home itching. This is a strong clue.

How scabies is treated

Scabies does not go away by itself. It needs a treatment that kills the mites, and everyone in the household needs to be treated on the same day, even if they have no symptoms. Always follow the instructions on the pack or from your doctor.

1. Choose a scabies treatment. Common options include permethrin products such as ScabFree Lotion (see the permethrin page), benzyl benzoate products such as Permecite Lotion and Permicite Cream, and sulfur ointment, which is often used for babies and young children, such as Sulfur Ointment 5% and Sulfur Ointment 10%.
2. Apply it to clean, dry skin over the whole body from the neck down, including between the fingers and toes, under the nails, around the navel and the genitals. In babies and the elderly, the scalp, face and ears also need treating, avoiding the eyes and mouth.
3. Leave it on for the time stated, usually overnight or for several hours, then wash it off.
4. Put on clean clothes after washing.
5. Repeat the treatment as the pack directs, which is often after about a week.

A medicated soap such as Scabno Soap can be used for washing during treatment, but a soap alone is not enough to cure scabies. Browse our skin conditions range for more.

Special cases: babies, pregnant or breastfeeding women, and people with very sensitive skin should see a doctor before using any scabies product. Do not use lindane products on children or pregnant women, and avoid them unless a doctor advises, since they are not suitable for everyone.

Cleaning bedding and clothes

• On the day of treatment, wash bedding, towels and clothes worn in the last three days in hot water, and dry them in strong sunlight or a hot dryer.
• Items that cannot be washed can be sealed in a plastic bag for at least three days. Mites die away from the skin within about three days.
• Vacuum mattresses, sofas and car seats. You do not need to fumigate the house.
• Do not share towels or clothes until treatment is finished.

Why am I still itching?

The itch can continue for two to four weeks after successful treatment, because the skin is still reacting to dead mites. That does not always mean the treatment failed. To calm the itch you can try cool compresses, calamine lotion, a moisturiser and short fingernails. A doctor can advise an antihistamine at night. See a doctor if there are still new burrows or bumps after two weeks, because you may need a second treatment, or the diagnosis may be wrong.

When to see a doctor

• You are not sure whether it is scabies, eczema or an allergy.
• The rash is crusted, thick or widespread. This can be crusted scabies, which is more contagious and needs medical care.
• Sores are red, painful, oozing or have pus. They may be infected.
• A baby, a pregnant woman, an elderly person or someone with a weak immune system is affected.
• The itching does not improve after two treatments.

Scabies and head lice are different problems. For the scalp, read our guide to head lice.

Frequently asked questions

Is scabies contagious before the rash appears?

Yes. A person can spread scabies for weeks before symptoms start.

Can I go to school or work with scabies?

Usually you can return the day after the first treatment is completed, but follow the advice of your doctor or school.

Can scabies be caught from a toilet seat?

This is very unlikely. Scabies spreads mainly through long skin contact.

Do home remedies cure scabies?

Neem, turmeric and similar remedies may soothe the skin, but they do not reliably kill the mites. Avoid kerosene, petrol or harsh chemicals, which burn the skin and are dangerous.

Order scabies treatments and skin care from Khasmart, with delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor or pharmacist. It does not include dosage; always follow the directions on the pack or from your doctor.