Conditions
Scabies: intense night itching and how to treat the whole household
Scabies is an infestation of the skin by a tiny mite that causes intense itching, especially at night, and a pimple-like rash between the fingers, on the wrists and in other skin folds. It is treated with prescription creams or lotions: over-the-counter products do not cure it. The doctor evaluates you by video and, if appropriate, prescribes and we send your prescription to your pharmacy.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Fever with a red, warm, swollen area that grows fast, or red streaks on the skin
- Widespread pus or yellow crusts from scratching, especially in a baby
- A rash with fever and spots that don’t fade when you press a glass on them
- Swelling of the face, lips or tongue, or trouble breathing
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At a glance
Scabies
Common symptoms
- Intense itching, worse at night
- A pimple-like rash
- Thin lines on the skin, like pencil marks (the mite’s burrows)
- Itching between the fingers, on the wrists, elbows, armpits, waist or genital area
- In babies and young children, a rash on the head, face, neck, palms and soles as well
- Other names
- Human itch mite infestation
- Treatment
- Prescription scabicide cream, lotion or pill, for the patient and close contacts, when the medical evaluation calls for it
- Possible complication
- Bacterial skin infection from scratching, such as impetigo
On this page(8)
What is scabies?
Scabies is caused by a microscopic human itch mite that burrows into the top layer of the skin to live and lay eggs. The itch is an allergic reaction to the mite and what it leaves in the skin. If you itch but no one else at home is scratching, see also itchy skin.
It spreads mainly through direct, prolonged skin-to-skin contact with someone who has it: sharing a bed, hugging and carrying children, or sex. Spread through clothing, towels or bedding is less common, and pets do not spread human scabies. That is why whole families often get it, and why outbreaks happen in nursing homes, child care centers and dorms. Scabies is not the same as head lice, which live in the hair on the head.
The first time, symptoms take 4 to 8 weeks to appear, and you can spread it during that time.
How we treat scabies by video
You see Dr. Diana Nieves Castro, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. Scabies is diagnosed from the kind of itch, where the rash is, and whether others at home are scratching too. Show your skin on camera in good light, or send photos only through the secure link we send you.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. Because the people you live with need treatment at the same time, the doctor explains who needs it. Each person who needs their own prescription has their own visit, and patients under 21 need a parent or legal guardian on camera with ID.
We see adults and children of all ages; for babies and young children the doctor chooses a treatment that is safe for their age. You need to be physically in Puerto Rico during the visit. See also our online skin care.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Request a visit online 24/7 — we confirm your time by email or text.
Request your visit.
Book a visit and choose "Doctor visit". You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer.
Get your plan.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy, with instructions for washing clothes and bedding.
What the visit costs
Scabies is handled in a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note after your visit is included at no extra charge. See all prices.
Scabies symptoms
The most common signs are:
- Intense itching, worse at night
- A pimple-like rash
- Thin lines on the skin, like pencil marks (the mite’s burrows)
- Itching between the fingers, on the wrists, elbows, armpits, waist or genital area
- In babies and young children, a rash on the head, face, neck, palms and soles as well
Scabies treatment
Scabies is treated with prescription creams, lotions or pills that kill the mite (scabicides). Over-the-counter products and insecticide sprays do not treat it. The cream goes on the whole body from the neck down, on clean skin, and is usually repeated after a week; in young children it also goes on the head and neck. Follow the instructions exactly.
The whole family and sexual partners are treated at the same time, even without symptoms, so the mite doesn’t pass back and forth. Avoid skin-to-skin contact until treatment is done, and tell anyone you had close contact with in the past two months.
The itch can last 2 weeks or more after treatment, even when the mites are dead. If it continues after 2 to 4 weeks or new spots appear, the doctor decides whether to repeat treatment in a follow-up visit.
- Before treatment, wash clothes, towels and bedding in hot water and dry them on high heat.
- Seal anything you can’t wash in a plastic bag for at least 72 hours.
- Vacuum carpets and upholstered furniture.
- For the itch, a cool bath or calamine lotion helps.
When you need in-person care
A severe form, crusted (Norwegian) scabies, causes thick crusts and huge numbers of mites. It mostly affects older adults and people with a weakened immune system, and it spreads very easily. If crusted scabies is possible, or if scratching has infected the skin (pus, yellow crusts, a red and warm area), you need to be seen in person. See impetigo and cellulitis.
For your safety: go to the emergency room or call 911 if you have any of the warning signs on this page.
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
Can scabies be treated by video?
Why does scabies itch more at night?
Does the whole family need treatment?
Why do I still itch after treatment?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (3)
- Scabies (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- About Scabies (CDC) (opens in a new tab) (accessed 2026-10-02)
- Treatment of Scabies (CDC) (opens in a new tab) (accessed 2026-10-02)