Adult Scabies Treatment (Sarcoptes scabiei Infestation)
MD-only scabies evaluation and treatment by secure online video visit, $49 flat-fee, no insurance required.
Scabies is a contagious skin infestation caused by a microscopic mite that spreads through close skin-to-skin contact. It often causes intense itching, especially at night, and can appear as small bumps, burrows, or a rash in typical areas like wrists, finger webs, waistline, groin, and ankles. TeleDirectMD physicians evaluate whether your symptoms and exposure history fit scabies and prescribe evidence-based treatment when appropriate. Because scabies commonly spreads within households, treatment planning and environmental steps matter as much as the prescription. If you have severe skin infection, high fever, or signs of crusted scabies, urgent in-person care is required.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
Last reviewed on January 21, 2026 by Parth Bhavsar, MD
Online MD-Only Scabies Care
- Adults 18+ with classic scabies symptoms or known exposure
- Prescription treatment when appropriate, plus household guidance
- Symptom relief for itching and post-scabies irritation
- Clear triage for infection or crusted scabies
Adults 18+ only. No controlled substances are prescribed through TeleDirectMD. Fever, rapidly worsening redness, severe pain, pus drainage, facial or eye involvement, or thick crusted plaques require urgent in-person evaluation.
What Is Scabies?
Scabies occurs when mites burrow into the outer layer of skin and trigger an allergic-type reaction. The itching can be intense and is often worse at night. The rash may include small bumps, tiny blisters, scratch marks, or thin burrow lines. Symptoms can take weeks to appear after a first exposure, but people who have had scabies before may develop symptoms sooner after re-exposure.
TeleDirectMD focuses on adult scabies evaluation and treatment when the pattern is classic and telehealth is safe. If the diagnosis is uncertain or complications are present, an in-person exam may be required.
Scabies Symptoms and Red Flags
Scabies can look like other itchy rashes. A careful history of exposure, symptom pattern, and rash distribution helps determine whether telehealth treatment is appropriate.
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Intense itching worse at night with bumps on wrists, finger webs, waistline, groin | Classic scabies pattern | Yes, often appropriate | No |
| Known close-contact exposure with similar symptoms in household or partner | High likelihood of scabies | Yes | No |
| Itchy rash with no clear exposure and atypical distribution | Could be dermatitis, bites, eczema, or other rash | Sometimes, depends on images and history | In-person if worsening, severe, or diagnosis unclear |
| Honey-colored crusting, pus, increasing warmth and tenderness | Possible bacterial skin infection from scratching | No as scabies-only care | Urgent evaluation |
| Fever, rapidly spreading redness, severe pain | Possible severe infection | No | Urgent or emergency evaluation |
| Thick crusted plaques, widespread scaling, minimal itch | Possible crusted scabies, highly contagious | No | Urgent in-person dermatology or ER |
| Face or eye involvement | Needs in-person assessment | No | Urgent evaluation |
| Pregnancy or trying to conceive | Medication selection needs careful review | Telehealth may triage | In-person follow-up may be needed depending on scenario |
Differential Diagnosis
Several conditions can mimic scabies. TeleDirectMD evaluates your rash pattern, timing, and exposure history to help distinguish scabies from other common causes of itching.
Conditions That Can Look Similar
- Bedbug bites or other insect bites
- Contact dermatitis
- Atopic dermatitis (eczema)
- Urticaria (hives)
- Folliculitis
- Head or body lice infestation
Clues That Support Scabies
- Itching that is worse at night
- Rash in classic locations, especially finger webs and wrists
- Close-contact exposure or multiple people itching in the household
- Burrow-like lines or clustered bumps
When Is a Video Visit Appropriate for Scabies?
When a Video Visit Is Appropriate
- Adult 18+ with classic scabies symptoms and distribution
- Known close-contact exposure or similar symptoms in household
- No fever or signs of severe skin infection
- No thick crusted plaques or widespread scaling
- Able to follow household and linen instructions
Red Flags Requiring In-Person or ER Care
- Fever, rapidly spreading redness, severe pain, pus drainage
- Thick crusted plaques or widespread scaling
- Immunocompromised state with extensive rash
- Face or eye involvement
- Severe allergic reaction symptoms
If any red-flag symptoms are present, seek urgent in-person or emergency care. TeleDirectMD is not an emergency service.
Scabies Treatment Options
Effective treatment requires both medication and household steps to prevent reinfestation. Even after successful treatment, itching can persist for 2 to 4 weeks due to the skin reaction. That does not always mean treatment failure.
What TeleDirectMD Can Do
- Evaluate whether your symptoms fit classic scabies
- Prescribe first-line treatment when appropriate
- Provide clear instructions for treating close contacts
- Recommend itch relief and skin care to reduce scratching
Household and Contact Treatment
- Close household contacts and intimate partners are typically treated at the same time, even if they have no symptoms.
- Wash clothing, towels, and bedding used in the prior 3 days in hot water and dry on high heat.
- Items that cannot be washed can be sealed in a bag for at least 72 hours.
- Vacuum upholstered furniture and common seating areas.
If symptoms are not improving after correct treatment, or new lesions continue to appear more than 2 weeks after therapy, an in-person exam may be needed to confirm diagnosis and rule out reinfestation or another rash.
Common Medications Used for Adult Scabies
TeleDirectMD can prescribe scabies treatment for adults when clinically appropriate. The table below lists common examples and typical usage instructions.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Permethrin 5% cream | Apply from neck down to all skin surfaces, including under nails, leave on 8 to 14 hours, then wash off | Repeat 1 time in 7 days | First-line treatment for classic scabies in most adults |
| Oral ivermectin | 200 mcg/kg by mouth once, then repeat once in 7 to 14 days | 2 doses total in most cases | Alternative regimen when appropriate, often for outbreaks or when topical therapy is not feasible |
| Cetirizine 10 mg tablet | 10 mg by mouth once daily as needed for itching | 7 days to 21 days as needed | Itch relief while the skin reaction calms |
| Hydrocortisone 1% cream OTC | Apply a thin layer to itchy areas 1 to 2 times daily as needed | Up to 7 days | Symptom relief for post-treatment irritation when appropriate |
Medication choice depends on your history, pregnancy status, and clinical presentation. Crusted scabies, severe infection, or uncertain diagnosis requires in-person evaluation.
Home Care, Contagiousness, and Return to Work
Scabies spreads through close contact, so household coordination is important. Many adults can return to work after appropriate treatment has started, depending on the setting and employer policies.
- Avoid close skin-to-skin contact until treatment has been completed and close contacts have been addressed.
- Trim fingernails and clean under nails to reduce mite persistence and prevent skin infection from scratching.
- Moisturize skin after treatment to reduce irritation and itching.
- Seek urgent care for fever, rapidly worsening redness, pus drainage, or severe pain.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual care for adults using secure video visits to evaluate suspected scabies and prescribe treatment when clinically appropriate. Visits are $49 flat-fee with no insurance required and are available in 25+ states. Our physicians provide clear home and household instructions and explain when in-person evaluation is needed. TeleDirectMD is not an emergency service.
Adult Scabies FAQs
Can TeleDirectMD treat scabies through an online visit?
Yes, for many adults 18+ with classic symptoms and no red flags. Your MD reviews rash pattern, exposure history, and any concerning symptoms, then prescribes treatment when appropriate.
What does scabies usually feel like?
Scabies often causes intense itching that is worse at night, along with small bumps or a rash in areas like wrists, finger webs, waistline, groin, and ankles.
How do I apply permethrin correctly?
Apply permethrin 5% cream from neck down to all skin surfaces, including under nails, leave it on 8 to 14 hours, then wash it off. A repeat application in 7 days is commonly recommended.
Do I need to treat my household contacts?
Often yes. Close household contacts and intimate partners are commonly treated at the same time to reduce reinfestation, even if they have no symptoms.
Do I need to wash everything in my home?
Focus on clothing, towels, and bedding used in the prior 3 days. Wash in hot water and dry on high heat. Items that cannot be washed can be sealed in a bag for at least 72 hours.
Why am I still itching after treatment?
Itching can persist for 2 to 4 weeks after successful treatment due to the skin reaction. Your MD can recommend itch relief measures. New burrows or new bumps continuing beyond 2 weeks may suggest reinfestation or another rash.
When should I seek urgent care instead of telehealth?
Seek urgent care for fever, rapidly spreading redness, severe pain, pus drainage, thick crusted plaques, face or eye involvement, or any symptoms suggesting a severe infection.
Is scabies a sign of poor hygiene?
No. Scabies can affect anyone and spreads through close contact. Prompt treatment and household steps are the key to stopping spread.
Can scabies be sexually transmitted?
Scabies spreads through close skin-to-skin contact, including intimate contact. Partners often need evaluation and may need treatment at the same time.
What makes TeleDirectMD different for scabies care?
TeleDirectMD provides MD-only video visits for adults with a $49 flat-fee model in 25+ states. We focus on clear diagnosis logic, correct medication instructions, household guidance, and safety triage for complications.
Think you may have scabies?
$49 flat fee. Adult-only video visits. MD-only care. Evidence-based treatment when appropriate, plus household guidance to stop reinfestation.