Overview
Scabies is a contagious skin disease caused by the itch mite Sarcoptes scabiei. The female mites dig fine burrows into the uppermost layer of the skin and lay their eggs there. The immune system's reaction to the mites, their eggs and their excretions causes the characteristic, tormenting itch, which becomes markedly worse at night and in the warmth of the bed. Scabies is not a sign of poor hygiene and occurs in all population groups; in recent years, case numbers in Germany have risen considerably again. Many affected people delay seeing a doctor out of shame – yet the condition is very treatable. At OpenClinic24 you describe your symptoms discreetly via a structured questionnaire and upload photos of the affected skin areas. Following medical assessment, a topical antiscabietic, such as a permethrin-containing cream, can be prescribed via private prescription. If the findings are unclear, you receive a clear recommendation for further in-person evaluation.
Common causes
Scabies is transmitted almost exclusively through prolonged, direct skin-to-skin contact – brief touches such as shaking hands are generally not sufficient. Typical transmission routes are living in the same household, sharing a bed, close physical contact when cuddling with children, and sexual contact. Outbreaks also occur repeatedly in community facilities such as daycare centres, schools, care homes or shared accommodation. Indirect transmission via clothing, bed linen or upholstered furniture is less common but possible, as the mites can survive outside the body for a few days. With a first infection, it usually takes two to five weeks from infection to the first symptoms; with reinfection, the itching often starts after only a few days. During this period, affected people can already be contagious without knowing it.
When to see a doctor
Medical evaluation is advisable as soon as scabies is suspected – especially with itching that is worse at night, visible mite burrows, or when several people in the household are affected. Without treatment, the condition does not usually resolve on its own. You should be examined in person promptly if there are warning signs of a bacterial superinfection such as fever, rapidly spreading redness, warmth, pus formation or severe skin pain. Extensively crusted skin changes (suspected crusted scabies), symptoms in infants, pregnant women or immunocompromised people, and a lack of improvement despite correctly performed treatment also belong in a local practice. If there are signs of a severe general reaction – such as shortness of breath, impaired consciousness, confusion or circulatory collapse – call emergency services 112 immediately.