Scabies and Lice: How to Tell, How They Spread, and Getting Treated the Same Day

Scabies is caused by tiny mites that burrow into the skin, causing an intensely itchy rash that's usually worst at night, often between the fingers, on the wrists, at the waistline and in skin folds. Head lice are small insects that live in the hair and lay eggs (nits) close to the scalp. Both spread through close contact, both are common, and neither is a sign of being unclean. Scabies needs a prescription. Lice can often be treated with over-the-counter products, but a clinician can help when they don't work.

What scabies looks like

• Intense itching, usually worse at night
• A rash of small red bumps or blisters, sometimes in thin, wavy lines (burrows)
• Common spots: between the fingers, wrists, elbows, armpits, waistline, buttocks, groin, and around the nipples
• In babies and young children: the palms, soles, head and neck too

If you've never had scabies, symptoms can take two to six weeks to appear after you catch it. You can spread it during that time.

What head lice look like

• Itching on the scalp, behind the ears and at the back of the neck
• Tiny tan or gray insects moving in the hair, about the size of a sesame seed
• Nits: small white or yellow eggs glued to hair shafts near the scalp, which don't flick off like dandruff
• A tickling feeling of something moving in the hair

Lice are most common in children ages 3 to 11 and their families.

How they spread

Scabies spreads through prolonged skin-to-skin contact: living in the same home, sleeping in the same bed, sexual contact, or caring for someone. It spreads less often through shared bedding, towels or clothing. Outbreaks happen in nursing homes, dorms and childcare.

Lice spread mostly through head-to-head contact, and sometimes through shared hats, brushes, headphones or pillows. They can't jump or fly, and pets don't carry them.

Treating scabies

Scabies needs a prescription: usually a cream applied from the neck down and left on overnight, or a pill. Everyone in the household and close contacts should be treated at the same time, even without symptoms, or it keeps passing back and forth. Itching can last two to four weeks after treatment while the skin heals. That doesn't mean it failed, though a second treatment is sometimes needed.

Treating lice

• Use an over-the-counter lice shampoo or lotion exactly as directed
• Comb wet hair with a fine-toothed nit comb every two to three days for two weeks
• Repeat the treatment if the product says to, usually after 7 to 10 days
• Check everyone in the household, and treat only those who have lice

If lice are still moving after two treatments, prescription products are available.

Cleaning your home

• Wash bedding, towels and clothing used in the last 3 days (scabies) or 2 days (lice) in hot water and dry on high heat
• Seal items you can't wash in a plastic bag: 3 days for scabies, 2 weeks for lice
• Vacuum floors and furniture
• Soak combs and brushes in hot water for 10 minutes

There's no need to spray the house with insecticides.

When to get seen

Come in for an itchy rash that's worse at night, a rash shared by people in your home, lice that over-the-counter treatment hasn't cleared, or skin that's broken and looks infected from scratching. A clinician can usually diagnose scabies by looking at the skin, and can prescribe treatment for you and your household. At an AfterOurs clinic, a standard self-pay visit is $175, and a self-pay in-clinic visit never costs more than $330. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare. See our lice and scabies page and the cost and insurance page. Our rash guide covers other itchy rashes.

Get seen the same day if scratched skin becomes red, hot, swollen, painful or starts draining pus. Go to the ER if that comes with a high fever, or if you see thick, crusted, scaly skin spreading over large areas in someone who is elderly or has a weakened immune system.

Where to find us

Four clinics across metro Denver, all ages welcome, se habla español:

• Hampden (Southeast Denver): 8 AM–11 PM daily
• Littleton: 8 AM–11 PM daily
• Thornton: 8 AM–11 PM daily
• Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM

Walk in, or book online.