There are many signs and symptoms of scabies. The most common and earliest one is intense itching.  The itching represents sensitization, a type of allergic reaction, to the adult female mites, their eggs, and their waste. Itching tends to be more severe at night and has the potential to interrupt the sleep of infested individuals. Along with the itching, you may develop a rash. The rash also represents an allergic reaction to the mite. The rash is typically described as pimple-like with surrounding inflammation and redness.  Mites prefer to burrow into the skin in certain parts of the body.  The most common places that adults can have an itchy rash associated with scabies are the hands, especially the webbing between the fingers, the skin folds of the wrist, elbow, or knee, the buttocks, the waist, the penis, the skin around the nipples, the armpits, the shoulder blades, and the breasts.  In children, the most common sites of infestation include the scalp, face, neck, palms of the hands, and soles of the feet. When you have scabies, tiny burrows are sometimes visible on the skin. These appears as tiny raised and crooked grayish-white or skin-colored lines on the surface of the skin. They are usually a centimeter or more in length. Burrows may be difficult to find as most people have only 10 to 15 mites in an average infestation. The intense itching caused by scabies sometimes leads to sores on the skin. The sores are at high risk for infection, which is often a complication of scabies. The sores are most often infected with bacteria such as Staphylococcus aureus, or beta-hemolytic streptococci, which predominate on the skin.   These bacteria can also lead to inflammation of the kidneys and sometimes sepsis, which is a life-threatening bacterial infection of the blood.  To avoid this, try to be gentle on your skin and do not scratch it. If you can't help yourself, consider wearing mittens or wrapping your fingertips with band-aids to keep yourself from damaging the skin. Keep your nails trimmed short. Signs of infection include increased redness, swelling, pain, or pus or discharge from the sores. If you believe your rash is infected, call your doctor right away. Your doctor can prescribe an oral or topical antibiotic to treat the infection. There is another form of scabies that has an additional symptom. Crusted scabies, also known as Norwegian scabies, is a severe form of the infestation. It is characterized by tiny blisters and thick skin crusting that can cover large areas of the body.  Crusted scabies primarily occurs in individuals with weakened immune systems. The impaired immune response allows mites to reproduce unchecked, with some infestations reaching upwards of two million mites.  Another consequence of the impaired immune response is that itching and the rash may be less severe or totally absent. You are at risk for the development of crusted scabies if you are elderly, have a weakened immune system, or are living with HIV/AIDS, lymphoma, or leukemia. You are also at risk if you have received an organ transplant and have any condition that may prevent you from itching or scratching, such as a spinal cord injury, paralysis, loss of sensation, or mental debility.
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