Adult Scabies Treatment (Scabies (Sarcoptes scabiei Infestation))
MD-only online care for suspected scabies in adults using guideline-based permethrin treatment and household decontamination plans. $49 flat-fee video visits, no insurance required, available in 25+ states.
TeleDirectMD is physician-led. You will always see a board-certified MD, not a mid-level provider. We focus on classic, uncomplicated scabies in adults and clearly identify when in-person evaluation is safer.
What Is Scabies (Sarcoptes scabiei Infestation)?
Scabies is an intensely itchy skin condition caused by microscopic mites called Sarcoptes scabiei. The mites burrow into the top layer of the skin, lay eggs, and trigger an allergic-type reaction that causes widespread itching and characteristic rashes.
It is usually spread through close, prolonged skin-to-skin contact, such as living in the same household or having sexual contact. Bedding and clothing can occasionally play a role in transmission, especially in crowded environments, but casual brief contact is less likely to spread classic scabies.
In adults, scabies often affects the hands (especially between the fingers), wrists, waistline, buttocks, and genital area but usually spares the head and neck in otherwise healthy individuals. TeleDirectMD focuses on classic scabies in adults and uses evidence-based topical regimens and household measures to clear infestation while screening for red flags that require in-person evaluation.
Scabies Symptoms and Red Flags
Scabies often presents with intense itching and characteristic bumps or lines. Certain patterns and host factors suggest complicated scabies or a different diagnosis and require in-person or urgent care.
| Symptom or pattern | What it suggests | Telehealth appropriate? | Red flag requiring in-person / ER care |
|---|---|---|---|
| Intense itching, especially at night | Classic symptom of scabies or other allergic/irritant eruptions | Often yes, if no signs of severe infection or systemic illness | Itching with widespread hives, swelling of lips or tongue, or breathing issues suggests allergic reaction and requires urgent care |
| Small bumps and thin lines between fingers, on wrists, or at waistline | Typical burrows and papules of classic scabies | Good fit for telehealth in adults with household exposure | Extensive crusting, thick scales, or large erosions raise concern for crusted scabies or secondary infection |
| Itchy rash on genitals and buttocks, plus similar symptoms in close contacts | Likely scabies or another contagious infestation | Yes for stable adults, with attention to partner treatment and environment | Painful open sores, pus, or spreading redness suggest secondary bacterial infection needing in-person care |
| Scratch marks with honey-colored crusts | Possible impetigo or secondary bacterial infection | Telehealth can triage; may need in-person or antibiotic therapy | Rapidly spreading redness, warmth, or systemic symptoms suggest cellulitis needing urgent in-person care |
| Thick crusted plaques on hands, feet, scalp, or body | Possible crusted (Norwegian) scabies with very high mite burden | No, this pattern requires in-person specialist care, often with systemic therapy | Crusted scabies in immunocompromised host is urgent and needs direct evaluation |
| Scabies-like rash in immunocompromised adult | Higher risk for extensive infestation or atypical presentations | Telehealth may provide initial advice but often requires in-person follow-up | Fever, malaise, rapidly spreading rash, or large crusted areas require urgent in-person evaluation |
| New intense itching in entire household or close contacts | Household scabies outbreak or bedbug/flea infestation | Yes for counseling and treatment of the adult TeleDirectMD patient | Infants, frail elderly, or severely immunocompromised household members should be evaluated in person |
| Rash with breathing difficulty, swelling, or dizziness after treatment | Possible allergic reaction to medication or another acute condition | No | Requires emergency department evaluation immediately |
Conditions That Can Mimic Scabies
Several other itchy rashes can resemble scabies. TeleDirectMD physicians consider these possibilities and use your history, rash pattern, and household exposures to guide the diagnosis and decide when in-person examination is needed.
Eczema and Atopic Dermatitis
Eczema can cause chronic itchy, dry, and scaly patches, often on the flexor surfaces of the arms and legs. Itching can be intense but is not usually limited to the classic scabies sites and may lack burrows. Eczema often responds to moisturizers and topical steroids rather than scabicide therapy.
Contact Dermatitis
Allergic or irritant reactions to soaps, detergents, or clothing materials can cause widespread itching and redness. The distribution often matches areas in direct contact with the trigger rather than scabies burrow sites and improves when the trigger is removed.
Bedbug or Flea Bites
Bedbugs and fleas cause clusters of itchy red bumps, often on exposed skin like arms, legs, and back. Unlike scabies, burrows are not present, and household inspection may reveal insects or droppings. Environmental control is essential, sometimes with pest control services.
Urticaria (Hives)
Hives appear as raised, pale or pink wheals that come and go within hours, often migrating to different areas. Scabies lesions tend to be more fixed over days to weeks and are accompanied by burrows and characteristic distribution.
Folliculitis and Bacterial Skin Infections
Folliculitis causes small red bumps centered on hair follicles, sometimes with pus. Pain or tenderness is more prominent than the intense, primarily itchy scabies pattern. Bacterial infection requires different treatment than scabies.
Drug Eruptions or Viral Exanthems
Medication reactions and some viral rashes can cause widespread itching and red spots. These often involve the trunk and extremities in a more uniform way, may be associated with fever or systemic symptoms, and require in-person assessment when concerning.
When Scabies Can Be Managed Through Telehealth
TeleDirectMD is well suited for adults with classic scabies features and stable overall health. More complex, extensive, or high-risk situations require in-person evaluation and sometimes systemic therapy.
When a TeleDirectMD Video Visit Is Appropriate
- Adult with intense itching, especially at night, and typical rash in web spaces of fingers, wrists, waistline, or genital area.
- Recent close contact with a partner or household member diagnosed with scabies.
- Localized or moderate body surface area involvement without thick crusts or large erosions.
- No high fever, systemic illness, or severe immunocompromise.
- Needs clear instructions on permethrin application, timing of repeat treatment, and household cleaning.
- Wants guidance on which close contacts should be treated and how long to avoid close skin contact.
Red Flags Requiring In-Person or ER Care
- Thick crusted plaques on hands, feet, scalp, or entire body suggesting crusted scabies.
- Severe skin breakdown, oozing, or rapidly spreading redness concerning for secondary bacterial infection.
- High fever, chills, or feeling very ill in association with the rash.
- Scabies-like rash in severely immunocompromised adults or residents of long-term care facilities.
- Signs of allergic reaction or serious side effects after any scabies treatment product.
- Infants, young children, or frail elderly household members who need direct pediatric or geriatric evaluation (TeleDirectMD serves adults).
How TeleDirectMD Treats Scabies in Adults
Treatment focuses on killing the mites and eggs on the skin, managing itching, and preventing reinfestation through household and contact measures. TeleDirectMD uses topical permethrin regimens for adults with classic scabies and does not prescribe oral ivermectin through this service.
Supportive Care and Itch Relief
- Cool compresses and lukewarm, not hot, showers to reduce itch.
- Short-term use of non-sedating or sedating over-the-counter antihistamines if appropriate for nighttime itching.
- Gentle fragrance-free moisturizers to support skin barrier, especially after treatment.
- Avoiding aggressive scratching to reduce skin breakdown and secondary infection.
First-Line Scabicide Treatment
For most adults with classic scabies, topical permethrin cream is the standard first-line treatment. It kills mites and eggs when applied correctly and repeated at an appropriate interval.
- Application to all skin from the neck down, including under nails, between fingers and toes, and in body folds.
- Leaving the cream on for the recommended number of hours before washing off.
- Repeating treatment once at a specified interval to ensure eradication of newly hatched mites.
TeleDirectMD prescribes topical permethrin for appropriate adult patients and focuses on careful application instructions rather than systemic scabicides.
Stewardship and Safety Principles
- Using topical treatment regimens that are well supported by guidelines for classic scabies in healthy adults.
- Not prescribing oral ivermectin or other systemic scabicides through this telehealth service.
- Avoiding overuse or repeated unnecessary courses when itching persists due to post-scabetic reactions rather than active infestation.
- Recommending in-person dermatology or primary care follow-up when rash persists or diagnosis is uncertain.
- No controlled substances are prescribed for scabies visits.
Common Medications Used for Scabies in Adults
The table below summarizes typical topical permethrin regimens for classic scabies in adults and supportive options for itch relief. TeleDirectMD individualizes recommendations based on rash pattern, comorbidities, and household exposures.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Permethrin 5 percent cream | Apply from neck down to all skin, including under nails, leave on 8–14 hours, then wash off | Single application, usually repeated once after 7–14 days | First-line scabicide for classic scabies in most nonpregnant adults with typical rash and exposure history. |
| Second permethrin 5 percent treatment | Same application as initial dose | One repeat treatment at MD-directed interval | Used to kill mites that hatch from eggs after the first treatment and decrease risk of treatment failure. |
| Topical permethrin for close adult contacts | Same application instructions as index case | Single or two-dose regimen as directed | Recommended in many household or sexual contacts, especially if symptomatic or with prolonged close contact. |
| Oral nonsedating antihistamine (for example cetirizine) | Typical over-the-counter adult dose | Short course as needed for itch, per label and MD advice | Used to help manage itching, particularly during the first days after treatment when immune reaction persists. |
| Oral sedating antihistamine (for example diphenhydramine) | Typical adult bedtime dose if safe for patient | Short course at night only | Select adults may use for nighttime itch, with caution regarding drowsiness and avoidance in unsafe situations such as driving. |
These examples reflect common adult patterns for classic scabies. TeleDirectMD does not prescribe oral ivermectin or other systemic scabicides through this program and does not use controlled substances for scabies-related itching. In-person evaluation is advised when crusted scabies, severe infection, or unclear diagnosis are suspected.
Home Care, Environmental Cleaning, and Return to Activities
Successful scabies management includes treating the skin, addressing close contacts, and cleaning the environment to prevent reinfestation. Most adults can return to work and regular activities after appropriate treatment has started.
Home Care After Treatment
- Follow the MD’s instructions exactly for permethrin application and repeat dosing.
- Change into clean clothes after washing off the cream and place used clothing and towels in laundry.
- Expect that itching can continue for days to weeks even after mites are killed; this does not always mean treatment failure.
Household and Environmental Measures
- Wash bedding, clothing, and towels used within several days before treatment in hot water and dry on high heat when possible.
- Items that cannot be washed may be sealed in a bag for several days based on MD instructions.
- Encourage evaluation and treatment of close contacts who share a bed, live in the same household, or have frequent skin-to-skin contact.
Work, School, and When to Recheck
- Many adults can return to work or school after completing the first treatment and changing into clean clothes, based on local policies.
- Schedule follow-up if new burrows or lesions appear after the full course, or if itching worsens rather than slowly improving.
- Seek in-person care for fever, rapidly spreading redness, pus, or other signs of secondary infection.
TeleDirectMD Scabies Care: What to Expect
TeleDirectMD provides MD-only virtual urgent care for adults, with $49 flat-fee video visits available in 25+ states. Our physicians evaluate your history, household exposures, and rash pattern, then prescribe guideline-based topical permethrin when appropriate and outline clear steps for contact management and environmental cleaning. We do not prescribe oral ivermectin or controlled substances and will direct you to in-person dermatology, primary care, or urgent care when crusted scabies, severe infection, or other red flags make telehealth alone unsafe.
Scabies FAQs for Adults
These questions cover how scabies spreads, how it is treated, what to expect after treatment, and when in-person care is necessary.
Scabies is usually spread through close, prolonged skin-to-skin contact, such as living in the same home or having sexual contact. It can affect people of any hygiene level and does not mean someone is unclean. Crowded conditions make spread more likely.
In many adults with classic symptoms, distribution, and household exposure, an experienced MD can make a working diagnosis and start topical treatment via video. If the rash is atypical, crusted, or associated with systemic symptoms, we will recommend in-person evaluation instead of relying on telehealth alone.
Itching often begins to improve within a few days to a couple of weeks after effective treatment, but it can persist for several weeks as the immune system calms down. Persistent itching alone does not mean treatment failed, especially if no new burrows or bumps appear.
A second treatment is often recommended about 7–14 days after the first to kill mites that hatch from eggs that survived the initial application. This two-step approach improves the chance of clearing infestation and reducing reinfestation risk.
Many guidelines recommend treating household members and close skin-to-skin contacts, even if they do not yet have symptoms, to prevent ongoing transmission. During your visit, the MD will discuss which contacts should be treated and how they can seek care.
Wash bedding, towels, and clothing used in the days before treatment in hot water and dry on high heat when possible. Items that cannot be washed can be sealed in a bag for several days. Routine cleaning and vacuuming are reasonable; extensive disinfection is usually not necessary for classic scabies.
No. TeleDirectMD uses topical permethrin regimens for appropriate adult cases and does not prescribe oral ivermectin or other systemic scabicides through this virtual urgent care service. More complex cases that may need systemic therapy are referred for in-person evaluation.
Classic scabies itself is usually not an emergency and can be managed with outpatient treatment. However, high fever, rapidly spreading painful redness, crusted scabies, or signs of allergic reaction to medication require urgent or emergency in-person evaluation.
Policies vary, but many adults can return to work or school after completing the first permethrin treatment and changing into clean clothes, as long as they feel well and local rules are followed. Your MD can provide guidance consistent with workplace policies.
No. TeleDirectMD does not prescribe controlled substances for scabies or associated itching. Care focuses on topical permethrin, over-the-counter options when appropriate, and careful triage for any concerning symptoms that need in-person care.