Is Your Scabies Worse After Treatment?

Updated on February 10, 2018
Scabies typically follow a highly predicable pattern: the writs, between the fingers, between the toes, and the groin are extremely common targets for infestation.
Scabies typically follow a highly predicable pattern: the writs, between the fingers, between the toes, and the groin are extremely common targets for infestation.

Don't Despair

Firstly, it is important to stress that just because your symptoms are not gone after applying treatment, it does not mean that the treatment has failed. With scabies, it is normal for itchiness and bumps to persist for up to a month after treatment, however, they will progressively diminish and fade as time goes by.

It is perfectly normal if your itch is just as intense or worse the day after you apply the treatment. The itchiness is caused principally by two things: the movement of the mites and your bodies immune reaction to the mites. Your body is allergic to the mites and the stuff that they leave behind (I bet you can guess what that is). Just because you have killed the mites does not mean that your body will stop reacting to them; your body will still exhibit a reaction to the mites' droppings. It will take time for your body to work them out of your system.

Scabies often affect the groin, which can be intensely itchy and socially awkward to scratch.
Scabies often affect the groin, which can be intensely itchy and socially awkward to scratch.

What Doesn't Work

  • Non-sedating antihistamines are not much use for providing itch relief. However, they do provide relief from some other conditions which are confused with scabies.
  • Natural treatments are unlikely to be particularly helpful as none have been shown to be effective treatments for scabies.

What You Can Do to Make Things Better

There are a number of things you can do to make yourself feel better while the treatment takes effect.

  • Take lukewarm showers.
    • You have probably noticed that taking a very hot shower makes the itching much worse. It makes sense, then, to turn down the temperature of your shower. A short, lukewarm shower is your best bet.
  • Take frequent showers.
    • This can help get the substances you are allergic to out of your system more quickly. However, don't overdo it. There is no need to shower more than twice a day. Excessive showering can make the irritation worse.
  • Use sleep aids only if necessary.
    • If you are having trouble sleeping, you may wish to ask your doctor for sedating antihistamine or another sleep aid. For milder cases, an over-the-counter product like Horlicks could help.
  • Cut your nails to reduce the risk of infection.
    • With scabies, it is possible to get a secondary infection such as impetigo if you scratch too much.
  • Wear loose clothing.
    • Wearing loose, cotton or silk clothing helps minimize skin irritation.

In very extreme cases, a doctor may prescribe an antidepressant to help you sleep

Permethrin 5% cream: The most common and effective treatment. This cream is highly effective at treating scabies.
Permethrin 5% cream: The most common and effective treatment. This cream is highly effective at treating scabies.

How to Prevent Reinfestation

Probably the most common reason for treatment failure is reinfestation. You should take steps to minimize the chances of this. This can be accomplished by following a few simple precautions.

  • Wash all of your clothes, bedding, and towels at over 50 oC. Anything that can't be washed should be sealed away for at least 3 days.
  • Household members (especially your partner or anyone you have prolonged skin contact with) must be treated simultaneously.
  • Apply the treatment (unless directed otherwise) twice, 7-10 days apart.

Reasons for Treatment Failure

If your symptoms persist for more than six weeks after treatment, there may be a treatment failure. There can be a number of reasons for this. In any case, speak with your doctor again and inform them of any changes (or lack thereof). Report any side effects of the treatment.

  1. Consider whether you applied the treatment exactly as directed.
    • Before deciding that the diagnosis or treatment was incorrect, determine whether you followed the treatment regimen as directed.
    • If even one mite survived, then you are not completely cured. This one mite may be enough to trigger reinfestation.
    • It is essential to apply the cream so that every part of the body is covered, usually excluding the face and head, unless specifically directed.
      • Common places missed include the cleft of the buttocks, the genitals, between the toes, and under the fingernails
    • This is why it's advisable to apply the 5% permethrin cream twice 7-10 days apart. However, it should be noted that the first application is 90% effective.
  2. If you are sure you applied the treatment correctly, there is a chance of an incorrect diagnosis.
    • Some other conditions present with similar indicators to scabies.
      • Presence of pimples and burrow-like structures may first be seen as scabies.
    • The only conclusive evidence of scabies is the presence of the scabies mite when skin samples are examined under a microscope.
    • Talk with your doctor to explore other possible causes of your symptoms. Your doctor can confirm or rule out scabies by examining a skin scraping.
  3. Reinfestation is another possibility.
    • Your treatment could have worked, but you may have picked it up again from your surroundings or other people.
    • This is why everyone you may have regular, prolonged skin contact with should be treated simultaneously, even if they do not have symptoms.
    • You should also thoroughly clean all of your clothes, furniture, carpet, and anything else made of fabric that you come in contact with regularly.

Nodular Scabies (Post-Scabies Syndrome)

If symptoms persist beyond six weeks, it is still possible that you did, in fact, have scabies and the treatment was, in principle, successful in that the mites are now dead. This is because some people have a hypersensitivity to mites and their leftovers. This causes the immune reaction and the itching to continue beyond what is normally associated with scabies. There is evidence that tacrolimus 0.03% ointment is an effective treatment for nodular scabies.

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This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers


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      • profile image

        Jennifer Smithey 

        2 years ago

        My soars are still help and bad after 3 months. They are I n my neckline and still itch. How else beside me pulling the black dots out can I get rid of them. HELP

      • profile image


        2 years ago

        pls I hv been hvinsg the symptoms of itching but no rashes on my body so Wat can be d cause

      • profile image

        Victoria Lahullier 

        3 years ago

        i have so many burrows with the dead eggs in my body. Is there anything I can do to bring these to the surface faster. I am going nuts. Please let me know.

      • profile image

        3 years ago

        I suffered for 6 months but could not find any pathology result with so many different specialist I have been through ... after cleared 5 months now, I have a anxiety symptoms of the mites as I still dont know what was small tiny black dots were coming out after i put cream on.


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