Last Updated: 2021-04-30

Author(s): Anzengruber, Navarini

Renucci, 1835.

Seven-year itch.

Pruriginous, globally occurring infectious disease caused by the Sarcoptes scabiei hominis parasite .

  • Incidence (worldwide): 200-400 million cases annually
  • Prevalence (worldwide): < 1% -40% annually
  • The trigger is close physical contact
  • Clothing is only used as a carrier for Scabies norvegica
  • In the area of the body folds (toe space, elbows), genital and in general almost on the entire integument there are erythematous, pruriginous, partly urticarial, partly blister-like papules and ducts
  • The back, head and neck are usually free
  • The curved, erythematous mite ducts are sometimes visible and can be visualized with ink
  • The pruritus is particularly pronounced at night
    • In case of first disease: manifestation after 3-6 weeks
    • In case of reinfection after 24 hours, as patients are already sensitized to the mite faeces antigens
  • Medical history: Travel history
  • Clinical picture: Reflected light microscope
  • The diagnosis is made clinically. Only by the detection of the mite, the diagnosis of a scabies is clearly confirmed
  • A deep biopsy is rarely necessary, but a really good dermatologist can show the mite well with a scratch biopsy and confirm it under the microscope

Scabies infest the patients in the imaginary "Circle of Hebra": axillae, elbows, wrists, hands and crotch, which is created when the hands are supported on the hips. 

  • Post-scabial eczema, always prescribe topical class III steroids with antiseptic together with scabicidal therapy
  • Persistent post-scabial papules

 General measures

  • Bed linen and clothing should be stored in airtight plastic bags for 4 days
  • Alternatively, bed linen and clothing can be washed at > 60°C
  • The whole family and close roommates should be treated to avoid a ping-pong effect

Topical therapy

  • Apply Permethrin 5% for 8-12 hours, if necessary repeat after 2 weeks
  • Face and capillitium can be left out. Exception: Scabies norvegica

Systemic therapy

  • Ivermectin p.o. 200 μg/kg KG one-off
    • Repeat if necessary after 2-4 weeks
    • Not available in Switzerland, but available in Germany
  1. Agathos M. Skabies. Der Hautarzt 1994;45:889-903.
  2. Fölster-Holst R, Rufli T, Christophers E. Die Skabiestherapie unter besonderer Berücksichtigung des frühen Kindesalters, der Schwangerschaft und Stillzeit. Der Hautarzt 2000;51:7-13.
  3. Paasch U, Haustein UF. Behandlung der endemischen Skabies mit Allethrin, Permethrin und Ivermectin. Der Hautarzt 2001;52:31-7.
  4. Shacter B. Treatment of scabies and pediculosis with lindane preparations: An evaluation. Journal of the American Academy of Dermatology 1981;5:517-27.
  5. Burkhart CG. Scabies: An Epidemiologic Reassessment. Annals of Internal Medicine 1983;98:498.
  6. Glover R, Young L, Goltz RW. Norwegian scabies in acquired immunodeficiency syndrome: Report of a case resulting in death from associated sepsis. Journal of the American Academy of Dermatology 1987;16:396-9.
  7. Taplin D, Meinking TL, Chen JA, Sanchez R. Comparison of Crotamiton 10% Cream (Eurax) and Permethrin 5% Cream (Elimite) for the Treatment of Scabies in Children. Pediatric Dermatology 1990;7:67-73.
  8. Taplin D, Meinking TL, Porcelain SL, et al. Community control of scabies: a model based on use of permethrin cream. The Lancet 1991;337:1016-8.
  9. Meinking TL, Taplin D, Herminda JL, Pardo R, Kerdel FA. The Treatment of Scabies with Ivermectin. New England Journal of Medicine 1995;333:26-30.
  10. Barkwell R, Shields S. Deaths associated with ivermectin treatment of scabies. The Lancet 1997;349:1144-5.
  11. Karrer S, Szeimies R-M, Wlotzke U, Stolz W, Hohenleutner U, Landthaler M. Steroidinduzierte Scabies norvegica. Der Hautarzt 1997;48:343-6.
  12. Tzenow I, Wehmeier M, Melnik B. Orale Behandlung der Scabies mit Ivermectin. Der Hautarzt 1997;48:2-4.
  13. Mancini AJ, Frieden IJ, Paller AS. Infantile acropustulosis revisited: history of scabies and response to topical corticosteroids. Pediatric Dermatology 1998;15:337-41.
  14. Chosidow O. Scabies and pediculosis. The Lancet 2000;355:819-26.
  15. Bezold G, Lange M, Schiener R, et al. Hidden scabies: diagnosis by polymerase chain reaction. British Journal of Dermatology 2001;144:614-8.
  16. Madan V, Jaskiran K, Gupta U, Gupta DK. Oral Ivermectin in Scabies Patients: A Comparison with 1% Topical Lindane Lotion. The Journal of Dermatology 2001;28:481-4.
  17. Victoria J, Trujillo R. Topical Ivermectin: A New Successful Treatment for Scabies. Pediatric Dermatology 2001;18:63-5.
  18. Chouela E, Abelda??o A, Pellerano G, Hern??ndez MaIs. Diagnosis and Treatment of Scabies. American Journal of Clinical Dermatology 2002;3:9-18.
  19. Katsumata K, Katsumata K. Norwegian Scabies in an Elderly Patient Who Died after Treatment with .GAMMA.BHC. Intern Med 2003;42:367-9.
  20. Orion E, Matz H, Wolf R. Ectoparasitic sexually transmitted diseases: Scabies and pediculosis. Clinics in Dermatology 2004;22:513-9.
  21. Perna AG. Localised genital Norwegian scabies in an AIDS patient. Sexually Transmitted Infections 2004;80:72-3.
  22. Scheinfeld N. Controlling Scabies in Institutional Settings. American Journal of Clinical Dermatology 2004;5:31-7.
  23. Wong SSY, Woo PCY, Yuen Ky. Unusual Laboratory Findings in a Case of Norwegian Scabies Provided a Clue to Diagnosis. Journal of Clinical Microbiology 2005;43:2542-4.
  24. Hengge UR, Currie BJ, Jäger G, Lupi O, Schwartz RA. Scabies: a ubiquitous neglected skin disease. The Lancet Infectious Diseases 2006;6:769-79.
  25. Dupuy A, Dehen L, Bourrat E, et al. Accuracy of standard dermoscopy for diagnosing scabies. Journal of the American Academy of Dermatology 2007;56:53-62.
  26. Kristjansson AK, Smith MK, Gould JW, Gilliam AC. Pink pigtails are a clue for the diagnosis of scabies. Journal of the American Academy of Dermatology 2007;57:174-5.
  27. Hu S, Bigby M. Treating Scabies. Arch Dermatol 2008;144.
  28. Bergstrom FC, Reynolds S, Johnstone M, et al. Scabies Mite Inactivated Serine Protease Paralogs Inhibit the Human Complement System. The Journal of Immunology 2009;182:7809-17.
  29. Hicks MI, Elston DM. Scabies. Dermatologic Therapy 2009;22:279-92.
  30. Kneisel A, Mittag H. Scabies norvegica sive crustosa. Aktuelle Dermatologie 2009;35:398-402.
  31. Mounsey KE, Holt DC, McCarthy JS, Currie BJ, Walton SF. Longitudinal Evidence of Increasing In Vitro Tolerance of Scabies Mites to Ivermectin in Scabies-Endemic Communities. Arch Dermatol 2009;145.
  32. Braun-Falco`s Dermatologie, Venerologie und Allergologie, 7. Auflage