Doctors explain infectious skin condition symptoms 'that can take eight weeks to appear'

Scabies is a common, yet often misunderstood, skin condition. It triggers itching and rashes, similar to other skin conditions, making it challenging to diagnose.

Experts have provided some insights on how to identify, manage, and prevent this infectious disease.

"Scabies is a common skin infestation caused by the Sarcoptes scabiei mite," clarifies Dr Miriam Mikicki, GP and functional medicine practitioner at health.miro. "These mites lay eggs under the skin, causing an allergic reaction that leads to intense itching and a distinctive rash."

According to the NHS website, symptoms may not appear until up to eight weeks after initial infection, as the body requires time to develop an allergic response to the mites. The site also mentions that scabies typically affects skin between the fingers, around the wrists, underarms, waist, groin, and bottom.

Dr Aleksandar Godic, consultant dermatologist at The Harley Street Dermatology Clinic, explains: "Scabies mites prefer warm, moist areas of the body, such as external genitalia, beneath the breasts, between the buttock folds, webs of the fingers and toes, and under the fingernails."

The NHS website states that individuals with a compromised immune system can occasionally contract a rare form of scabies known as crusted (Norwegian) scabies. "This form involves a widespread infestation with a large number of mites and is highly contagious," adds Dr Godic.

"The most characteristic sign of scabies is the presence of burrows, which appear as small, curved lines on the skin," explains Dr Godic. "However, these can be difficult to see.

"Other common symptoms include small, weepy spots, redness and swelling, intense itching, especially at night or in warm environments, inflamed, scaly scratch marks, often resembling severe eczema."

"You should seek medical advice if a rash is persistent, worsening or intensely itchy, particularly if it doesn't respond to over-the-counter treatments," recommends Dr Sophie Momen, consultant dermatologist at the Cadogan Clinic.

"Scabies should be suspected if multiple household members are itching, the rash appears in classic areas like between fingers or around the waist, or if burrow marks are visible. If you develop signs of infection (such as pus, swelling or fever), immediate medical attention is necessary."

Scabies is highly infectious. "Scabies spreads primarily through prolonged direct skin contact with an infected person," notes Dr Godic.

"In rare cases, it can also be transmitted through infested towels, clothing, or bedding."

Dr Momen adds: "Because symptoms can take several weeks to appear, people may unknowingly spread scabies before realising they are infected, making early detection and treatment crucial."

Scabies can affect anyone, but those in close-contact environments are more susceptible. "Infants, the elderly, and those with weakened immune systems are more vulnerable, as their bodies may struggle to control the infestation, sometimes leading to crusted scabies," says Dr Momen. "Healthcare workers, carers and individuals with frequent skin-to-skin interactions also face an increased risk of exposure."

While scabies is typically not a severe condition, it does require treatment. "First-line treatment usually involves a permethrin-based cream, which effectively kills the mites," says Dr Godic. "But, if permethrin is ineffective, a lotion containing malathion may be used. For severe cases (crusted scabies), oral ivermectin is prescribed."

As the itching is an allergic reaction, symptoms may continue even after the mites have been killed. "To relieve discomfort, doctors may prescribe topical steroid creams for inflammation and itchiness," adds Dr Godic.

Dr Mikicki emphasises that all close contacts must be treated simultaneously to prevent reinfection.

"Preventing scabies involves avoiding prolonged skin contact with infected individuals and not sharing personal items like clothing or bedding," says Dr Momen. "In high-risk settings, frequent hand washing and maintaining personal hygiene helps reduce transmission."