Key distinguishing features of scabies include: intense itching that worsens at night (often severe enough to disrupt sleep), visible burrows or thin grayish-white lines on the skin (particularly in finger webs, wrists, elbows, or waistline), small red bumps or blisters in characteristic areas, and similar symptoms appearing in household members or close contacts simultaneously. A dermatoscope examination can reveal the 'delta wing' sign (mite head at end of burrow). Definitive diagnosis requires microscopic examination of skin scrapings showing mites, eggs, or feces. If you suspect scabies, seek medical evaluation as treatment requires prescription medication.

Over-the-counter treatments are available for both conditions. For lice, permethrin 1% shampoo and pyrethrin-based products can be purchased without prescription. For scabies, permethrin 5% cream is prescription-only in many regions but may be available over-the-counter in some countries. However, we strongly recommend medical evaluation because: (1) proper diagnosis confirmation prevents unnecessary treatment, (2) secondary bacterial infections may require antibiotics, (3) crusted scabies in immunocompromised individuals requires specialized care, (4) treatment failure may indicate resistance requiring alternative medications like oral ivermectin, and (5) pubic lice warrant STI screening. At Healers Clinic, we ensure accurate diagnosis and comprehensive treatment.

While the mites are killed within 1-2 days of proper treatment, itching can persist for 2-4 weeks after successful eradication due to the allergic reaction to mite proteins remaining in the skin. This post-scabietic pruritus does not indicate treatment failure. You should see improvement in the rash within 1-2 weeks, with gradual resolution of itching. If new burrows or bumps continue to appear after 2 weeks, or if household members develop symptoms, this may indicate treatment failure, reinfestation, or resistance requiring retreatment. A follow-up examination 2-4 weeks after initial treatment confirms eradication.

Scabies is primarily transmitted through prolonged, direct skin-to-skin contact (typically 15-20 minutes of close contact). Brief contact like a handshake or hug is unlikely to transmit scabies. While mites can survive 48-72 hours off human skin, fomite transmission (from bedding, clothing, furniture, or toilet seats) is uncommon and accounts for a small percentage of cases. However, crusted (Norwegian) scabies is highly contagious and can spread through brief contact and contaminated surfaces due to the massive mite burden. To prevent transmission, all close contacts should be treated simultaneously, and bedding/clothing washed in hot water.

Head lice (Pediculus humanus capitis) and body lice (Pediculus humanus corporis) are different subspecies with distinct characteristics. Head lice infest the scalp, attach eggs (nits) to hair shafts, and are spread through head-to-head contact or shared items. They do not transmit disease. Body lice live in clothing and bedding, moving to skin only to feed, and are associated with poor hygiene and overcrowding. Body lice can transmit serious diseases (epidemic typhus, trench fever, relapsing fever). Treatment differs: head lice are treated with shampoos and combing, while body lice require washing/drying clothing and bedding at high temperatures and improving hygiene conditions.

Complete house fumigation is unnecessary and potentially harmful. Focused environmental measures include: washing all bedding, clothing, and towels used in the past 3 days in hot water (50C/122F or higher) and drying on high heat; dry-cleaning or sealing unwashable items in plastic bags for 72 hours (scabies mites cannot survive beyond this without human contact); vacuuming carpets, upholstered furniture, and car seats; and not sharing personal items until treatment is complete. Pets do not need treatment - human scabies mites cannot survive on animals. The key to preventing reinfestation is treating ALL human contacts simultaneously, not environmental fumigation.