Dear Leandra,

Scabies and crabs are two different organisms and are treated in two separate ways. For information on treating crabs (also called pubic lice), including which over-the-counter products to use, see Pubic lice/crabs... Oh my! and Crabs and nit-picking in Alice's Sexual Health archive.

Scabies is caused by a microscopic mite called Sarcoptes scabei. You become infected with scabies through direct, prolonged skin-to-skin contact with someone who already has it. It is normally spread via sexual contact, but contact of a sexual nature is not necessary. Scabies is commonly spread among members of the same household. Transmission is also possible, though less likely, through bedding, clothing, and towels.

Symptoms of scabies include pimple-like bumps, burrows on the skin, or rashes in the areas affected — most commonly between the fingers; on the wrist, elbow, or knee; on the genitals and buttocks; or, on the breasts or shoulder blades. These visible signs are accompanied by intense itching, especially at night. When people with scabies scratch constantly because of the itching, they risk causing sores that can become infected.

Scabies is treated with a pediculicide lotion including, most popularly, Permethrin cream, Lindane lotion/cream, or Ivermectin. A pediculicide is any drug that kills lice and similar microorganisms. All of these creams and lotions are prescription-only in the United States; over-the-counter medications are not strong enough to kill the organisms. Some of the creams are available without prescription in other countries — talk with a pharmacist if you are outside of the U.S.

The lotion or cream you use needs to be applied all over the body except for the head and face. You will probably want to get the help of someone else, since you need to make sure that every part of your body is covered. The lotion is left on the skin for 8 to 12 hours and then washed off with soap and water. Sometimes a second treatment with lotion is necessary about 7 days later — your health care provider will let you know. Do not apply the lotion a second time unless instructed to by a health care provider.

Even after treatment with the lotion, which should kill all of the mites, the itching may continue, even for up to 2 to 3 weeks after treatment. You might want to take an antihistamine to relieve the itching and/or apply cortisone cream to reduce inflammation. If the itching is severe, your health care provider may prescribe something stronger.

In addition to treating your body, it's important to treat any bedding, towels, and clothing that the infected person used in the two days before treatment. They all need to be washed in hot water [at least 140 degrees Fahrenheit (60 degrees Celsius... the hot water cycle) for 20 minutes] and dried in a hot dryer. Mites can live on many surfaces for 2 to 3 days, so it's important to clean and vacuum well. Some items that can't be washed easily — stuffed animals, for example — need to be sealed in bags for at least a week to make sure that any mites on them are dead.

If you suspect that you have scabies, see your health care provider as soon as possible.

Alice

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